Knowledge, attitudes and practice survey of family
planning among South Asian immigrant women in Oslo,
Norway
This research was conducted in partial fulfillment of the Masters of Philosophy
degree in International Community Health at the department of General Practice and
Community Medicine, Faculty of Medicine, University Of Oslo.
Dr. Asma Abedin
Supervisor: Prof. Dr. Babill Stray-Pedersen
DEDICATION
To my parents, children and to my beloved one, for being my greatest critic, for
sharing my frustration and for caring me and our children during my work on this
thesis.
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Acknowledgement
I would like to give my heartfelt thanks to the 309 women who answered the
questionnaires - for their participation and interest in the survey. This study could not
possible without their participation. I am ever grateful to them.
Prof. Babill Stray-Pedersen, my supervisor, has played an enormous role in helping
me to achieve this goal. She is the source of inspiration and encouragement for me.
During the study period, whenever I faced difficulties, she answered and made
issues of concern easy with her valuable comments and advice. I feel immensely
proud to express my gratitude for her continuous contribution.
Anne-Birth Vegge Arlt, leader of the Søndre Nordstrand health clinic for family,
children and youth - I gratefully acknowledge her cooperation. She and her
employees were of vital importance for my fieldwork.
Special thanks are given to the research assistants and staff of the Grønland,
Bjørndal, Prinsdal, Klemetsrud and Holmlia health centres.
It is a pleasure to thank, Kalaivani Thanabalan, Syed Israt Haque, Navneet Kaur,
Tony Ban Singh, Nazma Kareem,Tayibah Sheikh, Uzma Khan, Era Fatema, Dr.
Asaduzzaman, Rohan, and Sabbir Khan - all of whom made this thesis possible,
opened up to me, gave me access to immigrant communities and prompted me to
conduct the survey.
I owe thanks to Lien Deip for her enormous and indispensable support in statistics.
She is great for me.
I would like to express my sincere thanks and regards to Hildegunn Bomnes, director
of Stiftelsen Amathea, for her valuable guidance with fruitful and insightful
comments, suggestions and support at various stages of my field work.
I would like to thanks ansatte of Stiftelsen Amathea especially Berit Helde for her
supports during my field work.
I want to thank all of the wonderful classmates, especially Neupane who have given
me valuable support during the frustrations and prosperities of this course. I am
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especially grateful to Christina Brux, whose comments in improving my English
language and warm friendship have helped me to finish this writing.
I would like to express cordial thanks to Prof. Johanne Sundby and Prof. Akhtar
Hossain who inspired me to work with immigrant women.
Special thanks also to Line Low, Ragnhild Beyrer and Vibeke Christie, for always
being helpful. Their passionate support and care during my course of study will be
memorable. I would like to thanks the IT and other support staff at Fredrik Holst’s
Hus for their kindness during the master’s course.
Finally, I would like to give sincere thanks to Stiftelsen Amathea and the Norwegian
Directorate for Health and Social Affairs for financial support to do this project.
.
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1.
2.
3.
4.
Acknowledgement
3
Clarification of terms and abbreviation
9
Abstract
11
Introduction
12
1.1 Background
12
1.2 Literature review
13
1.3 Rational for study
15
Objective of the study
18
2.1 General objective
18
2.2 Specific objective
18
Research methodology
19
3.1 Study design
19
3.2 Study population
19
3.3 Sample size
20
3.4 Data Collection procedure
21
3.5 Data collection tool
22
3.5.1 Demographic
23
3.5.2 Knowledge
23
3.5.3 Attitude
25
3.5.4 Practice
26
3.5.5 Service for family planning
27
3.6 Data management
27
3.7 Data analysis and statistics
28
3.8 Missing data
29
Ethical consideration
31
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5.
Result
31
5.1 Demographic characteristics of South Asian immigrant women
Knowledge of family planning
33
5.2 Descriptive result for knowledge
34
5.2.1 Association between knowledge of family planning and marital status
34
5.2.2 Association between knowledge of family planning and immigration
36
status
5.2.3 Association between knowledge of modern contraceptives and
37
demographics
5.2.4 Association between knowledge of emergency contraceptives and
38
demographics
5.2.5 Association between knowledge of Chlamydia, STI’s and
39
demographics
5.2.6 Association between source of family planning information and
40
demographics
5.2.7 Association between received sex education at school and
42
demographics
Attitude towards family planning
42
5.3 Descriptive results for attitude towards family planning
42
5.3.1 Attitude towards family formation among South Asian immigrant
43
married women (n=228)
5.3.2 Attitude towards modern contraceptives among South Asian immigrant
45
married women (n=228)
5.3.3 Attitude towards family planning discussion among South Asian
46
immigrant married couples
5.3.4 Attitude towards family planning discussions among South Asian
47
immigrant women’s society from where they originate (n=228)
5.3.5 Attitude towards FP information among unmarried South Asian
48
immigrant women (n=81)
5.3.6 Preferable source for FP information among unmarried women
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49
Practice of family planning
49
5.4 Descriptive result of practice of family planning
49
5.4.1 Fertility background
51
5.4.2 Association between contraceptive use and demographics and 52
knowledge, attitude of family planning and number of children reported
by South Asian immigrant women (n=228)
5.4.3 Reason for not using contraceptives
52
5.4.4 History of requesting induced abortion and reason for termination of
53
pregnancy among South Asian immigrant married women
Family planning service
53
5.5 Preferred to talk or ask about family planning information by South Asian
53
immigrant women
5.6 Outcome
55
5.6.1 Logistic regression analysis to estimate the ORs and 95% CIs for 57
significant predictors of family planning knowledge among South Asian
immigrant women
5.6.2 Logistic regression analysis to estimate the ORs and 95% CIs for
significant predictors of contraceptive use among South Asian
immigrant women
6
7
Discussion
59
6.1 Summary of important findings
59
6.2 Discussion of result
61
6.3 Methodological consideration
65
6.4 Recommendation
67
Conclusions
68
Reference
69
Appendices
74
Annexure 1. Informed consent form for unmarried women
74
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Annexure 2. Informed consent form for married women
75
Annexure 3. Questionnaire for married women
76
Annexure 4. Questionnaire for unmarried women
83
Annexure 5. Ethical clearance letter from REK
86
Annexure 6. Map of Oslo districts
87
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Clarification of terms and abbreviation
Knowledge, attitude and practices (KAP): A KAP survey is a representative study
of a specific population to collect information on what is known, believed and done in
relation to a particular topic.
Unmet need: The concept of unmet need points to the gap between women's
reproductive intentions and their contraceptive behavior. Women with unmet need
for family planning for limiting births are those who are fecund and sexually active
but are not using any method of contraception, and report not wanting any more
children or wanting to delay the birth of the next child.
Contraceptive prevalence rate is the proportion of women of reproductive age who
are using (or whose partner is using) a contraceptive method at a given point in time.
Contraceptive methods include clinic and supply (modern) methods and nonsupply (traditional) methods. Clinic and supply methods include female and male
sterilization, intrauterine devices (IUDs), hormonal methods (oral pills, injectable and
hormone-releasing implants, skin patches and vaginal rings), condoms and vaginal
barrier methods (diaphragm, cervical cap and spermicidal foams, jellies, creams and
sponges). Traditional methods include rhythm, withdrawal, abstinence and
lactational amenorrhea.
Emergency contraception, or emergency post-coital contraception, refers to birth
control measures that, if taken after sexual intercourse, may prevent pregnancy.
Sex education is a broad term used to describe education about human sexual
anatomy, sexual reproduction, sexual intercourse, reproductive health, emotional
relations, reproductive rights and responsibilities, abstinence, contraception, and
other aspects of human sexual behavior. Common avenues for sex education are
parents or caregivers, school programs, and public health campaigns
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Immigrants are defined as being born abroad by two foreign-born parents, and
registered as residents in Norway. (“First-generation immigrants” or “migrants”)
Norwegian-born to immigrant parents is defined as those born in Norway with two
immigrant parents. (“Second-generation immigrants”)
http://www.nakmi.no/opplastede_filer/Public_Health%20 (2).pdf
South Asian Countries consists of Bangladesh, Bhutan, India, the Maldives, Nepal,
Pakistan and Sri Lanka.
(http://en.wikipedia.org/wiki/South_Asia)
Ethnic minority: A group that has different national or cultural traditions from the
majority of the population.
Chlamydia infection is one of the most common sexually transmitted infections
(STI) in humans caused by the bacterium Chlamydia trachomatis.
IUD
Intrauterine device
ECP
Emergency contraceptive pill
STI’s
Sexually transmitted infections
FP
Family planning
CM
Contraceptive method
ESCAP
Economic and social commission for
Asia and Pacific
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Abstract
‘Every man and woman has the right to be informed of, and to have access to, safe,
effective, affordable and acceptable methods of fertility regulation of their choice, and
the right of access to appropriate health care services that will enable women to go
safely through pregnancy and childbirth as well as provide couples with the best
chance of having a healthy infant.’1
Objective: The aim of the study was to investigate the family planning knowledge,
attitudes, and practices among the South Asian immigrant women (13-45 years) in
Oslo, Norway.
Methodology: A cross-sectional study using a quantitative approach was carried out
from August 2010 to December 2010 among 309 women - of which 23.3% were
recruited from health centers, and 76.3% from South Asian immigrant’s native
communities.
Result: One third participants originated from Pakistan, 72.5% were 1st generation
immigrant women. Among 309 respondents, 73.8% married; 66% unemployed;
62.1% had less than 12 years education and 41% were between 20-30 years. More
than half, South Asian immigrants 181 (58.6%) showed they have lack of family
planning knowledge while 128 women (41.4%) have average knowledge. The
majority (62.5%) received family planning information from their family members and
friends. Only 33% women had received sex education at the school. The majority of
the women (79.6%) never heard of STI’s like Chlamydia and among them 94.4% 13
to 19 years old. 84.2% women stated to discuss family planning information with
unmarried women is shame or embarrass in their society. Contraceptive use among
the immigrant women was 68.9%. Education is one of the most important predictors
for FP knowledge and practices. Conclusion: Nearly fifty percent women have
average family planning knowledge. FP knowledge before marriage is significantly
associated with country of origin. Therefore, there is need culturally sensitive
initiatives to encourage immigrant women for their positive attitude towards
discussion on family planning with unmarried women.
1http://www.who.int/topics/reproductive_health/en/
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Chapter 1. Introduction
1. Introduction:
Family planning allows individuals and couples to anticipate and attain their desired
number of children in addition to the spacing and timing of their births. It is achieved
through the use of contraceptive methods
(1).
Family planning is not only focused on
the planning of when to have children and use of birth control. Rather, in a broad
view, it includes sex education, prevention and management of sexually transmitted
infections (STIs), preconception counseling and management, and infertility
management
(2).
Family planning offers a positive view of reproductive life and
enables people to make informed choices about their reproduction and well-being (3).
1.1 Background:
The practice of family planning methods has increased since the 1960’s - both in
developed and developing countries. According to the United Nations in 2009, the
use of any contraceptive methods among women is at 62.9% worldwide, 81% in
Northern Europe and 54.2% in South Asia
(4).
On the other hand, the rate of induced
abortion has also reduced in both developed and developing countries. The induced
abortion rates are 29% in worldwide, 17% in Northern Europe, and 29% in Asia
(4).
Though the decline in induced abortion rate reduced from 34% to 29% in Asia, more
than half of abortions in developing countries were illegal and unsafe
(4).
In addition
to induced, illegal and unsafe abortion, unmet need for family planning is another
consideration in developing countries, especially in South Asia. Studies from South
and Southeast Asian countries indicate that the unmet need for contraception in
Bangladesh is 18.7%; in Pakistan, it is 23 %, while in India, it is 27.1%
South Asian countries presented a different picture
(6)
(5).
Thus, the
in contraceptive prevalence
rate, induced abortion rate and unmet needs of sexual and reproductive health
services. The combination of high unmet need of family planning with contraceptive
unawareness among the South Asian adolescents and youth will increase the risk
considerably (6).
Of the present, worldwide there were estimated 200 million immigrants, with 70.6
million immigrants living in Europe (7). In Norway 2011, 600 900 persons or estimated
Page 12 of 88
12.2% of the total population has an immigrant background (including Norwegian
born with two immigrant parents) (8)
1.2 Literature review:
A KAP study was done at Manipur India, to assess the knowledge, attitude and
practice of family planning (KAP) among the Meitei women. The knowledge of
condom and IUD was higher in the age groups of 31-35 years (34.9%) and 20-25
years (32.0%) compared to the respondents in the age group of (24.0%) 36-40 years
and (20.0%) 26-30 years. The main source of knowledge was friends at 44 percent.
(9)
In Karachi, Pakistan, a study was done to find out the level of awareness, attitude
and practice of family planning among rural women. The study revealed that nonsupportive attitudes towards family planning exist among the people due to the low
level of education, desire for male children and misinterpretation of religion. (10)
Another study at the urban health care center, Azizabad Sukkur, in Pakistan
investigated the awareness and pattern of utilization of family planning services
among women. The study shows that, before 18 years of age, 69.5% were married,
some desiring 4-5 children (37.5%) or more than five children (36%); 40%
participants had never used any contraceptive method. Health care providers were
the main source of family planning information among 48.5% of women. (11)
In Sri-Lanka, a study was done to investigate the induced abortion and family
planning knowledge, behavior and attitude among Sri-Lankan women. The study
revealed that 78% women have knowledge of at least one contraceptive method,
while only 16.3% were contraceptive users, 80% respondents in age group of 20-40
years were seeking induced abortion. The common reason for termination of
pregnancy was too little birth space, followed by three or more children (38.6%),
unmarried (13%), unplanned pregnancy (10%) and economic reasons. (12)
In Bangladesh, a study was done to investigate the unmet needs in family planning
among rural women. The study found that 72.1% of respondents were using
contraceptive methods, of which 61.7% were using oral contraceptive pills. Fear of
side effects (46.1%) was related to not using any contraceptives among the
remaining (28%) respondents. (13)
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There is no coordinated sex education at school in Bangladesh, Pakistan, Nepal,
and Myanmar
(14).
In India, state governments faced criticism for introducing sex
education in curriculum. Political parties argued that ‘sex education "is against Indian
culture" and would mislead children’. However, in Sri-Lanka when children are 17-19
years, they get information about sex through reading the reproduction section of
biology textbooks. Therefore, the family planning knowledge among adolescents
appears to be limited. (14) In these developing countries, cultural, social and religious
aspects of a community have influenced on family planning knowledge, attitude and
practice
(15).
In such a restrictive society, ‘even health care providers are hesitate to
provide contraceptive services and information to unmarried adolescents, and in
some instances, before providing such care, health providers are insisting on
parents' consent.2 Lack of trust and confidentiality between adolescents and health
care providers is a significant barrier to adolescents seeking care
(15).
As a result,
existence of unmet needs is increasing and especially in Bangladesh (18.7%), India
(27.1%) and Pakistan (23 %) (5).
Lower educational attainment and larger ideal family size with more children have an
association with early marriage. The practice of family planning has relation with
social and educational empowerment. Lack of educational empowerment has an
association with lack of family planning knowledge, non-supportive attitude and low
prevalence of contraceptive use. These facts were found from the analysis of the
data from demographic and health surveys among Muslim women in Pakistan,
Egypt, Jordan and Indonesia
(16).
In such countries, when women get married at an
early age, they are usually bound by the responsibility to either extended or nuclear
family or restricted by social barriers which often prevent further educational
attainment. The presence of a mother-in-law in the household is also influential in
determining family size
(15, 16).
The early married women are bound to start an early
reproductive life, to have less articulated ideas about family size, and to being noncontraceptive users
(16).
Another study in Pakistan was done on spousal
communication for family planning, which revealed that ‘Contraceptive use is
strongly associated with women's discussions with their husbands. It is accepted by
the above-mentioned studies that practice of contraceptives is related to having good
2
http://www.unescap.org/esid/psis/population/icpd/sec7.asp
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contraceptive knowledge and a positive attitude towards family planning discussions
(17).
1.3 Rationale for the study
There are considerable variations between immigrants and non-migrants in use of
family planning and contraceptive methods
(18).
Studies in the UK showed that
sexually active women from Pakistan, Asia, the Caribbean and Africa were less likely
to use reliable methods of contraception than British women
(19, 20).
According to a
study in Finland, in spite of immigrant women’s “age-adjusted abortion rate”, abortion
rates were lower among immigrants than women of Finnish origin, but abortion rates
were significantly higher among Russian, Southeast Asian and Chinese immigrant
women than other ethnic groups in Finland
(18).
According to Wilson and McQuiston
(2006), Mexican immigrant women in North Carolina, USA were reluctant to use
family planning methods and more than half of their pregnancies were accidental
(20).
Another study among former Soviet new immigrants in Israel also shows that the
contraceptive use and prevalence of contraceptives was lower among immigrants
than native women
(21).
Somalian women in the UK were attending the family
planning clinic, but they were unwilling to use contraceptive methods because of
religious convictions
(22).
Another study in the UK in 1998 shows a 3 to 4 fold
increase in the likelihood of abortion if the women were of Asian or African ethnicity
(19, 22).
Increase in migrant populations in Western Europe has led to specific
dilemmas in the area of sexual and reproductive health
(23).
Despite growing
awareness and available health services in host countries, the minority group does
not utilize these services.
Many multi-ethnic European societies now face the challenges of termination of
pregnancy among immigrant women
(18).
The Scandinavian countries are not an
exception. In many multi-ethnic Western societies, differences exist across ethnic
sexual cultures since requesting induced abortion is relatively common among
women of immigrant background women
and studies found in Sweden
(24,28),
(18,19,20,21,22,24)
Norway
(23,25,29),
compared to native women
the Netherlands
(31),
and
Denmark found this to be case(27). A landmark study in Sweden shows that 36% of
young women, who were attending Swedish abortion clinics and requesting induced
abortions in 2003 among them, were of immigrant backgrounds
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(24).
In Norway, of
women who were requesting induced abortion in 1999, 25% were from a nonWestern, immigrant background
(23).
“Literature shows that the most probable
reasons for the less frequent use of effective contraceptive and higher abortion rates
among women of immigrant origin were lower education, weaker social networks,
poverty, unemployment and a lack of properly informed access to health care”
27).
(18, 24,
This landmark Finnish study in 2008 shows that half of immigrant women didn’t
use contraceptives prior to abortion (18). The study also reveals that nonprofessional
Asian women experienced significant difficulties in using family planning services
because of communication barriers with the health professionals while professional
and married or unmarried immigrant women were able to meet their family planning
needs by utilizing existing family planning services in the host country.
(18).
A
yearlong study in Denmark also found that lack of contraceptive knowledge and a
partner’s negative attitudes and experiences of contraceptive failure were associated
with the choice of abortion more among the immigrant women than Danish-born
women (27). Another yearlong study in Sweden on the abortion rate and contraceptive
practices among immigrant and Swedish adolescents in 2006 shows that first and
second generation immigrants had more pregnancies and less experience of
contraceptive use than Swedish adolescents. This study also reveals that Swedish
adolescents had more experience with contraceptive counseling than immigrant’s
adolescents
(28).
Simultaneously, abortion rates and contraceptive practices among
immigrant women and native women
study in 2003 in Sweden
shows that
(24)
immigrant’s women had less experience with contraceptive use, more previous
pregnancies and more induced abortion. This study also reveals that immigration
status, weak social networks, unemployment and low education are associated with
requesting induced abortion among immigrant women
(24).
A study in Canada of
Chinese immigrant women who gave their reasons for not using oral contraceptives
found that their negative attitudes were related to the fear of contraceptive’s sideeffects, fear of weight gain and permanent infertility (18, 30).
According to Statistics Norway 2011, Oslo has the largest proportion with 28.4% or
170 200 Immigrants of which 109 959 or 65% are from in Asia, Africa, South-and
Central America, Turkey
(8).
The highest proportions of immigrants are living in
Søndre Nordstrand, Stovner and Alna
(8).
A study on “Induced abortion among
women with foreign cultural background in Oslo” shows most of the child deliveries
Page 16 of 88
were more prominent among the women less than 25 years of age. This study also
shows that requesting induced abortions was more prominent among women who
were more than 35 years old (25). Another study on “childbearing or induced abortion:
the impact of education and ethnic background” shows that induced abortion
requests were more associated with higher education among Pakistani women,
while low education was associated with requesting induced abortion among
Norwegian women
(23).
A recent study on “Termination of pregnancy according to
immigration status” shows that termination of pregnancy rates (TOP) was
significantly higher among Sri-Lankan (36.0, 95% CI=31.8–40.2), Indian (27.9, 95%
CI=22.8–33.2) and Pakistani (18.4, 95% CI=16.6–20.2) women than non-immigrants
(16.7, 95% CI= 16.3–17.1). The TOP study also reported that a high number of
women (36-57%) were not using any contraceptive methods at the time of
conception and requesting TOP (29).
‘It is acknowledged that the psychological and cultural aspects of the sexual health
dilemmas among immigrant women is related to socials norms and individual and/or
community’s attitudes towards family formation, sexuality, and gender. These norms
and attitudes affect women’s opinion and influence their sexual and reproductive life’
(18, 32).
In addition, sexual health is said to be affected by communication problems in
the health care centers. It may be due to the fact that many immigrant women from
developing countries have a low level of education in their countries of origin as well
as their new host society
(32, 18)
and therefore, they have poor employment
opportunities. All of these problems inevitably lead to a lower quality of care in sexual
health (18).
Two studies on induced abortion among immigrant women have been published (25)
(29)
in Norway. However, to my knowledge, no one has studied the family planning
knowledge, attitudes and practices among immigrant women in Norway. Therefore,
the purpose of the study was to investigate the family planning knowledge and
attitudes towards family planning discussions among South Asian immigrant
unmarried young girl and explore the FP knowledge, attitudes towards modern
contraceptives and practices of contraceptive methods among South Asian
immigrant married women.
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Chapter 2. Objective of the study
Research questions:

How many immigrant women are familiar with modern contraceptives
method?

What are the attitude towards family planning discussion and modern
contraceptives among the immigrant women?

What is family planning practice among immigrant women?

What types of reproductive health services do immigrant women prefer?

What are the important predictors for family planning knowledge and practice?
2. Objective of the study
2.1 General Objective: To investigate family planning knowledge, attitudes and
practices among South Asian immigrant women in reproductive age in Oslo,
Norway.
2.2 Specific Objectives:
o To describe the family planning knowledge
o To identify the attitudes towards family planning
o To learn about the attitudes towards discussions and information about
sexual health and family planning methods among unmarried women
themselves
o To explore contraceptive practices
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Chapter 3. Research methodology
“Research is defined as systematic collection, analysis and interpretation of data in
order to shed light on unanswered questions
(33, 35).
“For each particular photograph
the investigator must decide what kind of camera to use what scene on which to
focus, through which filter and with what intent (35, 36, and 37)”. The choice of methods
depends on the research questions (34)”. Keeping in mind the objectives of the study,
it is vital to have a quantitative design in order to find the contraceptives usage rate
among married South Asian immigrant women and to investigate the knowledge and
attitude towards contraceptives among immigrant married women and unmarried
youth.
3.1 Study design:
This study was a cross -sectional study among South Asian immigrant women of
fertile age during August 2010 to December 2010 in Oslo.
3.2 Study population
The study population was immigrant women from Pakistan, India, Sri-Lanka and
Bangladesh of reproductive age (13-49 years). They were recruited from the South
Asian immigrant’s communities, meeting places and different health centre’s in Oslo,
especially Bjørndal, Prinsdal, Klemetsrud, Holmlia and Gamle Oslo.
3.3 Sample size
3.3.1 Married women
According to the United Nations, contraceptive prevalence rate is 67% among
women in developing countries4. To estimate the sample size, we calculate with
following formula:
N= P (1-P) (1.96)2/d2
N= sample size, P=Prevalence of contraceptive rate 67%,
d=0.05 (allowable error of known prevalence),
N= (1.96*1.96*0.67*0.23)/ (0.05*0.05), N= 236.
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3.3.2 Unmarried youth
A study on “reproductive health survey of adolescents and young adults in Pakistan 6”
shows that knowledge of contraception among girls is 50%.
P=Prevalence of contraceptive knowledge 50%,
Assuming d=0.10(allowable error of prevalence rate),
N= (1.96*1.96*0.50*0.50)/ (0.10*0.10), N= 96.
Total sample size = 332 participants
Study respondents= 309
3.4 Data collection:
Ninety-three percent of study subjects were recruited in the above-mentioned period
by cluster and snowballing. Recruitment from health centers was difficult; therefore,
the author sent invitations to immigrant communities and visited immigrants meeting
places. After having verbal informed consent, the author collected phone numbers
from the respondents. In total 36.9% were interviewed through phone by the author,
39.8% were recruited from immigrant communities by research assistants while,
23% came from the Health centers.
Inclusion criteria

Immigrant women from Pakistan, India, Sri-Lanka and Bangladesh of
reproductive age (13-49)

A woman, who was mentally sound, gave verbal consent and was willing to
participate.
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Exclusion criteria

Women who were not able to give verbal consent and not willing to
participate.

Women who had menopause, although they were of reproductive age.
3.4.1 Data collection by principal investigator
Bjørndal, Prinsdal, Holmlia and Klemetsrud, four health centers under the district of
Søndre Nordstrand, were visited by the principal investigator every week from
Monday to Thursday during the above-mentioned period. From Grønland health
Centre, a health sister informed the author the day before if any South Asian women
had an appointment. After finishing the interview with study participants at the health
center, the author asked present respondents to nominate other women from the
same ethnicity. To obtain the sufficient number of subjects, the author continued this
snowball sampling process during the whole study period.
3.4.2 Data collection by research assistant
To collect data, four assistants were appointed from South Asian immigrant
communities who had more than 12 years of formal education and knew Norwegian,
English and their native tongue. They got training on how to ask family planningrelated questions. Before getting the training, they signed a written consent form to
protect the participant’s personal information related to this KAP survey. Every
assistant got 50 questionnaires with 50 informed consent forms in separate envelop.
In total, 61.5 % (123/200) brought back completed questionnaires.
3.5 Data collection tool
A two-structured, anonymous questionnaire was designed for the KAP survey. One
for married women (annex3) and another for unmarried women (annex4). The
survey instrument was prepared in English and then translated into Urdu and
Norwegian. The survey instrument has both closed and open questions.
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The questionnaire included
 Demographics of participants
 Knowledge about family planning
 Attitudes towards family formation family planning discussions
 Practice of family planning (fertile background and contraceptive usage)
 Family planning service
Pilot study with survey instrument: The survey instrument was pre-tested by 12
South Asian immigrant women before actual fieldwork began. The experience
showed that the questionnaires needed to be changed. Questionnaire had added
some family planning attitude information as statement.
3.5.1 Demographics
All the study subjects were interviewed for their demographics and immigration
information. It included information such as participant’s age, height, weight,
ethnicity, and highest level of education, marital status, employment status and
immigration status (birth country of study subject and their parents, arrival year and
age at the arrival year in Norway).
Age
Marital status
1= 13-19
0= Unmarried
2= 20-30
1= Married
3= 31-45
Highest level of education
Ethnicity
0= No education
1= Pakistan
1= Primary
2= Bangladesh
2= Secondary
3= Sri-Lanka
3= High school/college
4= India
4= University
Immigration status
Employment status
0= Immigration from South Asian country/1st
0= Unemployed
Page 22 of 88
generation
1= Employed
1= Birth in Norway/ 2nd generation
3.5.2 Knowledge
Family planning knowledge consisted of knowledge of modern contraceptives and
emergency contraceptives, source of information about family planning, sex
education at school, and if the women had heard of sexually transmitted infections
(STIs), like Chlamydia.
Heard about modern contraceptives, Female and male sterilization, intrauterine
devices (IUDs), Hormonal methods (oral pills, inject able, and hormone-releasing
implants, skin patches and vaginal rings), Condoms and vaginal barrier methods
(diaphragm, cervical cap and spermicidal foams, jellies, creams and sponges3.
0= No method, 1=Oral pill/Condom/IUD (1-3 method), 2= 4 and more methods
Heard about emergency contraceptives 0= No, 1= Yes
Source of information about contraceptives
1= Parents/ siblings/husbands/friends
2=Health care providers/ written information, media (pamphlets, internet, magazines)
Sex education at school 0=No/not remember, 1= Yes
Heard about STI’s like Chlamydia
0=No, 1= Yes
3.5.3 Attitude
Attitude towards family formation consisted of the ideal age of having first child,
desired number of children, ideal birth spacing, and contraceptive uses.
Attitudes toward family planning discussions included participant’s attitude
themselves, their husband’s attitudes, their society’s attitude from where they
originate, and the attitudes among unmarried women themselves.
3
http://www.who.int/whosis/indicators/compendium/2008/3pcf/en/index.html
Page 23 of 88
Ideal age of having first child
Desired number of children
1= Age 18-24
1= Children 1-2
2= Age 25-30
2= Children 3 -4
3= Age 30 and over
3= Children 5 and more
0= Don’t know
Birth spacing
Attitude towards contraceptives
1= 1-2 years
0= I never used
2= 3-4 years
1= I have used without any problems
3= 4-5 years
2= I have used
problems/troubles
in
spite
of
3= Its against the nature/ I don’t like to
use
Unmarried girl need to know about family Before marriage get family planning
planning
knowledge
0=No / Don’t know
0=No / not remember
1= Yes
1= Yes
Attitude among married participants Attitude among participants husband
themselves towards family planning towards family planning discussion
discussion
0= Negative/ Don’t want to talk
0= Negative/ Don’t want to talk
1=Positive/ enjoy the discussion
1=Positive/ enjoy the discussion
2=Embarrass/ avoid discussion
2=Embarrass/ avoid discussion
Attitude among unmarried participants Attitude of married participants society
themselves towards family planning from where they originate towards family
discussion
planning discussion
1=Feel embarrass to talk
1= Not common in society
2=Not common in our society
2= Embarrass or shame to discuss
3=I never think this topic before
4=I don’t like to talk/ don’t want to give
answer
Page 24 of 88
3.5.4 Practice
Practice of family planning included age of getting married, after marriage use of any
contraceptives, planned pregnancy, birth spacing, and history of requesting abortion,
cause of induced abortion, desire for more children, use any contraceptives now,
which method of contraceptives were being used and causes of not using any
contraceptives.
Usage of contraception refers to the use of contraceptives by at least one method,
either traditional or modern method such as pills, Injection, IUD, condom, male or
female sterilization, diaphragm, or withdrawal and abstinence.
Contraception refers to the use of any natural or artificial method to prevent
conception or pregnancy.
Traditional method refers to natural methods, including withdrawal and abstinence.
A modern method refers to artificial methods that include injection, IUD, condom,
male or female sterilization, and diaphragm.
Not used refers to who doesn’t use any natural or artificial method of contraception.
Age of marriage
After marriage use any of contraceptives
0= less than 18 years
0=No
1=18-24 years
1= Yes
2= 25-30 years
Number of children
Desire for more children now
1= 0-2,
0=No,
2= 3 and more
1= Yes
Planned pregnancy
History of requesting induced abortion
0=No/ not remember,
0=No,
1= Yes
1= Yes
Page 25 of 88
Which method are currently using
1=Condom
2= Oral pills
3=Intra uterine device
4=Calendar / withdrawal method
5= Sterilization (male/ female)
6= Others
Cause of abortion
Reason for not using any contraceptives
1= Study/student
1= I want to be pregnant
2= Pregnancy was not planned
2= I preferred traditional method
3= Too young for having 1st child
3= Fear of side effect
4= Economical reason
4=Others
5= Too little birth space
3.5.5 Service for family planning
This part included the place of service and satisfaction with the services. Place of
service included health centers, general physicians, gynecologists, and pharmacies.
Satisfaction with the available services included facing problems to have service and
the cause of the problem to have service (i.e., can’t explain in Norwegian, depend on
husband for ease communication, and others, if any).
For unmarried girls, we asked about to whom they prefer to talk and to where they
prefer to go.
Unmarried girl prefer to go: 0=No answer, 1=General physician/school nurse, 2=
Clinic for sexual information, 3=Health centre for youth, 4= Internet, 5= I never
thought about this before
Unmarried girl prefer to talk: 0=No where, 1= Parents, 2=Siblings 3=Friends, 4=
General physician, 5=School nurse, 6= Health center for youth
Page 26 of 88
Face problem to seek FP service
Possible cause to face problems
0=No
0=I can’t speak in Norwegian
1= Yes
1= I depend on my husband
3=Health staff never understand me
4= I don’t know where I can go
3.6 Data management
Data input was done by the author of this report. Questionnaires were gathered
every week and the data was entered at the Stiftelsen Amathea office. A codebook
for each variable was prepared beforehand. The data was recorded into Excel and
later converted into SPSS, version 16.
3.7 Data analysis and statistics
All analysis was done using SPSS, using a significant level of <0.05.
Cleaning of data as a first step was done to detect variables that could be missed or
invalid.
Descriptive analysis was done for all categorical variables by using frequencies (n)
and percentages (%). Variables with three or more categories were grouped into two
categories and analyzed with cross tabulation. Chi-square tests were used for
significant differences. Fishers’ exact test was used when variables/cells had less
than 5 counts.
The Chi-square tests was used to find the association between age, education,
immigration, marital status, employment status and knowledge, attitude and practice
of family planning. To get the correct p-values, spearman’s rank correlation was
used.
Logistic regression Relationship between demographics and family planning
knowledge, attitude and practice was analyzed at bivariate level. After bivariate
analysis, the significant association data was analyzed at multivariate level. A binary
logistic regression model was used to identify significant predictors for FP knowledge
and practice.
Page 27 of 88
To measure the level of knowledge, three questions were asked; for the answer, the
score was 1, and for no answer or no response, score was 0. The highest score was
3, while 1 was lowest. Initially, the level of the knowledge group was categorized into
three groups: good knowledge-scored 3, average knowledge scored 2, and lack of
knowledge-scored 0-1.
Later, for the logistic regression model, knowledge group was categorized into 2
groups: average knowledge (good knowledge group was merged here) and lack of
knowledge.
3.8 Missing data
Some
information
was
missing
demographics;
height,
weight,
information
family
planning
of
and
in
Missing Variable
in
Weight
4
4.1
%
Height
3
3.7%
Birth space between two children
2
0.9%
Get family planning knowledge before
marriage
2
0.9%
If you need to know about FP where
you would prefer to go
1
1.2%
Want more children
2
0.9%
Preferable service for family planning
8
3.5%
attitude;
attitude towards birth space, information
about contraceptives before get marriage. In
all
descriptive
analysis,
only
valid
percentages were used after omitted missing
data.
Page 28 of 88
n
%
Chapter 4. Ethical Considerations
Discussion of family planning varies from country to country, and depends greatly on
the cultures. Every individual is also varying from each other’s when it comes to
sharing their perceptions towards modern contraceptive methods and practices.
Sometimes talking about family planning methods might be regarded as
embarrassing or asking about practices of contraceptive methods among unmarried
young girl as unacceptable. According to the declaration of Helsinki in 2000, all
medical research should be following the general ethical research principles. As the
study was done among immigrant unmarried youth and married women, according to
Bhopal in 1997, research among ethnic minorities involves additional ethical
concerns
society
(38).
(39)
Bhopal suggests that ethnic minorities are vulnerable
(4)
groups in a
and that research amongst them demands careful consideration of
privacy. Therefore, this researcher practiced fundamental ethical consideration in
relation to this survey.
4.1 Informed consent
“Recruiting subject is the first step in the informed consent process. Any provision of
information by the investigator to a prospective subject or source of referral subject
begins by giving information about the project” (33).
The principal investigator used the snowball sampling method to obtain sufficient
sample size. The principal investigator asked present respondents to nominate
another one, whom she knew, as a potential participant. When the present
participant was interested in nominating other participants, she herself explained the
survey and provided information about the research project to the nominated and
potential study subjects. If and when the nominated woman indicated interest in
participating, then the respondent who had recruited her provided the contact
The Declaration of Helsinki states on the 8th paragraph “Medical research is subject to ethical
standards that promote respect for all human beings and protect their health and rights. Some
research populations are vulnerable and need special protection. The particular needs of the
economically and medically disadvantaged must be recognized. Special attention is also required for
those who cannot give or refuse consent for themselves, for those who may be subject to giving
consent under duress, for those who will not benefit personally from the research and for those for
whom the research is combined with care”.
4
Page 29 of 88
information to the principal investigator. The survey began with verbal informed
consent.
The four research assistants from four ethnic groups were also committed to having
informed consent prior to collect the data. The data was never collected without any
informed consent. During the study period, one respondent withdrew her information
and was not interested letting her daughters participate in this survey. That
information was removed from the collected data.
4.2 Confidentiality
The principal investigator always considered the issues of privacy and confidentiality
of all study participants. Research assistants made an agreement with the author to
keep the confidentiality of the respondents and their opinions. The author also
signed an agreement in the health centre’s of the Søndre Nordstrand districts to
protect the information of patients who attended the health centers.
Each study respondent was assigned an ID number that was kept separate during
the study; this ID followed throughout the data handling. A list was made for the
respondent’s identity with the ID number, which was destroyed after the valid data
was assured.
4.3 Ethical clearance and approval
All the necessary ethical and administrative approval was obtained before the study
took place. To obtain the ethical clearance, the protocol was sent to the regional
committee for medical research ethics (REK) in Norway (Annexure 5).
Page 30 of 88
Chapter 5. Result
Demographic characteristics
5.1 Demographic characteristics of South Asian immigrant women
Table 1.Demographic characteristics of 309 South Asian immigrant women in Oslo, Norway
1st generation
immigrant women
Variables
Age
Ethnicity
Education
Marital status
Employment
status
Page 31 of 88
2nd generation
immigrant
women
n=309
%
n=224
%
n=85
%
13-19
71
23.0 %
11
4.9 %
60
70.6 %
20-30
127
41.1 %
107
47.8 %
20
27.5 %
31-45
111
35.9 %
106
47.3 %
5
5.9 %
Pakistan
106
34.3 %
82
36.6 %
24
28.2 %
Bangladesh
52
16.8 %
30
13.4 %
22
25.9 %
Sri-Lanka
59
19.1 %
43
19.2 %
16
18.8 %
India
92
29.8 %
69
30.8 %
23
27.1
Less than 12
years
education
192
62.1%
122
55.4%
70
80%
More than 12
years
education
117
37.9%
102
46.6%
15
20%
Unmarried
81
26.2 %
15
6.7 %
66
76.6%
Married
228
73.8 %
209
93.3 %
19
22.4%
Unemployed
204
66 %
125
55.8 %
79
92.9 %
Employed
105
34. %
99
44.2 %
6
7.1 %
P-value
<0.001
0.064
<0.001
<0.001
<0.001
In total 309 South Asian immigrant women of reproductive age residing in Oslo,
Norway were recruited. Table 1 shows the demographic characteristics of women.
The range of ages was between 13 to 45 years. The mean age was 27.35, and
standard deviation was 8.253. The participants were divided into three age groups.
41.1% were in the age group of 20-30 years, dominant immigrant country was
Pakistan (34.3%), followed by India, Sri-Lanka and Bangladesh. As seen in the table
1, 117 immigrant women (37.9%) had more than 12 years education and more than
two-thirds 228 women were married.
Immigration status More than 70% of the participants were 1st generation
immigrants who born abroad with two foreign-born parents, and residents in Oslo,
Norway. Among them, 122 women (55.4%) have less than 12 year’s education. Most
of the first-generation immigrants were married (93.3%) and unemployed (55.8%).
Of the responder’s one fourth, 85 women were second-generation immigrants who
were Norwegian born with two foreign background parents. Among them, 60 women
(70.6%) were 13-19 years of age. The majority (80%) of 2nd generation’s
respondents had less than 12 year’s education and were unemployed (92.9%) and
unmarried 66 (76.6%).
Page 32 of 88
Knowledge of family planning
5.2 Descriptive Result of Knowledge
Table 2 Association between knowledge of family planning and marital status among South
Asian immigrant women (n=309)
Marital status
Unmarried
n=309
%
n=81
p-value
Married
26.2%
n=228
73.8%
Heard of modern
contraceptives
0,006
All methods
19
6.1
2
2.5 %
17
7.5 %
1-3 of methods
226
73.1
53
65.4 %
173
79.5 %
No method
64
20.7
26
32.1 %
38
16.7 %
No
181
58.6
35
43.2 %
146
64 %
Yes
128
41.4
46
56.8 %
82
36 %
No
246
79.6
77
95.1 %
169
74.1 %
Yes
63
20.4
4
4.9 %
59
29.9 %
Parents/sibling/friends
89
28.8 %
15
18.5 %
74
32.5 %
Husband
104
33.7 %
-
-
104
45.6 %
Health care providers
57
18.4 %
50
61.7%
7
2.6 %
Written information/media
59
19.1 %
16
19.8 %
43
18.9 %
No/no remembrance
207
67 %
15
18.5 %
192
84.2 %
Yes
102
33 %
66
81.5 %
36
15.8 %
Heard of emergency
contraceptives
0,001
Heard about
Chlamydia(STI’s)
<0.001
Received
contraceptives
information from
<0.001
Received sex education
at school
*Fisher’s exact test
Page 33 of 88
<0.001*
5.2.1 Association between knowledge of family planning and marital status
Table 2 shows the number and percentage of immigrant women’s family planning
knowledge and the association between FP knowledge with marital status of South
Asian immigrant women.
One hundred seventy-three married (79.5%) respondents had heard of one to three
modern contraceptive methods (p-value-0.006), 46 unmarried (56.8%) respondents
had heard about emergency contraceptives (p-value-0.001). Only 4 unmarried
(4.9%) respondents had heard of Chlamydia (p-value-<0.001).
A total 102 (33%) of the respondents received sex education at school, of which 66
respondents were unmarried (81.5%) (p-value-<0.001*), and 61.7% unmarried
respondents received the family planning information from health care providers
while the majority of married (45.6%) received information from their husband (pvalue-<0.001).
5.2.2 Association between knowledge of family planning and immigration
status
Table 3 shows the number and percentage of immigrant women’s family planning
knowledge and association between FP knowledge with immigration status.
Eighty one first-generation immigrant women (36.2 %) have knowledge of
emergency contraceptive, 56 women (25 %) have heard of STI’s like Chlamydia, 98
first generation immigrant women (43.8 %) received family planning information from
their husband (p-value-<0.001), and only 30 first generation immigrant women (13.4
%) received sex education at a school.
Sixty five second- generation immigrants (76.5 %) have knowledge on one to three
of modern method, 47(55.3 %) have knowledge of emergency contraceptive, and 72
(84.7%) received sex education at school (p-value-<0.001*), and 37 (43.5%)
received the family planning information from health care providers.
Page 34 of 88
Table 3 Association between knowledge of family planning and immigrant status among South
Asian immigrant women (n=309)
Immigration status
1st generation
n=309
%
n=224
%
P-value
2nd generation
n=85
%
Heard of modern
contraceptives
0.230
No one method
64
20.7 %
46
20.5 %
18
21.2 %
1-3 of methods
226
73.1 %
161
71.9 %
65
76.5 %
All methods
19
6.1 %
17
7.6 %
2
2.4 %
No
181
58.6 %
143
63.8 %
38
44.7 %
Yes
128
41.4 %
81
36.2 %
47
55.3 %
No
246
79.6 %
168
75 %
78
91.8 %
Yes
63
20.4 %
56
25 %
7
8.2 %
Parents/sibling/friends
89
28.8 %
63
28.1 %
26
30.6 %
Husband
104
33.7 %
98
43.8 %
6
7.1 %
Health care providers
57
18.4 %
20
8.9 %
37
43.5 %
Written information/media
59
19.1 %
43
19.2 %
16
18.8 %
No/no remembrance
207
67 %
194
86.6 %
13
15.3 %
Yes
102
33 %
30
13.4 %
72
84.7 %
Heard of emergency
contraceptives
0.002*
Heard about
Chlamydia(STI’s)
<0.001*
Received contraceptive
information from
<0.001
Received sex education at
school
Page 35 of 88
<0.001*
5.2.3 Knowledge of modern contraceptives
Ninety three respondents of 31-45 years (83.8%) heard of at least 1 to 3 methods.
Forty-nine Sri-Lankan women (83.1%) and 72 Indian (78.8%)
women have
knowledge of at least 3 of any modern methods, while 21 women from Pakistan
(19.8%), 15 from Bangladesh (29.3%) had never heard any of the CM (p-value0.004). 157 Women who have less than 12 year’s education (81.8 %) (p-value<0.001) and 86 employed women (81.9 %) have heard of one to three of modern
contraceptive methods
There was significant association with age, education and ethnicity and heard of
contraceptive method. (Table 4)
Table 4 Association between knowledge of modern contraceptives and demographic
characteristics among South Asian immigrant women (n=309)
Heard about modern contraceptives
4
Not one
1-3 methods
p
or more
Age
Ethnicity
13-19
21(29.6 %)
50(70.4 %)
.0 %
20-30
29(22.8 %)
83(65.4 %)
15(11.8 %)
31-45
14(12.6 %)
93(83.8 %)
4(3.6 %)
Pakistan
21(19.8 %)
73(68.9 %)
12(11.3 %)
Bangladesh
15(29.3 %)
36(68.5 %)
1(2.2 %)
Sri-Lanka
10(16.9 %)
49(83.1 %)
0%
India
11(11.5 %)
72(78.8 %)
9(9.6 %)
Less than 12 years
education
22(11.5 %)
157(81.8 %)
13(6.8 %)
More than 12 years
education
42(35.9%)
69(59 %)
6(5.1%)
Unemployed
48(23.5 %)
Employed
16(15.2 %)
86(81.9 %)
3(2.9 %)
64(20.7 %)
226(73.1 %)
19(6.1 %)
<0.001
0.004
Education
<0.001
Employment status
140(68.6 %)
16(7.8 %)
0.034
Total
* Fisher's Exact Test
Page 36 of 88
5.2.4 Emergency contraceptives
Table 5 shows 181 women - more than half of the total respondents (58.6%) had no
knowledge of emergency contraceptive, while 128 women (41.4%) have knowledge.
Of these, 40 respondents were 13-19 years (56.3%).
The dominant ethnic group for knowledge of emergency contraceptives was women
of Sri-Lankan origin 28 (47.5%). 85 women who have less than 12 years education
(44.3%) and 93 unemployed (45.6%) were much more aware of emergency
contraceptive pill.
Table 5 Association between knowledge of emergency contraceptives and demographic
characteristics among South Asian immigrant women (n=309)
Heard of emergency contraceptives
Age
Ethnicity
Education
Employment
No
Yes
13-19
31(43.7 %)
40(56.3 %)
20-30
77(60.6 %)
50(39.4 %)
31-45
73(65.8 %)
38(34.2 %)
Pakistan
57(53.8 %)
49(46.2 %)
Bangladesh
35(67.4 %)
17(32.6 %)
Sri-Lanka
31(52.5 %)
28(47.5 %)
India
55(59.6 %)
37(40.4 %)
Less than 12 years
education
107(55.7 %)
85(44.3 %)
More than 12 years
education
74(63.2 %)
43 (36.8 %)
Unemployed
111(54.4 %)
93(45.6 %)
Employed
70(66.7 %)
35(33.3 %)
181(58.6 %)
128(41.4 %)
Total
*Fishers exact test
Page 37 of 88
p
0.011
0.182
0.118*
0.025*
5.2.5 Knowledge of STI’s like Chlamydia
Only 20.4% of total respondents had heard of Chlamydia (Table 6). Among them, 33
women (26%) were 20-30 years and 26 women (23.4%) 31-45 years; only 4
respondents (5.6%) were 13-19 years (p-value 0.002).
Ethnically, the majority of respondents who had heard of Chlamydia were 25
Pakistani women (29.2%) and 23 women of Indian (25%) origin compared to other
ethnic group (p-value-0.008). 34 women who had more than 12 years education
(29.2 %) had heard of Chlamydia (p-value-0.001).
Table 6 Association between heard of sexually transmitted infections, like Chlamydia and
demographic characteristics among South Asian immigrant women (n=309)
Heard of sexually transmitted infections Chlamydia
Age
Ethnicity
No
Yes
13-19
67(94.4%)
4(5.6%)
20-30
94(74%)
33(26%)
31-45
85(76.6%)
26(23.4%)
Pakistan
91(70.8 %)
25(29.2 %)
Bangladesh
46(89.1 %)
6(10.9 %)
Sri-Lanka
50(84.7 %)
9(15.3 %)
59(75 %)
23(25 %)
Less than 12 years education
165(86.3 %)
27(13.7 %)
More than 12 years education
83(70.8 %)
34(29.2 %)
Unemployed
159(77.9 %)
45(22.1 %)
Employed
87(82.9 %)
18(17.1 %)
246(79.6 %)
63(20.4 %)
P
0.002
0,008
India
Education
0,001
Employment
Total
*Fishers exact test
Page 38 of 88
0.194*
5.2.6
Source of family planning information
Table 7 Association between source of family planning information and demographic
characteristics among South Asian immigrant women (n=309)
Received family planning information from
Family
Husband
member/
Health care
Media/written
providers
information
p-value
Friends
Age
Ethnicity
%
%
%
%
13-19
13(14.6 %)
-
43(76.8 %)
15(25.4 %)
20-30
56(62.9 %)
42(40 %)
12(21.4 %)
17(28.8 %)
31-45
20(22.5 %)
63(60 %)
1(1.8%)
27(45.8 %)
Pakistan
33(37.1 %)
41(39.4 %)
17(29.8 %)
15(25.4 %)
Bangladesh
18(20.2 %)
19(18.3 %)
9(15.8 %)
6(10.2 %)
Sri-Lanka
18(20.2 %)
19(18.3 %)
5(8.8 %)
17(28.8 %)
India
20(22.5 %)
25(24 %)
26(45.6 %)
21(35.6 %)
Less than 12 years
49(55.1 %)
86(82.7%)
37(64.9 %)
20(33.9 %)
40(44.9 %)
18 (17.3 %)
20(35.1 %)
39(66.1 %)
Unemployed
52(58.4 %)
62(59.6 %)
57(100 %)
33(55.9 %)
Employed
37(41.6 %)
42(40.4 %)
-
26(44.1%)
<0.001
0.022
Education
education
<0.001
More than 12 years
education
Employment
<0.001*
*Fisher’s exact test
Table 7 shows that 43 respondents (76.8%) who were 13-19 years received
information from health care providers, 56 respondents (62.9%) aged 20-30 years
got information from family members or friends and 63 (60 %) aged 31-45 years
received information from their husband (p-value-<0.001).
For those with less than 12 years education, 86 women (82.7%) received information
from their husbands, while 39 highly educated women (66.1%) got information from
media and written information and 40 highly educated women (44.9%) got their
Page 39 of 88
information from the family (p-value-<0.001). Of those unemployed, 57 women
(100%) got information from health care providers, while 26 employed women
(44.1%) got information from media.
Source of FP information was statistically significant with age (p-value <0.001),
education (p-value <0.001), and employment status (p-value <0.001*Fisher’s exact
test).
5.2.7 Sex education
Table 8 shows 60 respondents (84.5%) who were 13-19 years, 34 women (26.8%)
who were 20-30 years and only 8 women (7.2%) who were 31-45 years had received
sex education at school. 96 (47.1%) unemployed and 84 women (43.8 %) who had
less than 12 years worth of education received education on sex at school.
There was significant association to receive sex education at school with age (pvalue <0.001), education (p-value <0.001*) and employment status (p-value
<0.001*).
Table 8 Association between received sex education at school and demographic
characteristics among South Asian immigrant women (n=309)
Sex education at school
Age
Ethnicity
Education
Yes
No
13-19
60(84.5%)
11(15.5 %)
20-30
34(26.8%)
93(73.2 %)
31-45
8(7.2%)
103(92.8 %)
Pakistan
38(35.8%)
68(64.2 %)
Bangladesh
12(23.9%)
40(76.1 %)
Sri-Lanka
19(32.2%)
40(67.8 %)
India
41(44.6 %)
51(55.4 %)
Less than 12 years
education
84(43.8 %)
108(56.3 %)
More than 12 years
education
18(15.4 %)
99(84.6 %)
Unemployed
96(47.1 %)
108(52.9 %)
6(5.7%)
99(94.3%)
102(33%)
207(67%)
p-value
<0.001
0.078
<0.001*
Employment
Employed
Total
* Fisher's Exact Test
Page 40 of 88
<0.001*
5.2.8 Family planning Knowledge group
Figure 1 Percentages of different knowledge group among South Asian immigrant women
Figure 1 illustrates the percentages of different knowledge groups. Only 34 women
(11%) made up the good knowledge group, A total 181respondents (59%) belonged
to the lack of knowledge group while 94 women (30%), were referred to the average
knowledge group.
Page 41 of 88
Attitude towards family planning
5.3 Descriptive results for attitude towards family planning
5.3.1 Attitude towards family formation among married women
Among the participants, 228 respondents (73.8%) were married. Married
respondent’s minimum age was 21 years, maximum age was 45 years and mean
age was 31.22 years; standard deviation was 5.677. They were asked about their
thoughts on family formation. Nearly half of the married respondents (46.1%) thought
25-30 years is ideal for having a first child; more than half (53.1%) of the women
desired 3 or 4 children to complete the family. (Table10).
Table 10 Attitude towards family planning among South Asian immigrant married women=228
Variables
n
%
Ideal age of first child
18-24 years
72
31.6
25-30 years
105
46.1
30 years and over
32
14.0
Don't know
19
8.3
1 yr
10
4.4
1-2 yr
88
38.6
3-4 yr
121
53.1
4-5 yr
7
3.1
72
31.6
121
53.1
35
15.4
Birth space between children
Desired number of children
Child 1-2
Children 3-4
Children 5 and more
Page 42 of 88
5.3.2 Attitude towards modern contraceptives
Figure 4 illustrates that nearly half (47.8%) of the respondents were using modern
contraceptives without any problem and one fourth of the respondents didn’t like to
use or thought contraceptive usage was against nature while18.9% of the
respondents never used any modern contraceptives.
Figure 4 Attitude towards modern contraceptives among South Asian immigrant married women
contraceptives use
8%
19%
48%
I have used without any
problem
25%
It is against nature/don’t like
to use
I never used
I have used in spite of
problems/troubles
Table11 shows 59.5% of the respondents were 31-45 years and have a positive
attitude towards contraceptives while 53.0% women 20-30 years shows negative
attitudes like they never used modern methods. The relationship between age group
and attitude towards modern contraceptives shows slightly significant association (pvalue 0.007).
Page 43 of 88
Table 11 Attitude towards contraceptive use among South Asian immigrant women n=228
Attitude towards moderen contraceptives
P-value
I have used
Age
20-30 years
31-45 years
Total
I have used
in spite of
It is against
I never
without any
problems/
nature/don’t
used
problem
troubles
like to use
25(21.4%)
43(36.8%)
12(10.3%)
37(31.6%)
18(16.2%)
66(59.5%)
7(6.3%)
20(18.0%)
43(18.9%)
109(47.8%)
19(8.3%)
57(25.0%)
0.007
Figure 5 Attitude towards FP discussions among immigrant women themselves by ethnicity
Negative/don’t want to talk
Positive/we enjoy the discussion
Embarrass/avoid discussion
0.635
0.667
0.622
0.581
0.378
0.302
0.247
0.118
Pakistan
0.116
Bangladesh
Sri-Lanka
0.27
0.063
India
Figure 5 illustrate 42 or nearly two third of the Indian origin women (66.7% ) show
positive attitudes towards family planning discussions followed by 54 women of
Pakistan (63.5%), 25 women of Sri-Lanka (58.1%) and 14 Bangladesh origin women
(37.8%). Twenty three or more than half of the Bangladesh origin women (62.2%)
feel embarrassed during discussions.
There was a significant association (p-value 0.002) between ethnicity and attitude
towards family planning discussion.
Page 44 of 88
5.3.3 Attitude towards family planning discussion among South Asian
immigrant married couples
Table 12 Attitude among married women (n=228) towards
More than two-thirds (72.4%) of family planning (FP) discussion with the other study
the respondent’s husbands were participants and with their own husbands
positive towards family planning,
16.2% of women reported their
Variables
husband felt embarrassed, and
%
n
11.4% of respondents husband
Attitude towards FP discussion
among study participants themselves
were negative or didn’t’ want to
talk, while 59.2% of respondents
Negative/don’t want to talk
themselves were positive during
Positive/we enjoy the discussion
discussion. Respondents who felt
Embarrass/avoid discussion
embarrassed or wanted to avoid
Positive/we enjoy the discussion
between
family
59.2
74
32.5
26
11.4
165
72.4
37
16.2
Embarrass/avoid discussion
husband’s and wives’ attitudes
toward
135
Negative/don’t want to talk
(table 12, 13,). There was a
association
8.3
Attitude among participants husband
towards discussion
the discussion comprised 32.5%
significant
19
planning
discussions.
Table 13 Association between husbands and wives attitude towards family planning (n=228)
Participants husband’s attitude
Participant’s
own attitude
Negative
Positive
Embarrass
n (%)
n (%)
n (%)
Negative
14
73.7%
3
15.8%
2
10.5%
Positive
0
0%
135
100%
0
0%
Embarras
s
12
16.2%
27
36.5%
35
47.3%
26
Page 45 of 88
p-value
11.4%
165
72.4%
37
16.2%
<0.001
5.3.4 Family planning discussions in countries of origin
Table 14 Attitude towards FP discussions in the country of origin among South Asian immigrant married
women
Received family planning information
before marriage
n= 226 (100%)
1st generation
immigrant women
n= 108 (100%)
2nd generation
immigrant women
p-value
n= 18 (100%)
No/don’t know
178 (78.8%)
172
(83.1%)
6
Yes
48 (21.2%)
36
(16.9%)
12 (68.4%)
(31.6%)
<0.001*
Need to know family planning information before marriage
n= 228 (100%)
n= 209 (100%)
n= 19(100%)
No/dont know
132(57.9 %)
127(60.8%)
5(26.3%)
Yes
96(42.1 %)
82(39.2%)
14(73.7%)
0.004*
Attitude towards FP discussions with unmarried women in the country of origin
n= 228 (100%)
n= 209 (100%)
n= 19(100%)
Not common in society
No
55(24.1%)
52(15.8%)
3(24.9%)
Yes
173(75.9%)
157(84.2%)
16(75.1%)
0.282*
Shame or embarrass to discuss
No
36(15.8%)
31(14.8%)
5(26.3%)
Yes
192(84.2%)
178(85.2%)
14(73.3%)
0.160*
*Fishers exact test
Table 14 shows the numbers and percentages of attitudes among 228 married
respondent’s parent’s society towards family planning discussions along with
unmarried women.
Married participants were asked whether or not they had received any
contraceptives information before marriage, 78.8% of respondents didn’t receive any
information before they got married. Out of 19 second-generation immigrant women
Page 46 of 88
12 (68.4%) received family planning information before marriage while only 36
(16.9%) out of 209, 1st generation immigrant women got information. The relationship
between immigration status and attitudes towards family planning information before
marriage shows statistically significant p-value<0.001*.
More than two thirds of the respondents said that discussion of family planning
before marriage either was not common in their society or was embarrassing to ask
about.
When they were asked whether unmarried women need to know about family
planning information, 42.1% of the respondents answered that young girls should
know about contraceptives before they get married of which 14 respondents were
second-generation immigrants (73.7%).
5.3.5 Attitude towards FP information among unmarried South Asian women
(n=81)
Unmarried respondents comprised 26.2% of the study group with a minimum age of
13 years and maximum age of 24 years; the mean age was 16.44 years, with a
standard deviation of 2.77. When the unmarried respondents were asked about
whether they feel the need to discuss family planning, 43.2% responded that there is
need to know about contraceptives.
With a majority of 71 the young respondents (87.7%) feel embarrassed to ask, and
more than half (58%) of the young girls said they never had thought about this topic
before. The attitudes toward family planning discussions among respondents are
shown in Table 15.
Table 15 Positive Attitude towards family planning discussion on among young South Asian unmarried
women (n=81)
N
%
35
43.2
Feel embarrass to talk
71
87.7
Not common in our society
64
79.0
I never thought about this topic before
47
58.0
Unmarried girl need to know about Family planning
Attitude towards family planning among study participants themselves
Page 47 of 88
5.3.6 Preferable source for FP information among unmarried women (n=81)
One third of the respondents 28 (34.5%) preferred not go anywhere to get family
planning service, while only 14 (17.3%) preferred health centre’s followed by
12(14.8%) who preferred clinics for sexual information and 12(14.8%) who checked
the internet.
If they needed any information about contraceptives, 31% respondents preferred to
discuss it with friends. Half of the young (50.6%) respondents know that in Norway
girls under the age of 16 can get oral contraceptive pills to avoid the conception.
Figure 6 South Asian unmarried women’s preferable source for family planning information
Prefer to ask about family planning information
31%
21%
12%
12%
10%
7%
Friends
Page 48 of 88
Parents
Siblings
General
practitioners
No one
School nurse
6%
Health
centre for
youth
Practice of family planning
5.4 Descriptive result of practice of family planning
5.4.1 Fertility background
Table 16 Fertility background of South Asian immigrant married women (n=228)
n
%
6
2.6
18-24
190
83.3
25-30
32
14.0
No
152
66.7
Yes
76
33.3
No
78
34.2
Yes
144
63.2
6
2.6
0-1
129
56.6
2 and more
99
43.4
Want more children
n
%
No
218
95.6
Yes
10
4.4
No
71
31.1
Yes
157
68.9
Total
228
100.0
Age of marriage years
Less than 18
After marriage contraceptives
use
Planned Pregnancy
No rememberance
Number of children
Currently use contraceptive
methods
Table 16 shows the majority of the (83.3%) of the South Asian immigrant women
married in the age of 18-24 years. Two third of the (66.7%) respondents had not
Page 49 of 88
used any contraceptives after marriage and half of the (56.6%) respondents have at
least one child.
Among the South Asian immigrant respondents, 68.9% of women were using
contraceptives either modern or traditional contraceptive methods. Over forty
percent (40.1%) of
South Asian immigrant married respondents take oral
contraceptive pills followed by 31.2% of women who use intrauterine device, 12.1%
who use condoms and 13.4% of women who practised traditional methods (table
17).
Table 17 Number and percentage of ever used of contraceptives
Family planning method
Modern contraceptive
methods
Traditional method
n
%
Oral contraceptive pills
63
40.1
IUD
49
31.2
Condom
19
12.1
Male sterilization
2
1.3
Female sterilization
3
1.9
Calendar/withdrawal method
21
13.4
157
100.0
Table 18 shows more than two third (80.2%) of the women 31-45 years were using
contraceptives. The majority (76.7%) of the women using contraceptive were SriLankan in origin using contraceptive. Only 57.1% women of Pakistani origin were
using contraceptives compared to other ethnic group.
Women who had less than 12 years of education 84.3% were using contraceptives.
There is a significant association between use of contraceptives and age (p-value
<0.001*) and education (p-value <0.001).
Women who had positive attitude towards family planning (78.1%) and women who
have 2 or more children (85.9%) were using contraceptives and there was significant
association between positive attitude (p-value 0.001*Fisher’s exact test), number of
children (p-value-<0.001* Fisher’s exact test) and contraceptive use.
Page 50 of 88
Table 18 Association between contraceptive use and demographics and knowledge, attitude of family
planning and number of children reported by South Asian immigrant women n=228
Use any contraceptives
No
Age
Ethnicity
Immigration
status
Education
Employment
Knowledge
of FP
Attitude
towards FP
Number of
children
Yes
20-30 yrs
49
41.9%
68
58.1%
31-45 yrs
22
19.8%
89
80.2%
Pakistan
36
42.4%
39
57.6%
Bangladesh
9
25.4%
28
74.6%
Sri-Lanka
10
23.3%
33
76.7%
India
16
24.3%
47
75.7%
1st
65
31.1%
144
68.9%
2nd generation
6
31.6%
13
68.4%
Less than 12 years
education
20
15.7%
107
84.3%
More than 12 years
education
51
50.5%
50
49.5%
Unemployed
42
33.3%
84
66.7%
Employed
29
28.4%
73
71.6%
Lack of knowledge
24
13.3%
157
86.7%
Average knowledge
47
100%
-
-
I never used/don’t
like to use
43
43.0%
57
57.0%
I have used without
problem/ in spite of
problem
28
21.9%
100
78.1%
0-1 children
57
44.2%
72
55.8%
2 and more
14
14.1%
85
85.9%
71
31.1 %
157
68.9%
generation
Total
*Fishers exact test
Page 51 of 88
p-value
<0.001*
0.046
0.575*
<0.001
0.258*
<0.001*
0.001*
<0.001*
5.4.2 Reason for not using contraceptives
Figure 7 Percentage of reasons for not using contraceptives (n=71)
Desired for children
Prefer traditional method
Fear of side effect
14%
30%
56%
Figure 4 illustrates that the majority of the women 40 (56.3%) mentioned that fear of
side effects was the main reason for not using contraceptives while 21 preferred
traditional method and only 10 respondents desired for children.
5.4.3 History of requesting induced abortion and reason for termination of
pregnancy
Figure 7 Percentage of requesting abortion and its reason among South Asian immigrant women(
n=81)
Reason for termination of pregnancy(%)
Economical reason
14.8
Too little birth spacing
7.4
Too young for having child
16
25.9
Pregnancy was not planned
35.8
Study
0
5
10
15
20
25
30
35
40
Figure7 shows that one third of the respondents 81 (35.5%) have a history of
induced abortion. One third of the women mentioned study as the reason, followed
by not planned pregnancy, economical reason, and too young or too little birth
spacing.
Page 52 of 88
Family planning service
5.5 Preferred to talk or discuss about family planning
Among 309 respondents, only 40 women preferred to visit health centres (17.5%)
for family planning service, while 62 respondents preferred not to go anywhere
(27.7%). Nearly one fifth of the respondents preferred discussions with their general
physician (21.5%) and 37 respondents wanted to talk with family member and
friends (16.2%).
Figure 8 preferred to talk or discuss about family planning (n=309)
No where
Parents/Siblings / friends
Health care providers
0.606
0.551
0.282
0.113
13-19
0.291
0.157
20-30
0.55
0.306
0.144
31-45
Figure 8 illustrates that the youngest group prefers to talk with family or friends while
the two elder groups preferred to get service from health care providers either by
visiting health centres or visiting physicians. There was significant association
between preferred to ask or discuss for family planning information and age group
(p-value<0.001).
More than two third of the immigrant married women 168 (73.7%) never faced any
problem when they were seeking for family planning service.
Only 60 respondents (26.3%) faced problems, among them 29 (48.3 %) mentioned
they couldn’t speak Norwegian language and 26 respondents (43.3%) depended on
their husbands to ease communication at health centres.
Very few women 3 (5%) mentioned that the health staff never understood them; and
2 (3.3%) women said they didn’t know where to go.
Page 53 of 88
5.6 Outcome of the result
5.6.1 Relationship between knowledge of family planning and independent
variable (demographic factors)
Results from logistic regression showed that age group(Ref=13-19,1=20-30 and
2=31-45), immigration status(1= 1st generation-ref. 2= 2nd generation), ethnicity(
1=Pakistan,
2=India
3=Sri-Lanka
and
4=
Bangladesh-ref),
marital
status(1=unmarried and 2=married-ref) and employment status(1=unemploymentref. and 2=employment) had significantly higher odds for family planning knowledge
compared to the reference group.
More than half, South Asian immigrants 181 (58.6%) showed they have lack of
family planning knowledge while 128 women (41.4%) have average knowledge..
Table 21 shows that the odds of FP knowledge were 3 times higher for the women of
Indian compared to Bangladeshi women and 2 times higher for first generation and
19 times higher for more than 12 years educated women compared to less than 12
years educated women..
Page 54 of 88
Table 21 Odds Ratio (OR) with 95% confidence interval (CI) for good family planning knowledge according to
demographic characteristics among South Asian immigrant women of reproductive age
95% CI
OR
p-value
aOR*
0.137
Ref
95% CI
p-value
13-19 yrs
Ref
<0.001
20-30 yrs(1)
1.7
0.9
3.0
0.082
8.4
2.6
27
<0.001
31-45 yrs(2)
1.1
0.6
2.0
0.720
4.9
1.4
16
0.009
Pakistan(1)
3.2
1.7
6
<0.001
2.6
1.2
5.9
0.014
India(2)
4.2
2
8.8
<0.001
3.7
1.5
8.7
0.003
Sri-Lanka(3)
2.6
1.3
5.4
0.007
2.2
1
5.1
0.050
Bangladesh
Ref.
<0.001
Ref.
1st generation
immigrant women
Ref
0.015
Ref.
0.328
2nd generation
immigrant women
1.2
0.7
2.1
Less than 12 years
education
11
6.2
22
More than 12 years
education
Ref.
<0.001
2.6
0.9
7.5
0.058
19
9.4
41
<0.001
Ref.
*aOR indicates adjusted Odds Ratio after adjusting for other variables in the model
Ref.= Reference category
We wanted to find out the impact of our explanatory variables (Age, ethnicity,
immigration status, education) to the level of family planning knowledge. Therefore
we fitted these variables into a binary logistic regression model with two categories
of family planning knowledge.
The Hosmer-Lemeshow test supported the model as being worthwhile. The Chisquare value for Hosmer-lameshow test is 5.740 with significance level of 0.676.
This value is larger than 0.05. Therefore it indicated support for the model.
Page 55 of 88
The model explained between 31.6% and 42.5% of variance in the family planning
knowledge. Here education withstood adjustment for each other indicating that being
age 20-30 yrs women 8.4(95% CI=2.6, 27), for more than 12 years educated women
19 (95%CI=9.4, 41.7) most important predictor of good knowledge of FP with an
adjusted OR of 3.7 (95%CI=1.5, 8.7) for Indian women; 2.6 (95%CI=0.9, 7.5) for
second generation immigrant women.
5.6.2 Relationship between contraceptive use and demographics, knowledge,
attitude towards CM and number of children among women n=228
We wanted to find out the impact of our explanatory variables (Age, ethnicity,
immigration status, education, marital status, employment status, knowledge of
family planning, number of children and attitude towards modern contraceptives) to
the use of contraceptives. Therefore we fitted these variables into a binary logistic
regression model with the contraceptive use as dependent variable.
Page 56 of 88
Table 22. Odds Ratio (OR) with 95% confidence interval (CI) for current contraceptive use according to
demographic predictors among South Asian immigrant women of reproductive age
OR
95%CI of
OR
p-value
aOR*
95%CI of
aOR*
p-value
Age
20-30 yrs(1)
Ref
31-45 yrs(2)
2.9
Pakistan(1)
Ref
India(2)
1.6-5.2
<0.001
2.0
0.9-4.7
0.077
2.2
0.9-5.4
0.061
6.8
1.8-25.9
0.004
Sri-Lanka(3)
2.4
1.0-5.5
0.036
8.4
2.6-26.6
<0.001
Bangladesh(4)
2.1
1.0-4.3
.0.034
4.4
1.3-14.3
0.012
1st generation
Ref
2nd generation
1.5
0.4-4.8
0.484
1.3
0.3-5.5
0.676
Less than12 years
education
5.4
2.9-10.1
<0.001
8.3
3.7-18.5
<0.001
More than12 years
education
Ref
1.5
0.6-3.6
0.306
Years of Education
Ref
Employment status
Employed
Ref
0.427
Unemployed
1.2
0.7-2.2
Lack of knowledge
1.8
1.0-3.2
0.039
2.1
1.0-4.5
0.047
Average knowledge
Ref
2.4-9.3
<0.001
8.4
3.4-20.5
<0.001
1.5-4.7
0.001
2.5
1.1-5.3
0.016
Knowledge of FP
Number of children
0-1(1)
Ref
2 and more(2)
4.8
Attitude towards CM
Negative(1)
Ref
Positive(2)
2.6
*aOR indicates adjusted Odds Ratio after adjusting for other variables in the model ; Ref.= Reference
category
Page 57 of 88
The Hosmer-Lemeshow test supported the model as being worthwhile. The Chisquare value for Hosmer-lameshow test was 10.439 with significance level of 0.236.
This value is larger than 0.05. Therefore it indicated support for the model.
The model explained between 33.8% and 47.6% of variance in the contraceptive
use. Here ethnicity, education and number of children withstood adjustment for each
other indicating that being a Indian women and Sri-lankan woman was the most
important predictor of contraceptive use with an adjusted OR of 6.8(95% CI=1.8,
25.9); for Sri-Lankan women 8.4(95%CI=2.6, 26.6); for less than 12 years
educated
women
8.3(95%CI=3.7,
18.5)
and
number
of
children
8.4(95%CI=3.4,20.5). Age, family planning knowledge, employment status, marital
status and attitude towards modern contraceptives did not withstand adjustment
(control) for other variables in the model.
Page 58 of 88
Chapter 6. Discussion
6.1 .Summary of important findings
The main research objective of the study was to investigate family planning
knowledge, attitudes and practices among South Asian immigrant women in
reproductive age in Oslo, Norway.
6.1.1 Knowledge of family planning:

A total of 181 women (58.6%) show they have lack of family planning
knowledge while 128 women (41.4%) were in knowledgeable group.

The relationship between family planning knowledge and demographics shows
significant association with age, ethnicity, and education.

Most important predictor of good knowledge of FP with an adjusted OR of
8.4(95% CI=2.6, 27) for age 20-30 yrs women for more than 12 years
educated women 19 (95%CI=9.4, 41.7) 3.7 (95%CI=1.5, 8.7) for Indian
women; 2.6 (95%CI=0.9, 7.5) for second generation immigrant women.
6.1.2 Attitudes of family planning:

Nearly two-thirds of the Indian origin women (66.7 %) show positive attitudes toward
family planning discussions. More than half of the Bangladeshi women feel
embarrassed during discussions. There was a significant association between
ethnicity and attitudes toward FP discussion.

Even though more than two third of the respondents’ husbands were positive
towards family planning discussion and 59.3% of the respondents were themselves,
81 married women (35.5%) have a history of induced abortion.

The majority of married women did not receive any information before they got
married. Second-generation immigrant women, 12(68.4%) received family planning
information before marriage, while only 36 (16.9%) out of 209 first generation
immigrant women got this information. There was a significant association between
immigration status and attitudes toward family planning information before marriage
(p-value<0.001).
Page 59 of 88
6.1.3 Practice of family planning:

Among the married women, 68.9% were using contraceptives. Furthermore,
84.5% of women with less than 12 years of education and 80.1% of those
between 31-45 years were using contraceptives.

The majority of the women 76.7% of Sri-Lankan origins were using
contraceptive.
There
was
significant
association
between
use
of
contraceptives, age groups and education.

Over seventy eight percent of women who had the positive attitudes toward
family planning and 85.9% women who have 2 or more children were using
contraceptives. There was a significant association between modern
contraceptive attitudes, number of children and contraceptive use.

The odds of contraceptive use were 2.9 times higher among women 31-45
years compared to women of 20-30 years (95% CI was 1.6 - 5.2).

Contraceptive use was 5.4 times higher among women who had less than 12
years of education compared to higher educated women (95% CI : 2.9, 10.1).

For women who have 2 and more children the odds of contraceptive use were
4.8 times higher compared to women who have only 1 child (95% CI :2.4,
9.3).

The positive attitudes toward modern contraceptives among immigrant
women were associated with a 2.6 fold increased Odd ratio for using any
contraceptives (95% CI was: 1.5, 4.7).

The odds ratio for contraceptive use was increased when education adjusted
for age 5.7 (95%CI: 3.0, 10.8); attitude towards contraceptives 5.5 (95%CI:
2.9, 10.5); and for knowledge of family planning 2.1 (95%CI: 1.0, 4.5)
6.1.4 Family planning service:

For family planning service, only 17.5% preferred to visit health centres, while
27.7% would not prefer to go anywhere.

During seeking family planning service, 60 respondents (26.3%) faced
problems. Language barrier was the main reason to face problems.
Page 60 of 88
6.2 Discussion of result
‘Knowledge, attitudes toward family planning and contraceptive use are the most
fundamental indicators that are used by different national and international
organizations to assess the success of family planning programs. Regarding the
level of contraceptive use, knowledge has an effect on the women to practice family
planning more than others who have lack of the knowledge’.
(48)
‘Migrants possess
limited knowledge of modern contraceptive methods and, therefore, may experience
unmet need for contraception or may have a limited choice of modern contraceptive
methods during their first years in an urban destination.’(49)
6.2.1 Knowledge and attitude of family planning
Age. Sexual and reproductive health education is part of the health education of the
Norwegian educational system, and it is generally assumed that adolescent females
who live in Norway are well aware of basic physiology and how to avoid unwanted
pregnancy. The present study indicates that knowledge of family planning is higher
among younger than older age groups. The majority of the respondents (55.9%)
were female adolescent of 20-30 years of age who have average family planning
knowledge.
Immigration status First-generation immigrants were associated with an 3 fold
increased OR for family planning knowledge compared to second generation
immigrant women. This finding is not consistent with the other findings as study in
Denmark in 2007. Though, most of the 2nd generation immigrant women received
family planning information before getting married and received sex education at
school while the majority of 1st generation women never received any family planning
information at school.. The 1st generation immigrants get contraceptive information’s
either from friends, family members or media and this is compatible with the findings
from India,8 Sri-Lanka 11 and Pakistan 9.
The country of origin among immigrants showed that there was a taboo to discuss
about reproductive health with unmarried adolescents. In addition when the
adolescents answered questionnaire with same ethnic or same race; it might be
influence them to not answer correctly whether anybody get to be informed that she
Page 61 of 88
had knowledge of family planning. During study, it was noticed that there was
presence a lack of trust between health care providers and unmarried adolescents
which was also found in the ESCAP region
(15)
Therefore, women have little
knowledge on contraceptive due to country of origin even though they born in
developed country. This study indicates that family planning discussions were not
common in their society from where they originate. After adjusting education to other
independent variables, the study reveals that demographically, family planning
knowledge has improved among immigrant women. It is acknowledged that
education can improve the knowledge about reproductive health, but knowledge
doesn’t always transfer into actions.
Of the 2nd generation immigrant women who participated in this study most were
unmarried and unemployed and most of the young girl have less than 12 years
education. Therefore, knowledge of family planning among 1 st and 2nd generation
immigrants was significantly different by demographics.
Attitudes of family planning discussions among immigrant women are related to their
husband’s attitudes. There is a significant association between attitudes among
married couples towards FP discussions, but there is no significant association
between uses of contraceptives and husbands attitudes as Inter-spousal
communication towards contraceptive use has been observed in many studies in
Pakistan 1999, 15 in Nigeria 2005 52, and in Ghana 1993 51.
Experience during the KAP survey: One of the married study respondents after
giving an interview was asked by the author to let her daughters to participate in this
survey. Study respondents gave verbal informed consent with regards to her
daughter’s interview. A few days later, the respondents called the author to withdraw
her information. She didn’t want to let her daughter to participate in this survey.
Another few weeks later, the author called other respondents of same ethnic
community, study subject mentioned that she didn’t want to participate because it
involves very personal and family planning information and it also involves an
unmarried young girl which is not acceptable. The study subjects’ comment was that
unmarried girls never give any interviews related to contraception and sexual health.
After this incidence, the survey was discontinued within this ethnic group.
Page 62 of 88
Experience during the survey with unmarried young girl:

One of respondents mentioned they were not allowed to go school on the
scheduled day when they were supposed to get their class on reproductive
health. The young respondents mentioned that she lives in one district but
prefers to visit other districts health centre for youth.

During survey, there was a discussion on sex education in school among the
immigrant native communities. The guests of get together program in festival
stated that when children were 13 years they moved from Oslo to their native
country to avoid the sex education. When the children became 18 years they
back again and started their required education. According to their statement,
a young girl shouldn’t need to learn about sex before marriage furthermore, it
depends on time when they need family planning relevant information.

To fulfill the required sample size, the author asked respondents to nominate
others to whom she knew like her sisters or cousins or friends and if they
would be willing to participate. The author received negative feedback from
one of unmarried respondents that was, respondents didn’t prefer to let the
author introduce her siblings or friends because they will be informed that
respondents visited health centers or have knowledge of contraceptives. It
would make a negative impression about the respondents to her family or
friends.
6.2.2 Explore the contraceptive practices
Age. The use of contraceptive is lowest among women of 20-30 years while the
percentage is highest among 31-45 years. Nearly two third of respondents of 31-45
years old in this study show that they were positive towards contraceptives and they
were using modern contraceptives without any problems. They have achieved the
desired family size and want to limit births. Therefore, it is logical to say
contraceptive usage is highest among the older age group. In descriptive analysis
and logistic regression analysis, age groups show a significant difference in use of
contraceptives. An increase in the proportion of contraceptive users with age has
been also observed in Thailand (46) among Myanmar migrant women, and in Nigeria
(50).
Page 63 of 88
Ethnicity. A consideration of the use of any contraceptives by country, according to
the United Nations in 2009, shows that contraceptive prevalence rate among
Pakistani women is low compared to those from Sri-Lanka, India and Bangladesh.
This study also indicates that immigrant women from Pakistan were using less
contraceptives compared to other immigrant women in Oslo (Table 25).
Table 25 Percentage of contraceptive use among women
Percentage using contraception among women
(2009) according to United Nation
Percentage using contraception among women
(2009) according to United Nation
Worldwide
62.9 %
Norway (20-44)
88.4 %
Asia
67 %
Europe
70.5 %
South Asia
54.2 %
Northern Europe
81 %
Percentage using contraception among women
(2009) according to United Nation
Percentage using contraception among women
(during August-December 2010) (20-45) this KAP
survey
76.7%
Sri Lanka(15-49)
68.0 %
India(15-49)
56.3 %
75.7%
Bangladesh(15-49)
55.8 %
74.6%
Pakistan(15-49)
29.6 %
57.6%
Education The use of contraception is higher among women with less than 12 years
education 107(84.3%) than compared to women with more than 12 years of
education women. In descriptive analysis, there is a significant association between
contraceptive use and education. In bivariate analysis, contraceptive use is 5.4 times
higher among lower educated women compared to higher educated women. After
controlling for other variables, education has a significant effect for using
contraceptives. This finding is consistent with the study in Bangladesh 2000 (50).
Attitudes towards contraceptives The positive attitudes toward contraceptives
have a significant association with use of contraceptives. The majority of
respondents are positive towards using contraceptives especially older groups. They
share their experience or suggest modern contraceptives use to others who want to
stop births. Women 31-45 years are usually giving advice to young couple to have
children early and complete their family. Developed infertility by using modern
Page 64 of 88
contraceptives is one of the common reasons given by immigrants for not using
modern contraceptives. Therefore, most of the women have their first child at their
age of 18-24. Before reaching 30 years, most of the respondents want to have their
desired family size. The most common reason related to not using modern
contraceptives among young women is the fear of side effects from modern
contraceptives. Number of children, age and attitudes is significantly related to
contraceptive use in this study and is also observed in the study of Bangladesh 2010
12,
in Thailand 2007 46.
One-third of study respondents had a history of requesting induced abortion. The
most frequently given reasons for termination of pregnancy was wishing to finish
education (35.8%), unplanned pregnancy (25.9%), too little birth space (7.4%), and
economical reasons (14.8%). This study finding is consistent with the study in SriLanka 2004 and in Sweden in 2000.
6.3 Methodological consideration: Do the results of the thesis tell us truth?
There are several possible sources of systematic errors that may influence the
validity or the accuracy of the results. These include selection biases, information
biases, confounding and sampling bias.
Recruitment rate was 93%. The sample size was not fully achieved from August
2010 to December 2010. The study population was not representative for the
population. Data was supposed to be collected from the health centres in the Alna,
Stovner and Søndre Nordstrand districts. Due to lack of resources at Alna and
Stovner (lack of private room for conversations with participants), the participants
were recruited only from health centres of Søndre nordstrand district and Gamle
Oslo.
Information on ethnic background, immigration status is valid, but it was difficult to
obtain quality information on knowledge, attitude and practice, because, the
questionnaire was including both closed and open questions. There was missing
information in respondents’ self answered questionnaire. Especially for the
unmarried young girls, they choose multiple answers to some questions; it was
confusing when the data was entered.
Page 65 of 88
Sexual and reproductive health education is part of the health education of the
Norwegian educational system however, the younger , second generation immigrant
girl shows according to this study that they have lack of family planning knowledge. It
was puzzling when the data analysis was completed.
Knowledge of family planning part only includes the heard of contraceptive methods.
Questionnaire should have included questions regarding the benefit of the modern
method or when CM should be used etc. Therefore, measure of family planning
knowledge was difficult. The measuring tools were not good enough to determine the
attitude of family planning by this questionnaire. Some questions needed to be
revised by degree of agreement and disagreement with the statement under
attitudes part of questionnaire. Though confounding factors for FP knowledge was
found, but confounding factors for attitudes toward FP discussion with unmarried
young girls was not possible to measure. Prevalence of contraceptive use was not
possible to measure here either. In the questionnaire, it was asking ‘are you currently
using any contraceptives method’ instead, the questionnaire should be asking ‘are
you using any contraceptive methods since last three months’.
This study’s results are only valid for the groups who reside in Oslo, but are not a
valid result for the population from where they originate. However, it may be valid for
South Asian women who live in other Scandinavian countries. Considering the
ethnicity, though women migrated from same country, they are differing in their own
community by language, education and understanding of health as a girl who is born
and brought up here will be different from others who migrated here after marriage.
They are also different by their migration status (e.g. refugees, labour migrants,
asylum seekers and skilled migrants).
The author has no idea of the true distribution of the target population and the
sample. The author was recruiting study subjects by cluster and snowball sampling.
The snowball sampling is sometimes inexact, and can produce varied and inaccurate
results. It might be that the initial subjects tended to nominate another to whom she
knows well. Because of this, if the nominated subjects share the same traits and
characteristics, it could be sampling bias. Therefore this study can’t generalize the all
the South Asian immigrants because the representativeness of the sample was not
guaranteed.
Page 66 of 88
6.4 Recommendation
1. Study reveals the knowledge of Chlamydia among South Asian Immigrants
remarkably low; therefore, health care providers should inform about
Chlamydia and its long- term consequences.
2. To encourage for using modern contraceptives among immigrants there is
need of available information about the benefits of these modern
contraceptives.
3. The study reveals that one-third respondents had a history of requesting
abortion. To identify the relevant cause for not using contraceptives in relation
to unplanned pregnancy further studies are needed.
4. This study had a time constraint. Therefore, more in depth knowledge about
the cultural beliefs and social norms related to family planning discussion with
regard to unmarried women further research should be carried out by
qualitative research.
5. Reproductive health relevant service and information should be delivered to
newly arrived immigrants with consideration towards their native tongue.
6. Health care providers should reflect on the difficulties among immigrants
reproductive health that is related to language and cultural differences.
7. Health care staffs need to be empowered in order to manage culturally
sensitive issues related to immigrants health.
Page 67 of 88
Chapter 7. Conclusion
There was a difference in family planning knowledge among immigrants living in
Oslo, Norway. Most important significant predictors for good FP knowledge are age
20-30 yrs., education and being a Indian women. Compared to second generation
immigrant women, first generation immigrant women have 2 times higher family
planning knowledge. The family planning knowledge was 3 times higher among
women from India compared to women of Bangladesh origin.
Family planning discussions with unmarried youth is not common in societies where
the respondents originate. There is a significant association between received FP
knowledge before marriage and immigration status.
Over two-third of the immigrants are using any of contraceptives. The most important
statistical significant demographics related to use of contraceptives was age,
education, number of children and attitude towards modern contraceptives. Fear of
side effects (63.3%) was the most common reason related to not using modern
contraceptives..
.
For family planning services, only 17.5% of the women preferred to visit health
centre, while 27.7% respondents would not to go anywhere. The language barrier is
one of the difficulties related to seeking family planning service among 18.7%
immigrants.
Positive attitude towards family planning knowledge can promote a good
reproductive health and well being. This study reveals that education is one of the
significant confounding factor to increase the knowledge and practice of family
planning among immigrants. However, further research is needed to explain the
observed difference in family planning knowledge, attitude and contraceptive uses
(e.g. age groups, ethnicity) among immigrants.
Page 68 of 88
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Annexure: 1
Informed consent form for youth groups (young girls)
Dear Participant
I am a doctor from Bangladesh and my name is Asma Abedin. I am pursuing a Master of
philosophy at the University of Oslo. I am very interested in family planning especially sexual
health and contraceptive knowledge among young girls in Oslo.
The purpose of the study is to know whether young girls have knowledge about sexual
health and contraceptive methods, and whether they are interested in discussion family
planning before getting married.
This interview will only be used for research purposes. The questions are about your
menstrual cycle, and your knowledge and attitude towards sexual health and contraceptive
methods and where you should go to get the information and service.
The interview time will take about 10- 15 minutes and the questionnaire is anonymous that is
your name will not be asked for and no identification number will be used to identify you. If
you agree to participate in this survey, all of the collected information will be kept in
confidential. If you decide to withdraw yourself from this survey, all of the information will be
destroyed. So, participation is entirely voluntary.
I would really appreciate your valuable time for this interview because your opinions are very
important to me as a doctor and researcher. The findings of this study will be made available
to you. If you have any questions before, during, or after the study please feel free to contact
me by telephone 46 84 53 73.
I declare that oral and written information has given as well as the declaration of consent to
the participant.
Date: _________
Signature: _________________________
For participant:
I hereby confirm that, after receiving the above information, both by talking and by writing, I
agree to participate in this survey. My information will only be used for research purposes by
the Asma Abedin (researcher). I am informed that participation is voluntary, and that I can
withdraw my participation at any time.
Date: _________
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Signature: __________________________
Annexure 2:
Informed consent form for women
Dear Participant
I am a doctor from Bangladesh and my name is Asma Abedin. I am pursuing a Master of
philosophy at the University of Oslo. I am very interested in family planning especially sexual
health and contraceptive knowledge among women in Oslo.
The purpose of the survey is to increase our knowledge about family planning and different
contraceptive methods in women from your country. This interview will only be used for
research purposes. You will ask about your reproductive history and your attitude towards
information and discussions of different family planning method. You will also ask about
where you go to get the service.
The interview time will take about 15- 20 minutes and the questionnaire is anonymous that is
your name will not be asked for and no identification number will be used to identify you. If
you agree to participate in this survey, all of the collected information will be kept in
confidential. If you decide to withdraw yourself from this survey, all of the information will be
destroyed. So, participation is entirely voluntary.
I would really appreciate your valuable time for this interview because your opinions are very
important to me as a researcher. The findings of this study will be made available to you. If
you have any questions before, during, or after the study please feel free to contact me by
telephone 46 84 53 73.
I declare that oral and written information has given as well as the declaration of consent to
the participant.
Date: _________
Signature: _________________________
For participant:
I hereby confirm that, after receiving the above information, both by talking and by writing, I
agree to participate in this survey. My information will only be used only for research
purposes by the Asma Abedin (researcher). I am informed that participation is voluntary, and
that I can withdraw my participation at any time.
Signature or mark of the Subject:
Page 75 of 88
Date: _________
This questionnaire is entirely anonymous and confidential: please answer as truthfully as possible. Write and tick possible answer
Annexure 3:
Code W
Interview start: __ __: __ __
Date of Interview:
Section-1 BACKGROUND CHARACTERISTICS
1. Age
2. Ethnicity
3. Weight (kg./pound)
4. Height (feet/cm.)
5. Highest level of education
Primary
Secondary
High school
College/ University
6. Immigration
Country of your parents birth place Country of your birth place If born outside Norway when did you arrive? Year:
How old you were at that time of arrival in Norway?
8. Employment status
Full time job
House wife
Part time job
Student
Maternity leave
Other
Section-2
9
Where did you get your first knowledge about sexual health and contraception?
Parents/ Siblings / family member
Family planning clinic
School
Friends
Nurse or doctor After child birth
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Physician
Magazine/ Internet/Books
Tv/Movies/ Media
Husband after marriage
10 Did you receive any reproductive health and contraceptive related education at your school in
home country?
Yes
No
Do not remember
11 Which methods of contraceptives have you heard about?
12 Have you ever heard about any emergency contraceptive method?
Yes
No
13 Have you ever heard about sexually transmitted infections like Chlamydia?
Yes
No
Section-3
14 How old you were when you got married?
15 Did you know your husband before you got married?
Yes
No
Cousins
16 How did you get to know each other?
School
College
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Family
University
Friend
Other
17 If you married with your cousins then how close relative you are?
1st cousins
2nd cousins
3rd cousins
18 Which one is ideal time to have first child?
Between 18-21
Between 22-24
Between 25-27
Between 28-30
Over 30
19 How many children do you like to have or suggest to other?
Number of children
20 What is the ideal age space between children?
One year
One and half to two years
Three to five years
Five years or more
21 Did you get any education about sexual health and contraceptive methods before you got
married?
Yes
No
Don’t know
22 Do you think unmarried young girl should know about sexual health and family planning?
Yes
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No
Don’t know
23 What do you think, attitude towards discussion about sexual health and family planning
information with unmarried girl ,in your social context
Not common in our society to discuss
Shame to discuss/ Embarrass to discuss
Common topics in our society to discuss
24 I never think this before
25 If you think yes that unmarried young girl need to know about sexual health and family
planning, then please mention.
26 What was your attitude when you discussed with your husband or your surroundings about
contraceptive methods?
Embarrass/avoid to discuss
Positive/ we are enjoying discussions
I never discussed
27 What was your husband’s attitude or your surroundings attitude when they discussed with you
about contraceptive methods?
Embarrass/ avoid to discuss
Positive/ we are enjoying discussions
Avoid or never discussed
28 What is your view about contraceptive methods?
I have used contraceptives without any problems
I have used contraceptives in spite of problems
It is troubles to use
It has side effects
It is against nature
I don’t like to use
I never used
29 If you don’t like contraceptive methods, then please mention why?
30 If you have any bad experiences with using of contraceptives, then please mention the
experience with name of contraceptives method
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Section-4
If you have no children you can go quest 36
31 How old you were when you got your first child?
Age
32 Have you used any contraceptives before having your first child?
Yes
No
33 How many children do you have?
34 Are all of your children born healthy?
Yes
No
35 Do you like to have more children now?
Yes
No
36 If you are not wanted to have more children then are you using any contraceptives now?
Yes
No
37 Who are using any contraceptives?
Me
My husband
No one
38 If you are using contraceptives then which methods you are using now?
Condom
Calendar method
Male sterilization
Oral contraceptives
Withdrwal method
Female sterilization
IUD/spiral
Breast feeding
Diaphragm
Injection
No, one
39 If you are not using any of contraceptives, please mention the possible reason.
I want to be pregnant
Preferred traditional method
Fear of side effect
othres
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40 Were your all pregnancies was planned?
Yes
No
Don’t remember
41 Have you ever done requesting abortion?
Yes
No
42 If yes, what was the reason for requesting abortion?
Carrier/study
Pregnancy was not planned
I had complication in my last pregnancy
Social cause
Too young to have first child
Too little birth space between children
Economical reason
43 If, any other reason, please mention
If you have no children you can go 49
44 Have you ever heard that intake of folic acid can protect against serious congenital
malformation like neural tube defects?
Yes
No
45 Did you take regularly folsyre/ folic acid, the months before you got pregnant and the first three
months of pregnancy?
Yes
No
46 Did you take regularly vitamin the month before you got pregnant and during the whole
pregnancy?
Yes
No
47 Did you take regularly omega 3 or Tran the month before you got pregnant and during the whole
pregnancy?
Yes
No
48 Did you take regularly iron tablet the month before you got pregnant and during the whole
pregnancy?
Yes
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No
49 Have you ever heard that when husband and wife come from same family, there is a risk of birth
defect among children?
Yes
No
50 If you need medical service where do you prefer to go?
Health centre
Generalpractitioner
Gynaecologist
Pharmacy
No where
51 Have you ever feel any barrier when you seeking for medical service?
Yes
No
Don’t know
52 What stops you from getting family planning advices or services?
TIME INTERVIEW ENDED
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__ __: __ __
This questionnaire is entirely anonymous and confidential: please answer as truthfully as possible. Write and tick possible answer
Annexure 4:
Code- Y
Date of interview:
Interview start: __ __: __ __
Interview ended: __ __: __ __
Section-1 BACKGROUND CHARACTERISTICS
1. Age
3. Weight
(kg./pound)
2. Ethnicity
5. Number of siblings:
Brothers
4. Height
(feet/cm.)
6. Age of your siblings: Brothers / Sisters:
1
7. Sisters
2
3
4
7. Highest level of education
Primary
Immigration
Secondary
Country of your parents birth place -
High school
Country of your birth place -
College/ University
If you born outside Norway when did you arrive? Year:
How old you were at that time of arrival in Norway?
Section1
8. Age of your first menstrual cycle:
9. Do you have regular menstrual cycle in each month?
Yes
No
2 months
interval
10. Have you experienced irregular menstrual the
cycle?
Yes
No
2 Months
11. Have you experienced heavy bleeding
during cycle?
Yes
No
interval
13. Which part of a normal menstrual cycle are girls more at risk of getting pregnant?
During the bleeding period
Mid- cycle
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Just before the bleeding period
Don’t know
Section 2
12. Have you heard about sexually transmitted infectious
disease like Chlamydia?
Yes
13. Have you heard about family
planning?
No
Yes
No
14. Do you get family planning information from your
school?
Yes
No
15. Have you heard about any emergency contraceptives?
Yes
No
16. Which methods of contraception have you heard so
far?
Section 3
17. Where did you get knowledge about sexual health and contraception?
Parents
Family planning clinic
Tv/Movies/ Internet
Siblings / family member
School nurse
Books/Magazines
Friends
Physician
Hot lines phones
18. If you need family planning information, where you can get it/ prefer to go?
Pharmacy
Klinikk for seksuell opplysning
Health centre for youth
General practitioners
Internet
I don’t know
School nurse
No where
19. Can an adolescent under the age 16 get
contraceptives legally in Norway?
Yes
I Don’t know
No
Section 4
20. If you need any information or service would you
like to go alone (to health center or to
physician)?
Yes
No
21. If you need any service or information to whom you would like to ask?
Parents
Friends
Siblings /family member
General practitioners
22. Do you think an unmarried young girl should have
knowledge about sexual health/ contraceptive
methods?
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School Nurse
Yes
No
Don’t know
23. Do you feel embarrass or shy when you talk about
sexual health/ family planning?
Yes
No
24. Do you think that young unmarried girls should
talk about contraceptives issue?
Yes
Don’t know
No
25. What do you think about family planning discussion with unmarried young girl?
Not common topic to
discuss
I never thought this topic
before
Embarrass /shame to
discuss
I don’t like to talk/ I will not
give any answer
If any other, please
mention
26. If you think yes, that it should need to discuss before marriage then please mention:
Page 85 of 88
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Annexure 6. Map of Oslo districts
Districts
1 Gamle Oslo
7 Vestre Aker
13 Østensjø
2 Grünerløkka
8 Nordre Aker
14 Nordstrand
3 Sagene
9 Bjerke
15 Søndre Nordstrand
4 St. Hanshaugen
10 Grorud
Sentrum
5 Frogner
11 Stovner
Marka
6 Ullern
12 Alna
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South Asian Immigrants and Norwegian born two South Asian immigrant parents by country of birth 5
Norway
Pakistan
Sri-Lanka
India
Bangladesh
Oslo
Pakistan
Sri-Lanka
India
Bangladesh
31884
14017
10096
850
21629
7232
3823
362
Oslo districts health centre’s (8):
Targeted
Immigrants from Asia, Africa, Turkey and South and
area
Central America are living
Søndre Nordstrand:
Stovner:
13 756 (38.4%)
12 070(40%)
Holmlia health centre
Stovner health centre
Klemetsrud health centre
Prinsdal
Bjørndal
Alna:
Gamle Oslo:
17 188(36.6%)
10 881(24.9 %)
Furuset health centre
Grønland health centre
Furuhuset
Fyrstikktorget health
Haugerud health centre
5
centre
Population statistics. Immigrant population 1, January 2011, statistics Norway (http://ssb.no/innvbef_en/)
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