Assessment of Knowledge, Attitude and Practice regarding Eugenics among Eligible Couples in Ambala, Haryana, India
Hemlata1, Dr. Poonam Sheoran2, Adiba Siddiqui3
1 M.Sc.Nursing student, Maharishi Markandeshwar University, Mullana, Ambala, Haryana, India
2 Head of the Department, Obstetrics and Gynecological Nursing Department, Maharishi Markandeshwar University, Mullana, Ambala, Haryana, India
3 Professor, Obstetrics and Gynecological Nursing Department, Maharishi Markandeshwar University, Mullana, Ambala, Haryana, India
Objective: The study aimed to assess the knowledge, attitude and practices of eligible couples regarding eugenics in Ambala, India.
Methods and Material: A quantitative descriptive comparative study was conducted among 318 eligible couples. Structured questionnaires were used to collect relevant information from the study subjects. Descriptive statistics, independent t-test, Pearson's correlations, Analysis of Variance, and hierarchical multiple regression procedures were employed to analyze the data.
Results: Half (50.62%) of couples knowledge regarding eugenics was below average. Majority of couples (96.85%) had moderately favourable attitude towards eugenics. More than half (59.25%) of husbands and 67.90% of wives followed non-traditional expressed practices as compare to traditional practices. There was a partial significant association between knowledge, attitude and traditional and non-traditional expressed practices among husbands and wives with selected demographic variables.
Conclusion: Educational based intervention program need to be conducted to enhance knowledge of eligible couples towards eugenics and further for improvement of mother and child health status.
Key-words: Eugenics, Knowledge, Attitude, Practices, Eligible Couples
Eugenics refers to methods that are adopted by eligible couples for having physically and psychologically healthy conception and pregnancy. Pregnancy can be one of the life's most exciting and fulfilling adventures. A couple always wishes for a healthy baby and healthy pregnancy starts before conception; actually, it begins with the thinking of planning a pregnancy or to extend a family. Reproductive health covers a wide range of issues like conception, pregnancy, family planning, and prevention of sexually transmitted diseases etc.
The health of women is just not only important for healthy conception instead men health too important, to choose to stay healthy and support as well as encourage the partner. If couples can be sensitized about the issues of reproductive health, it may contribute to a reduction of unwanted pregnancies, reduction in the incidence of sexually transmitted diseases and reduced maternal and neonatal mortality rates.1
Eugenics is a set of beliefs and practices that aim at improving the genetic quality of the human population.2 the word Eugenics was firstly coined by Sir Francis Galton in 1883. It is derived from the ancient Greek word eugenes which mean "well born" from Eu- "good" or "well" and Genos- "race " or "kin”. It is an applied science which advocates the improvement of human traits with the aim of preventing diseases, improving physical and mental traits, saving society's resources, and lessening human suffering.
Globally, the rate of unintended pregnancy is 53 per 1,000 women aged 15-44 years. Out of 190 million (89%) of pregnancies, 40% (85 million) is count as unintended, of these, 49% ended in abortion, 13% ended in miscarriage, and 38 % unplanned birth.5 Each minute, a woman dies due to complications of pregnancy and childbirth.
Women of reproductive age and attending the primary care setting should be considered as a candidate for pre-conception care and provided with health education of reproductive planning linked with the provision of contraception to prevent unintended pregnancies and improve maternal and child health.7
India was among those developing countries with current maternal mortality rate of 174 and 49 Infant Mortality Rate while the percentage of pregnant women receiving prenatal care is growing from 68.92% to 83.32% in the year 2000 and 2012 respectively but pre-conception period is being neglected. It is estimated that within a month of birth around 3,03,000 (previously 2,70,000 in the year 2010) newborns die every year due to congenital anomalies (e.g.- heart defects, neural tube defects, and down syndromes) which in turns contribute to long-term disability cause significant impact on individuals, families, health care system and society (World Health Organization Report, 2015).
Preconceptional and Antenatal care are one of the important factors in reducing maternal and neonatal morbidity and mortality. Unfortunately, many women in developing countries like India don't receive such care.6 Improving preconception health and pregnancy outcomes will require more than effective clinical care for women. Changes in the knowledge and attitudes and behaviours related to reproductive health among both men and women need to be made to improve preconception health.
It has been reported that only 11% of women were aware of preconception care and about 33% had positive attitude towards preconception care whereas 49% women intended to seek preconceptional care next time.10 Deep rooted beliefs and taboos related to conception and pregnancy cause health complications to mother and infants 12
From the above research studies, it is proved that the knowledge about eugenics was very limited among the reproductive age group and very few researches were conducted on eligible couples regarding same. The present study was conducted to assess the knowledge, attitude and practices of eligible couples regarding eugenics.
This study was approved by Institutional Ethical Committee of Maharishi Markandeshwar University.
Materials and Methods:
A quantitative non experimental descriptive comparative study was conducted at Barara (sub-district) in Ambala district of India from August 2015 to May 2017. The study subjects were eligible couples and the data was collected from both husbands and wives separately. Study enrolled the married couples where wife was in the age group of 15-45 years planning for conception have conceived and may or may not have any living child. The sample sizewas determined by power analysis based on the information (particularly using the eligible couple's population of Barara Sub-District, Ambala Haryana) by using the following formula:
In which n = z*z [p(1-p)/(d*d)]
Sampling Process and Technique
Barara Sub-District consist of 4 Primary Health Centre out of which Barara PHC was chosen conveniently whereas, Barara PHC has 7 Subcenters out of which 3 Subcenters were chosen conveniently. Moreover, Purposive Sampling Technique was used to collect the data of eligible couples.
Instrument development and data collection
Total 3 tools were prepared, A structured knowledge questionnaire to assess knowledge, 5-point likert attitude scale for attitude and expressed practice checklist for practices of eligible couples. The tools were developed with simple, accessible language and complied by adapting questions from published studies with appropriate modification and/or improvements.
The knowledge questionnaire included the multiple choice questions with single correct answer of content areas like Concept of Eugenics, Screening of Disease, Nutrition, Vaccination, Lifestyle and Exposure to substance abuse and toxins. The 5-point likert scale consists of 15 Positive and 15 Negative statements. Positive statements scored as scored SA (Strongly Agree) -5, A (Agree)-4, U (Undecided)-3, D (Disagree)-2, SD (Strongly Disagree)-1 whereas, Negative statements scored as SA (Strongly Agree) -1, A (Agree)-2, U (Undecided)-3, D (Disagree)-4, SD (Strongly Disagree)-5.
The expressed checklist consists of traditional and non traditional practices (yes/no) for either being practicing or not.
Reliability of knowledge questionnaire was tested by Kuder- Richardson Formula KR20 (0.75), Attitude scale was tested by Cronbach Alpha Formula (0.74), Expressed checklist for husbands(0.75) and wives (0.86) was tested by test –retest method.
After approval from Sarpanch of the villages, ASHA workers were approached, where eligible couples were recruited by describing the study purposes. The eligible couples were told that their participation was voluntary and consent was taken for approval of participation in the study. Data were collected through Self-Reporting Technique by researcher.
The study data were statistically analysed using the Statistical Package for the Social Sciences version 20 Software (SPSS, Chicago, IL). Means, standard deviations, frequencies, and percentages were calculated for descriptive data analyses. To determine the relationship between Knowledge, Attitude and Practices Pearson's correlation analyses were performed. ANOVA/t/Welch test were performed in order to determine association with demographic variables. Further, hierarchical multiple regression was used among these dependent variables and the subjects' independent predictor variables. The level of significance was set at P ≤ 0.05. Subject independent variables included demographic characteristics and dependent variables were knowledge, attitude and practices. The significant demographic characterstics variables from ANOVA/t/Welch analysis (P ≤ .05) were entered into the first step and non-significant were entered into second step of hierarchical multiple regression models. Hierarchical multiple regression model was employed to separately assess the influence of demographic variables. Hierarchical multiple regression analyses were performed for each of the three dependent variables.
The Sample Characterstics of husbands (n=318) and wives (n=318) is presented in Table 1.
Table1.Sample Characterstics of Husbands and Wives (n=318)
f ( %) Wives
f ( %) p-value
Age in years
Graduate and above
Family Income per month in rupees
< 5000 / month
5001-10000 / month
>15001 / month
Source of Health Facilities
If yes, Source of Information
Do you have Children ?
If yes, specify number of children
Any contraception method used?
Any family history of congenital abnormality
Note. Values are expressed as number (%), unless otherwise indicated. CHC- Community Health Centre, PHC-Primary Health Centre. *Statistically significant (P < 0.05). *Chi-square test.
All (100%) husbands and wives had knowledge regarding conception and pregnancy. Majority of husbands (55%) and wives (69.20%) were in the age of group of 22-28 years and 85.5% were Hindu by religion. Majority of wives were housewives (88.10%) and 51.60% of them were graduate and above among them 34.90% of wives received health information regarding conception and pregnancy from relatives. More than half (54.10%) of husbands were private employed and 47.20% were graduate and above and among them 31.80% received health information of conception and pregnancy from friends. Majority (76.40%) of eligible couples used contraception.
Level of Knowledge of Couples is presented in Fig 1. Whereas, Eligible couples (98.11%) attitude was moderately favorable.
Fig1. Pie diagram of level of knowledge of couples.
All the husbands and wives followed non-traditional practices more than non-traditional practices. There was a significant difference (p< 0.000) between the knowledge, attitude and expressed practices of husbands and wives. Pearson Correlation shows a significant moderate positive correlation between knowledge and attitude scores of eligible couples regarding eugenics as evident by computer ‘r' value of (r=0.467, p≤0.000) shown in Table 2.
Table2. Correlation among Knowledge and Attitude
Eligible couples Knowledge
*Statistically significant (P < 0.05), Pearson Correlation
Association between the variables and sample characterstics was checked by ANOVA/t/Welch test showed that the knowledge of husbands and wives dependent on age, educational status and family income. Attitude of husbands and wives dependent on educational status and source of information regarding conception and pregnancy. The traditional practices and non-traditional practices of husbands where independent whereas, wives traditional practices were dependent on family income, occupation and Source of information regarding conception and pregnancy. Table 3 and 4 shows the hierarchical multiple regression analysis using the significant variables as the first dependent variable of husbands and wives respectively.
In addition, Table 3 shows the hierarchical multiple regression analysis using the knowledge of Eugenic as the first dependent variable. The first step variables explained 3.2% of the variance in Knowledge of Husbands (R2= 0.032). The entry of second step variables changed the R2= 0.105(P = .001), resulting in the total R2 of 0.137. This indicates that the combination of all predictor variables explained a large fraction (13.7%) of the variance in Knowledge of Eugenics. Among the predictor variables, the Age, Education and Source if health facility (beta = −.13. beta = −.12, beta = .18, P = .05) reached statistical significance.
For the Attitude toward eugenics as the second dependent variable, first step variables explained 2.8% of the variance in Attitude of Husbands (R2= 0.028). The entry of second step variables changed the R2= 0.089(P = .001), resulting in the total R2 of 0.117. This indicates that the combination of all predictor variables explained a large fraction (11.7%) of the variance in Attitude towards Eugenics. Among the predictor variables, any family history of congenital abnormality and education (beta = −.11 and beta = .20, P = .05) reached statistical significance. (Table 3).
Therefore, the results from the hierarchical multiple regression analysis indicate that eugenics as measured by sample characteristics effect the knowledge of eugenics more than attitude towards eugenics. This is an important finding since it is the knowledge of eugenics is influenced by age, education and source of health facility and attitude by family history of congenital abnormality and education.
Table 3. Hierarchical Multiple Regression Model Predicting Characterstics of Husbands (n-=318)
Predictors Knowledge of Eugenics Attitude towards Eugenics
B SE(B) Beta B Std. Error Beta
(Constant) 10.83 2.12 87.46 5.11
Age 0.86 0.32 0.15* 0.51 0.77 0.03
Religi Religion -0.08 0.29 -0.01 -0.48 0.71 -0.03
Type Of Family 10.6 0.59 0.10 2.06 1.42 0.08
Do You Have Children 0.37 0.50 0.04 0.16 1.20 0.00
Any Family History of
Congenital Abnormality 0.14 0.08 0.01 4.63 1.94 0.13*
(Constant) 9.17 2.32 81.87 5.62
Age 0.71 0.31 -0.13* 0.24 0.77 0.01
Religion 0.03 0.29 0.00 -0.36 0.71 0.02
Type of family 1.10 0.58 0.10 2.10 1.42 0.08
Do you have child -0.12 0.58 -0.01 1.23 1.40 0.61
Any family history of
congenital abnormality -0.09 0.79 -0.00 3.90 1.91 0.11*
Education 0.47 0.28 0.09 2.31 0.69 0.20*
Occupation -0.44 0.19 -0.12* -0.31 0.46 -0.03
Family income 0.01 0.27 0.00 0.24 0.66 0.021
Source of health facility 0.65 0.21 0.18* 0.51 0.52 0.06
Any contraceptive method used 0.76 0.47 0.10 -1.86 1.16 -0.10
R2= 0.032 for step1
ΔR2= 0.105 for step2
ΔF(10,307) = 3.60** R2= 0.028 for step 1
ΔR2= 0.089for step 2
ΔF(10,307) = 2.98**
* P ≤ .05 **P ≤ .001
Table 4 shows the hierarchical multiple regression analysis using the knowledge of Eugenic as the first dependent variable. The first step variables explained 3.2% of the variance in Knowledge of Wives (R2= 0.024). The entry of second step variables changed the R2= 0.158(P = .001), resulting in the total R2 of 0.182. This indicates that the combination of all predictor variables explained a large fraction (18.2%) of the variance in Knowledge of Eugenics. Among the predictor variables, education and Source if health facility (beta = −.30, beta = .12, P = .05) reached statistical significance.
For the Attitude toward eugenics as the second dependent variable, first step variables explained 1.6% of the variance in Attitude of Wives (R2= 0.016). The entry of second step variables changed the R2= 0.079(P = .001), resulting in the total R2 of 0.095. This indicates that the combination of all predictor variables explained a large fraction (9.5%) of the variance in Attitude towards Eugenics. Among the predictor variables, education (beta = .21, P = .05) reached statistical significance. (Table 4).
Therefore, the results from the hierarchical multiple regression analysis indicates that eugenics as measured by sample characteristics effect the knowledge of eugenics more than attitude towards eugenics. This is an important finding since it is the knowledge of eugenics is influenced by education and source of health facility and attitude by education
Table 4. Hierarchical Multiple Regression Model Predicting Characterstics of Wives (n-=318)
Predictors Knowledge of Eugenics Attitude towards Eugenics
B SE(B) Beta B Std. Error Beta
(Constant) 15.73 2.23 93.48 5.39
Age 0.70 0.39 0.10 1.606 0.95 0.09
Religi Religion 0.01 0.32 0.00 0.59 0.79 0.04
Type Of Family -1.01 0.66 0.08 1.23 1.59 0.04
Do You Have Children 1.07 0.54 1.11* 1.08 1.31 0.04
Any Family History of Congenital Abnormality 0.09 0.83 0.00 1.28 2.02 0.03
(Constant) 9.17 2.30 83.16 5.78
Age 0.13 0.38 0.02 0.80 0.96 0.04
Religion -0.17 0.31 0.03 0.29 0.79 0.21
Type of family 0.73 0.63 0.06 1.51 1.60 0.05
Do you have child 0.67 0.62 0.07 1.14 1.56 0.52
Any family history of congenital abnormality -1.11 0.79 -0.00 1.11 1.99 0.03
Education 1.53 0.28 0.30* 2.67 0.72 0.21*
Occupation 0.28 0.29 0.05 0.45 0.74 0.03
Family income 0.36 0.22 0.09 0.16 0.55 0.01
Source of health facility 0.49 0.20 0.12* 0.90 0.52 0.09
Any contraceptive method used 0.35 0.51 0.45 -0.43 1.29 -0.02
R2= 0.024 for step1
ΔR2= 0.158 for step 2
ΔF(10,307) = 5.77** R2= 0.016 for step1
ΔR2= 0.079 for step 2
ΔF(10,307) = 2.61*
* P ≤ .05 **P ≤ .001
Maternal and child health status is a vital health indicator to a country's wellbeing. The unborn child's health is dependent on the couples knowledge, attitude and practices for healthy conception and pregnancy.
In the present study, 69.20% of wives and 55% of husbands were in the age group of 22-28 years and 51.60% of wives and 47.20% of husbands educational status was graduate & above, which was similar to a study conducted by Megan. A Lewis et al which showed that 57% of women and 51% of men were in the age group of 25-34 years and 40% of women and 36% of men were college graduates13
The present study findings showed that 58.50% of wives used contraceptive methods which is consistent with a study conducted by S.K Rasania et al which showed that 58% of women used contraception.14.
Study showed that 37.42% of wives had average level of knowledge and 16.66% of wives had good level of knowledge regarding eugenics, which were inconsistent with the study conducted by Prashansa Gautam et al which showed that 84.58% of women had average level of knowledge.15 whereas these study findings were consistent with the study conducted by Yitayal A et al which showed that 27.50 % of women had good knowledge regarding pre-conception care.16
The findings of present study revealed that 4.08% of wives had favourable attitude towards eugenics, which were contrary with the study conducted by Ojong Idang et al which showed that 65.50% of pregnant women had favourable attitude towards focused antenatal care.17
The study results revealed that 32.10% of wives practicing to prefer the day of ovulation for coitus, which were consistent with the study conducted by Lisbet S. Lundsberg et al (2014) which showed that 20% of women had sex during ovulation and had a sex on schedule.18Present study reveals that there was a significant association of knowledge scores of wives regarding eugenics with educational status (p=0.000), which were inconsistent with the study conducted by Gautam.P et. al (2016) which showed that there was no significant relationship with knowledge of women regarding pre-conception care with educational status (p= 0.264).15
The study limited to data collected for contraception from husbands and wives was not same which could be because of Hawthorne effect due to the presence of researcher.
In the light of the study discussion, our study important information about knowledge, attitude and practices of eligible couples regarding eugenics in northern area of India. The study results revealed that eligible couples knowledge was below the average and attitude was moderately favourable and follow more non-traditional practices than traditional practices regarding eugenics.
There was a significant association of knowledge, attitude and practices with age, educational status and source of information regarding conception and pregnancy. An Educational Based Intervention Programme can be conducted to enhance the knowledge of eligible couples regarding eugenics.
We are indebted to the eligible couples of Barara Tehsil of Ambala District who took part in the study. Special thanks to ASHA workers of the selected are for their tremendous help for identify the eligible couples from the field. Our thanks to Indian Council of Medical Research (ICMR, 2006).
Financial support and sponsorship Nil.
Conflicts of interest: There are no conflicts of interest.
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