СЕМЕЙНЫЕ УСТАНОВКИ И РЕПРОДУКТИВНЫЕ ПЛАНЫ ИНДИЙСКИХ СТУДЕНТОВ-МЕДИКОВ

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Introduction India becomes the first country in the world for initiating National family programme in 1952, second most populous country in the world with 1.45 billion people, such large and diverse population. Family setup and reproductive plan become important aspect of life. It has significant implication for public health, social development and economic growth [3, 5]. Promotion of contraceptive use and legalisation of MTP in 1971 in India shed light on factor that influence decisions about desired number of children. Among young eligible people premarital sex and unwanted pregnancies become the most sensible topic to discuss. Illegal abortion in India continues to be a significant issue despite the legalisation of abortion in India, many girls over 18 still performing unsafe abortions, often putting their life at risk. This study shows factor contributing to this behaviour social and religious cues, parent’s attitude towards premarital sex and reproductive plan of their child, their support and how social stigma influence their behaviours towards premarital pregnancies [1, 4]. The article touched upon the issues of reproductive plans of Indian medical students studying mainly in Russia and India or recently graduated. The following issues are proposed for discussion: 1) Family planning, 2) Premarital sex, 3) Use of contraceptive in couple, 4) Factors determining the decision to have an abortion when a premarital pregnancy occurs, 5) The role of parents in reproductive choices, 6) Male and female individual perception about reproductive plan. Objective - family Planning and Reproductive Health are core issue in context of large and diverse population of India's large and diverse population. Methods The above topic is studied among eligible people studying in universities or graduated. This survey held by the Department of obstetrics and gynaecology under the guidance of head of the department professor Vita N. Pokusaeva. In this survey 241 people were participated in which 212 (88%) were student and 29 (12%) has recently graduated. Opportunity of participation was given equally to female and male. 143 (59.3%) female and 98 (40.6%) males had given their response via google form in which there was 20 questions. For each question there was possible answer and selection of one answer only. This form was an anonymous only responses were gathered in the form of statistical data. We tried to compare their ideas and views about future family planning. Participants chosen the appropriate option according to their will and responses were gathered and studied and following results were obtained (Table). Most students were over 20 years old (79.3%), only 50 (20.7%) participants were aged 18-20 years. As they are enough capable of giving their ideas about future plan and the factors influences their decisions. The age composition of the boys and girls who participated in the study turned out to be approximately the same. We tried to analyze the upcoming reproductive plans of youth and how modern society has changed in developing countries, which were previously dominated by traditional family foundations. Our current generation has more access to information and resources about family planning than previous generation this allows individual to make more independent decisions based on their personal circumstances, goals and values. Additionally, the current generation is more likely to have open discussions about family planning with their partner. The only child in the family was only 12% of students, with more often young men (18.3% against 9.0%, p=0.028). 6 out of 10 (154 - 63.9%) participants had two children in their families. It is due to effect of campaign held by National family planning programme of India with slogan “HUM DO HAMARE DO”. It aims at having an only two child policy, thus it can help in slowing down the fast pace growth of India’s population [9]. Increase in literacy rate, use of contraception and educating about reproductive health, late marriages greatly affect the mindset of people. To control adverse effect of growing population such as poverty, unemployment, health issues and to deal with upcoming future challenges, it was implicated. Table. Survey results of the respondents Question Features Male, N=98 Female, N=143 General, N=241 Abs % Abs % Abs % Age 18-20 21 21.4 29 20.2 50 20.7 21-22 27 27.5 47 32.8 74 30.7 Over 22 50 51.02 67 46.8 117 48.5 What country do you currently live in? Russia 58 24.1 69 28.6 127 52.7 India 40 16.6 66 27.4 106 44.0 Other countries 1 0.4 7 2.9 8 3.3 No of children in family I am only child 18 18.3 13 9.0 31 12.8 two 58 59.1 96 67.1 154 63.9 Three 14 14.2 26 18.1 40 16.5 More than three 8 8.1 8 5.5 16 6.6 Discussed with parents possible no of future children Never 69 70.4 94 65.7 163 67.6 A couple of 23 23.4 39 27.2 62 25.7 Often 6 6.1 10 6.9 16 6.6 Grandchildren would parents like to have One 19 19.3 28 19.5 47 19.5 Two 69 70.4 100 69.9 169 70.1 Three, more 7 7.1 10 6.9 17 7.0 No kids are needed 3 3.0 5 3.4 8 3.3 Importance of parent’s opinion about number of children My decision 44 44.8 52 36.3 96 39.8 Important guided by circumstances 36 36.7 67 46.8 103 42.7 Very important 18 18.3 24 16.7 42 17.4 I plan to have (no of children) One 21 21.4 33 23.0 54 22.4 Two 58 59.1 83 58.0 141 58.5 Three 6 6.1 12 8.3 18 7.4 Four or more 10 10.0 6 4.1 16 6.6 Child free 3 3.06 9 6.2 12 4.9 First child at what age Under 25 4 4.08 4 2.7 8 3.3 25-30 53 54.0 104 72.7 157 65.1 Over 30 41 41.8 35 24.4 76 31.5 Age of first sexual experience Less than 15 6 6.1 1 0.6 7 2.9 15-18 12 12.2 7 4.8 19 7.8 19-22 18 18.3 29 20.0 47 19.5 Over 22 7 7.1 13 9.0 20 8.2 Didn’t start 55 56.1 93 65.0 148 61.4 Premarital sex opinion Strongly against 29 26.5 53 37.0 82 34.0 Its normal 55 56.1 76 53.1 131 54.3 If partner doesn’t mind, I would refrain 14 14.2 14 9.7 28 11.6 Contraceptive use in couple Don’t use 5 5.1 10 6.9 15 6.2 Natural ways 4 4.0 8 5.5 12 4.9 Condoms 40 40.8 41 28.6 81 33.6 Hormonal 0 0 0 0 0 0 Never did sex 49 50 84 58.7 133 55.1 If you become pregnant now (for girls) Abortion - - 49 34.2 - - Give birth - - 26 18.1 - - As partner decide - - 8 5.5 - - As parents decide - - 6 4.1 - - No idea - - 47 32.8 - - Didn’t answer 7 4.8 - - If your partner become pregnant (for boys) I will advise her to abortion if not this is her problem 35 35.7 - - - - I will advise her abortion if she refuse, I will get married 12 12.2 - - - - I’m getting married 39 39.7 - - I will not get married but I will acknowledge paternity and financially support 9 9.1 - - - - Didn’t answer 3 3.06 At this moment what is important Career, money 85 86.7 119 83.2 204 84.6 Family, children 13 13.2 24 16.7 37 15.3 Didn’t answer 7 7.1 10 6.9 17 7.0 Continuation of the table Not wanting child before age 25 (reason) Too young to decide 9 9.1 16 11.1 25 10.3 Material, housing problem 2 2.0 6 4.1 8 3.3 At this age career is more important 73 74.4 106 74.1 179 74.2 At this age no reliable partner 7 7.1 5 3.4 12 4.9 I want to be childfree 3 3.0 5 3.4 8 3.3 Didn’t answer 4 4.0 5 3.4 9 3.7 Main reason for abortion if you get pregnant or your partner get pregnant Family & society pressure 27 27.5 43 30.0 70 29.0 Health issues 13 13.2 26 18.1 39 16.1 Fear of losing career 33 33.6 55 38.4 88 36.5 Your partner decided 18 18.3 9 6.2 27 11.2 Didn’t answer 7 7.1 10 6.9 17 7.0 Despite of this act people living in rural area, still giving priority to having more than one child and also religious factor has great influence. 141 (58.5%) respondents in our study plan to have two children Modern young people are increasingly choosing a one-child policy - 54 (22.4%) of 241. It is important to note that modern youth, both men and women, choose a family model with one child 2 times more often than their parents (p = 0.004) (Figure 1). During the statistical analysis, we did not reveal any differences in comparing the plans of medical students from large and small families. In general, this trend was inherited from their parents, but there was a further change towards reducing the number of children from owning many children to 2-3, and now to 1-2. As well as new population trends some want to be child free. 12 (4.9%) don’t want any child and responsibilities in their future. They declared their child-free life position. It seems to us that a survey of girls shows important results. They are more likely than young men to seek childlessness. Figure 1. Reproductive plans of respondents and the number of children in parental families The role of the parent in family planning and the opinion of parents regarding the determination of the number of children in the family is becoming less and less significant. In Indian society most parents don’t like to talk about sex education, still now this conversation makes them awkward. Indian morals taught this is private thing and should not be discussed. This will lead their children having sex. This is why premarital pregnancy quite often ends with abortion sometimes under guidance or with self-induced. PAN India report released on 2018, on children day (14 November) showed that 6 out of 10 Indian parents do not discuss sex education with their children. They often think their children already know this. Young generation often hesitant to talk about their sexual life. As the survey showed, in Indian families it is not customary to discuss their future reproduction with children, whether sons or daughters (Table 1). Only 16 (6.6%) students answered that this topic was often raised in a conversation with parents, the rest did not discuss at all (163.0-67.6%) or talked about it a couple of times (62.0-25.8%). It is interesting to note that the significance of these conversations for future decision making does not correlate with the frequency of conversations. Only 42 respondents (17.4%) consider the opinion of parents extremely important, 103 (42.7%) are more likely to listen, 96 (39.8%) are ready to completely ignore. Analysis of reproductive plans demonstrates the idea of delayed parenthood. At the same time, girls still plan to give birth to their first child earlier than boys (Fig. 2). Figure 2. The planned age at first birth Despite the fact that almost all respondents postponed childbirth to 25 +, only 148 (61.4%) did not start their sexual activity, while 47 (19.5%) began in their twenties (Fig. 3). Premarital sex in India is still considered as tobacco. In India sex before marriage has been a topic of great discussion and controversy for decades. In traditional Indian society premarital sex was seen as immoral and violation of scantity of marriages. Sex without marriage was strictly forbidden, with severe social and legal consequences resulting from such act. However, in recent years there has been shift in attitude towards sex and marriage in India with rise of globalisation and exposure to western culture younger generations are increasingly questioning traditional beliefs and practices. Figure 3. Age of first sexual experience Medical students were asked their opinion about premarital sexual activity. Both male and female have alliance, they feel it is normal to have sex before marriage. Although more than half of boys and girls have not yet begun sexual relations, the vast majority believe that pre-marriage sexual relations are normal (Fig. 4). At the same time, the opinion of girls practically does not differ from the opinion of boys. 82 out of 241 (34.0%) respondents are categorically against this, since they adhere to traditional beliefs in their morality. Pop culture has played significant role in shaping the perception of relationship with movies and TV shows. Despite of changing attitude towards sex still there is significant cultural and religious barrier. People living in urban areas are more accepting of the idea of premarital sex. Due to the fact that the number of urban residents has changed significantly, this has led to another problem related to pregnancy and unsafe abortions [7]. Researchers note that delayed marriage has brought premarital sexual relations and unwanted pregnancies. Moreover, the risk of sexually transmitted infection and unplanned pregnancies where higher among people below age of 25 as they often did not use contraceptive or use them ineffectively [6]. According NFHS-4 40.2% men think it is women responsibility to avoid getting pregnant, but men are often primary decision maker in family planning. Contraceptive methods and services are mainly targeted at women, although some studies show that 20% of men believe that women's use of contraceptives contributes to her promiscuous sex [8]. Figure 4. Premarital sex opinion Discussing unmarried contraception is an uncomfortable issue for most people, including health professionals who are responsible for meeting the reproductive health needs of young people. This is because of prevailing social norms, where sex outside marriage is discouraged and stigmatised. These social norms give importance to virginities and children outside marriage are not welcomed. At the same time, the expansion of premarital sex highlights the need to provide sexual and reproductive health services to all young people, regardless of their marital status [9]. And more an important role in lowering the rates of premarital sex is open parent-child communication [2]. Real life shows that the number of unmarried women in India using contraceptives has increased (Figure 5). In this study participants were asked about their contraceptive method 133 (55.1%) denied sexual activity. Of the sexually active unmarried, the majority use condoms and spermicides (pharmatex): men - 40 out of 49 (81.6%), girls - 41 out of 59 (69.5%). As condoms are easily accessible contraceptive and it is widely used in India [6]. Every tenth prefers natural planning methods: men (4-8.2%) are somewhat less likely than women (8-13.6%). None of them use hormonal contraceptives. But the authors doubt the truth of this answer, since often Indian students take hormonal contraceptives to normalize menstrual function and treat polycystic ovary syndrome. Unfortunately, 13.6% (10 out of 59) of girls and 10.2% (5 out of 49) of boys do not think about the real consequences of unprotected sex and do not use any contraception methods. Figure 5. The number of unmarried Indian women using contraception [6] Talking about unprotected sex, we first think about unwanted premarital pregnancies and abortion. India legalised medical termination of pregnancy (MTP) in 1971 under 24 weeks. It was believe that this law is for married women. Later, supreme court of India in 2022 revised this law for unmarried women also, still lot of girls performing unsafe abortion. This becomes critical issue in India [10]. When we asked girls about premarital pregnancy 49 out of 143 (34.2%) had chosen abortion. Didn’t answer 7 (4.9%), they probably don't know what to do in this situation. And we can add them to the 47 (32.8%) who have «No idea» what to do (Figure 6). Figure 6. if you get pregnant (girls) or if your partner become pregnant (boys) As girls don’t feel it is child bearing age they give more priority to their career as 55 (38.4%) they think career is more important at this stage while 43 (30.0%) girls feel that society and family will not accept them. Rejection from parents, feeling of ashamed provoke them for abortion (Figure 7). Our study identified the following reasons why, in the event of an unplanned pregnancy, respondents would terminate the pregnancy: fear of losing career opportunity, family and society pressure, health issue, decision of partner. Two main reasons were highlighted for abortion (fear of losing career, family and society pressure). This is because of social norms of India. Till now it is considered as a crime. Cultural background and religious belief have great impact on this. Figure 7. Main reason for abortion if you get pregnant or your partner get pregnant When the same question was asked to boys 35 (35.7%) out of 98 told that they will advise their partner to abort. Surprisingly, these indicators are identical to women's. But men are more likely to be ready to take their responsibility for a child: they get married immediately and 39 (39.7%) or if the partner refuses to have an abortion (12.0-12,2%) or will acknowledge paternity and financially support (9.0-9.1%). It is important to note 3 (3.1%) didn’t answer as they afraid of giving truthful answer or may lack of surety about their decision. While career and money are more important to both genders at the moment than family and children (Table), our study shows that women are more dependent on the opinions of parents and partner in determining their reproductive plans. Considering the importance of knowledge on contraception, the Department of Obstetrics and Gynecology with a course in prenatal diagnostics of Smolensk State Medical University conducts informational lectures with students on effective contraception. Students highly appreciate the importance of such sanitary educational measures (Figure 8). Figure 8. Indian students attend a lecture on contraception (2024) Conclusion This research provides a comprehensive overview of the current state of family setup and reproductive plans among unmarried people, their ideas and thought were studied. Analysis shows results, which correlate with world trends: the model of a family with 1-2 children, delayed reproductive plans, the predominance of material needs over family values. This study highlights tolerant attitude towards premarital sex and unwanted pregnancy, the reason for abortion among youth in India, parents attitude and behaviour towards sex education. The findings highlight the need for holistic approaches aimed at improving the health literacy of young people in matters of reproductive behaviour, timely familiarization with effective reversible contraception.

Об авторах

Назнин Абдул Салам Чоудхари

Смоленский государственный медицинский университет

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студентка факультета иностранных учащихся ФГБОУ ВО «Смоленский государственный медицинский университет» Минздрава России Россия, 214019, Смоленск, ул. Крупской, 28

Вита Николаевна Покусаева

Смоленский государственный медицинский университет

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Россия, 214019, Смоленск, ул. Крупской, 28

Наталья Александровна Мицюк

Смоленский государственный медицинский университет

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доктор исторических наук, доцент кафедры философии, биоэтики, истории медицины и социальных наук ФГБОУ ВО «Смоленский государственный медицинский университет» Минздрава России Россия, 214019, Смоленск, ул. Крупской, 28

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