https://doi.org/10.15218/ejnm.2024.15 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article Knowledge and Attitude regarding the Family Planning among Spouses in Sub-Urban Primary Health Care Centres in Erbil Province ABSTRACT Background and Objectives: Family Planning refers to couples who make educated choic- es about having children, such as timing their pregnancies and limiting the number of chil- dren that they will have via contraceptive techniques. Objective of the Study: To assess couples' knowledge and attitudes about family planning and its association with their socio-demographic characteristics. Methods: A quantitative, cross-sectional study using a self-administered questionnaire which consisted of socio-demographic characteristics, couple’s knowledge (17 question) and couple’s attitude (18 questions) among 288 couples in primary health care centers sub-urban Erbil province from September 2021 to December 2022, met the exclusion cri- teria for pregnant who refused participation and inclusion criteria in reproductive age 15- 49, married women with their partner and who use contraceptives. The data were ana- lyzed with the statistical package for the social science version 26. Results: Most of the spouses were in the age group 25–34 years old. The sources of infor- mation about family planning methods for husbands were 56.3% from social media, and the wives 54.9% from family. Most of the husbands are 51.4%. Their overall knowledge regarding family planning methods was fair. There was an association between the hus- bands’ occupation and knowledge of family planning methods (P-value=0.044). The high- est proportions of the study sample (66%) of the husband and (63.2%) of wives preferred oral contraceptive pills as the best method for family planning. Conclusion: The overall knowledge of the husbands was fair(acceptable), while the wives had good knowledge. There was a correlation between the husband's knowledge and the wife's attitude towards family planning methods based on sociodemographic characteris- tics, but there was no correlation between the husbands' knowledge and the wives' knowledge. Keywords: Knowledge; Attitude; Practices; Family Planning Methods; Contraceptive Types. Suzan Mustafa Muhammed; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq (Correspondence: suzan.muhamad@hmu.edu.krd) Tiran Jamil Piro; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq 156 Received: 27/11/2022 Accepted: 22/01/2023 Published: 30/11/2024 Copyright ©2024The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. mailto:jawdat.baker@hmu.edu.krd?subject=jawdat.baker@hmu.edu.krd%20%20%20 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.15 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article A couple describes family planning and spacing as a deliberate attempt to limit or minimize the number of children they want using contraceptive methods. The way of life is accepted by individuals and couples, based on knowledge, attitude, and respon- sible decision-making, to promote the well- being and health of their families and con- tribute to promoting society. Birth control is recognized as an important response to improving women’s health and human rights [1].People may use family planning to achieve their desired number of children and calculate the spacing between their pregnancies and births. It is accomplished by the use of contraceptive techniques as well as the treatment of infertility prob- lems. A family planning program assists couples and individuals in realizing their basic right to select for themselves when they want to have children and how many children they want to have[2].Birth control is a decision by a person or a couple to know how many babies they want to have, when to decide to have children and how long to continue between conceptions. The action should be freely taken without force after a person has had full knowledge of the benefits of family-size planning, the procedures to use, the relative benefits of each approach, and the expected compli- cations of the mentioned methods [3].Contraceptives are tools or medications that inhibit ovulation or avoid sperm deliv- ery to the womb to prevent conception. It is claimed that a woman’s ability to space and track pregnancy directly impacts her health and her children’s health. Contra- ceptive use also has a vital role in allevi- ating problems like accidental pregnancy and abortion. To increase maternal health, abortion is also used, and the criteria for family planning are reduced[4].While the adolescent fertility rate in Iraq is still among the highest in the area, contraception is only approximately 36% of the total population of Iraq. This implies that many couples and people who need family planning services will not get them, violating their reproductive rights. The Ministry of Health developed the National Family Planning Strategy (2021-2025) with the support of the United Nations Population Fund (UNFPA) and funding from Sweden, and in consultation with a wide range of stakeholders, including women and young people, to ensure that their rights and needs are adequately addressed [5]. Importance of the study: No major studies have been conducted to elaborate on the standard of family planning methods in the Kurdistan region, but it seems that males play an important role in family planning-related decision- making, and they are the ones who usually fix the number of kids in the family. In the few previous studies, only one partner participated (female). The aim of the study is to assess couples' knowledge and attitudes about family planning and its association with their socio-demographic characteristics. A descriptive (cross-sectional) study was conducted to identify knowledge, and attitude of family planning among spouses in sub-urban primary health care centers in Erbil province.The study was carried out in three primary health care centers in sub- urban areas in Erbil province, Kurdistan region, (Razhan, Kasnazan and Daratw) primary health care centers (PHC). The distribution of the area was according to municipalities. Razhan health care center belongs to the Bnaslawa Municipality, Kasnazan primary health care center belongs to Kasnazan Municipality and the Daratw health care center belongs to the Daratw Municipality.This study was carried out from 1st September 2021 to 1st 157 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. INTRODUCTION METHODS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.15 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article method was used for the statistical calcula- tion to determine the overall knowledge and attitude. Knowledge of Spouses Re- garding Family Planning consists of 17 questions and the knowledge is classified as follow: good, fair, and poor. Attitudes of Spouses Regarding Family Planning. It con- sists of 18 questions, and the attitude is classified as follows: positive, neutral, and negative. According to the statistical find- ings, the overall level of the husband’s knowledge was 51.4% and the wife’s 39.6% and the husband’s attitude was 39.2% and the wife’s 37.5%. Data from the study were analyzed using the Statistical Package for Social Science (SPSS, Version 26), included a descriptive statistical analy- sis of frequency, the percentage of the questionnaire items and a chi-square test for the association between demographic characteristics and other sections of the questionnaire. Table 1 shows that the highest percentage of the husband-and-wife participants were in the age group 25–34 years, which is 33.3% for husbands and 41.3% for wives. The highest percentage of the sample members in the level of education holding a secondary school were 27.8% for hus- bands and 31.3% for the wife. As for the occupation, the findings reveal that most husbands had skilled manual workers, about 25.7%, while 30.6% of wives were unemployed. December 2022. This period includes pre- paring the questionnaire tools and writing the methodology with data collection, data analysis, result and conclusion. Prior to the initiation of the present study, the approv- al was obtained from the ethical and scien- tific committee of College of Nursing / Hawler Medical University and Minister of Health/ Director of Health/ Planning De- partment of Kurdistan region, Iraq. The ethical form was approved with code num- ber (116) dated on 7th Oct 2021. Both ano- nymity and the confidentiality of the par- ticipants were preserved. The names of the participants, their addresses, and any other information that could be used to personally identify them were not used in this study. The objectives of the study were explained to the people who took part in the research, and their agreement was gained. Epi Info 7 was used to calcu- late the sample size. This method was used to calculate the sample size by entering the total number of spouses which was about 1145, with a confidence level of %95 and an error margin of %5. The calculation resulted in 288 samples. The researcher took 288 spouses in Razhan, Kasnazan, and Daratw health care centers in Erbil city. A thorough examination of the pertinent lit- erature was used by the researcher as the basis for the construction and selection of a questionnaire as well as an interview technique. The interview lasts for approxi- mately 7 to 10 minutes. A structure for conducting interviews in the form of a questionnaire was designed in order to en- sure accurate data collection. This format is comprised of five components and in- cludes the information presented below. Demographic characteristics: such as; spouses age, religion, ethnicity, husband and wife occupation, husband and wife education, income, house ownership and car ownership. Family planning history. The absolute Category Rating (ACR) 158 Copyright ©2024The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. RESULT https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.15 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article The finding in Figures 1 illustrated that the highest percentage of both husbands and wives were in the age category under 20 years old regarding the family planning history related to age at marriage, which is about 43%, and 55% of the wives were un- der 20 years old for the same age category related to age at marriage. 159 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 1: Distribution study sample according to the socio-demographic characteristics of Spouses Variables Husband Wife Frequency(%) Frequency(%) Age group 15-24 71(24.7) 100(34.7) 25-34 96(33.3) 119(41.3) 35-44 89(30.9) 57(19.8) 45-54 32(11.1) 12(4.2) Education level Illiterate 33(11.5) 33(11.5) Read & write, and prima- 76(26.4) 35(12.2) Intermediate 63(21.9) 83(28.8) Secondary 80(27.8) 90(31.3) College and above 36(12.5) 47(16.3) Occupation Unemployed 47(16.3) 88(30.6) Unskilled manual worker 57(19.8) 57(19.8) Skilled Manual workers 74(25.7) 56(19.4) Non-manual workers 65(22.6) 51(17.7) High level occupations 45(15.6) 36(12.5) Number of the sample study= 288 Figure 1: Husband and wives age at marriage https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.15 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article 160 availability for wives were health care centers, pharmacies, and government hospitals, with 53.5%, 55.2%, and 52.4%, as shown in the same figure 3. The result in figure 2 regarding the sources of contraceptive availability for husbands were pharmacies, which is about 55.9%. While the sources of contraceptive Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Figure 2: Sources of availability of contraception for husband Figure 3: Sources of availability of contraception for Wife https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.15 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article of wives expressed a good level of knowledge regarding family planning. family planning, while 31.9% of them ex- pressed a neutral level and 28.8% ex- pressed negative level. association between other variables of so- cio-demographic characteristics and age group of husbands (P-value 0.493), husband's religion (P-value 0.893), hus- band's education level (P-value 0.608) and husband's age at marriage (P-value 0742). 161 Table 2 demonstrated that 51.4% of hus- bands expressed a fair level of knowledge regarding family planning. While 39.6% Table 3 indicated that 37.5% of wives ex- pressed a positive attitude regarding fami- ly planning, while 39.2% of husbands ex- pressed a positive attitude regarding Table 4 shows a significant association between the husband's occupation and the husband's knowledge regarding family planning, where the significance value was (P-value 0.044). This value was less than the alpha value (P-value ≤ 0.05). While, there was non-significant Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 2: Overall husband’s and Wife’s knowledge’s regarding family planning Husbands Wives Levels Frequency (%) Frequency (%) Good 111(38.5) 114 (39.6) Fair 148 (51.4) 80 (27.8) Poor 29 (10.1) 94 (32.6) Total 288 (100) 288 (100) Table 3: Overall Husband’s and wife's attitudes of spouses regarding family planning Husbands Wives Levels Frequency (%) Frequency (%) Positive 113 (39.2) 108 (37.5) Neutral 92 (31.9) 82 (28.5) Negative 83 (28.8) 98 (34.0) Total 288 (100) 288 (100) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.15 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article 162 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 4: Association between socio-demographic characteristics and husband's knowledge regarding family planning in the study sample Variables Overall Knowledge P-Value Yes No Age group of husband 15-24 46 25 0.493 NS 25-34 66 30 35-44 61 28 45-54 14 18 Husband's Religion Muslim 150 81 0.893 NS Christian 37 20 Husband's education level Illiterate 21 12 0.608 NS Read & write, and primary 52 24 Intermediate 38 25 Secondary 56 24 College and above 20 16 Husband’s occupation Unemployed 29 18 0.044 S Unskilled manual work- er 29 28 Skilled Manu- al workers 48 26 Non-manual workers 49 16 High level occupations 32 13 Husband's age at marriage Under 20 years 78 47 0.742 NS 20-25 32 10 26-31 59 35 32-37 6 5 38 and above 12 4 Number of the sample study= 288 Spouses https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.15 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article and the wife's knowledge of spouses re- garding family planning, where all values were greater than the alpha value (P-value 0.05). Table 5 revealed that there was a non- significant association between all varia- bles of the socio-demographic characteris- tics, 163 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 5: Association between socio-demographic characteristics and wife's knowledge regarding family planning in the study sample Variables Overall Knowledge P-Value Yes No Age group of wife 15-24 69 31 0.845 NS 25-34 84 35 35-44 35 22 45-54 6 6 Wife's Religion Muslim 154 74 0.254 NS Christian 40 20 Wife's educa- tion level Illiterate 21 12 0.466 NS Read & write, and primary 23 12 Intermediate 51 32 Secondary 65 25 College and above 34 13 Wife’s occupa- tion Unemployed 56 32 0.897 NS Unskilled manual worker 39 18 Skilled Manual workers 39 17 Non-manual workers 37 14 High level occupations 23 13 Wife's age at marriage Under 20 years 110 49 0.414 NS 20-25 53 32 26-31 26 9 32-37 3 3 38 and above 2 1 Number of the sample study= 288 Spouses https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.15 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article where all values were more than the alpha value (P-value 0.05). The result accepted the null hypothesis, which is that the varia- bles are independent, and rejected the al- ternative hypothesis. Table 6 demonstrated that there was a non-significant association between all variables of the socio-demographic charac- teristics, and the husband's attitudes of spouses regarding family planning, 164 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 6: Association between socio-demographic characteristics and husband's attitudes regarding family planning in the study sample Number of the sample study= 288 Spouses Variables Overall Attitude P-Value Agree Neutral Disagree Age group of husband 15-24 34 22 15 0.575 NS 25-34 29 35 32 35-44 30 26 33 45-54 20 9 3 Husband's Religion Muslim 86 75 70 0.303 NS Christian 27 17 13 Husband's education level Illiterate 15 12 6 0.298 NS Read & write, and primary 35 17 24 Intermediate 25 17 21 Secondary 21 35 24 College and above 17 11 8 Husband’s occu- pation Unemployed 19 16 12 0.846 NS Unskilled manual worker 24 20 13 Skilled Manual workers 34 21 19 Non-manual workers 21 20 24 High level occupations 15 15 15 Husband's age at marriage Under 20 years 51 40 34 0.722 NS 20-25 17 14 11 26-31 35 28 31 32-37 4 5 2 38 and above 6 5 5 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.15 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article socio-demographic characteristics and age group of the wife (P-value 0.062), wife's religion (P-value 0.898), wife's education level (P-value 0.661), and wife's occupation (P-value 0.367), where these significance values were more than the alpha value (P- value 0.05). Table 7 shows that there was a significant association between the wife's age at mar- riage and the wife's attitudes toward spouses regarding family planning, where the significance value was (P-value 0.016). While there was a non-significant associa- tion between other variables of 165 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 7: Association between socio-demographic characteristics and wife's attitudes re- garding family planning in the study sample Variables Overall Attitude P-Value Agree Neutral Disagree Age group of wife 15-24 34 36 30 0.062 NS 25-34 48 26 45 35-44 24 17 16 45-54 2 3 7 Wife's Religion Muslim 86 66 76 0.898 NS Christian 22 16 22 Wife's education level Illiterate 13 10 10 0.661 NS Read & write, and primary 16 10 9 Intermediate 28 24 31 Secondary 34 22 34 College and above 17 16 14 Wife’s occupa- tion Unemployed 33 30 25 0.367 NS Unskilled manual worker 27 11 19 Skilled Manual workers 19 18 19 Non-manual workers 13 16 22 High level occupations 16 7 13 Wife's age at marriage Under 20 years 60 47 52 0.016 S 20-25 35 22 28 26-31 10 11 14 32-37 3 0 3 38 and above 0 2 1 Number of the sample study= 288 Spouses https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.15 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article Table (2) demonstrated that more than half of the husbands overall knowledge regarding family planning was expressed at a fair level, which is friendly to a study that was conducted in Egypt among 284 mar- ried husbands in 2017 and showed the highest percentage of husbands were fair in knowledge regarding FP [12].While in (Table 2) the wives expressed a good level of knowledge of spouses regarding family planning. Similar to the present study, a cross-sectional study was done in Pakistan in 2016 among 503 married women which showed the majority 99% of wives have good knowledge regarding FP [13].In the current study, both the husbands and the wives expressed a positive overall attitude regarding family planning, as shown in (Table 3). Similar to the present study, a cross-study was conducted among 560 married couples in Saudi Arabia in 2017 which showed the highest rate of spouses having a good attitude toward family plan- ning methods [14]. The present study shows a significant association between the husband's occupation and section two of the questionnaire related to the hus- band's knowledge regarding family plan- ning, where the significance value was (P- value 0.044) as shown in (Table 6). In con- trast to the current study, in 2021 in India, a cross-sectional study carried out among 200 married husbands. The result showed that there is a non-significant association between the husband’s knowledge of FP methods and socio-demographic charac- teristics; the values were more than (P- value 0.05) [15]. The current study shows there is a non-significant association be- tween all variables of the socio- demographic characteristics and the wife's knowledge regarding family planning, where all values are greater than the alpha value (P-value 0.05) as shown in (Table 6). Similar to the recent study, a non- experimental survey that was conducted in The finding of the current study is similar to a quantitative, cross-sectional study that has been done in Karachi, Pakistan in 2014 on 200 couples for the age group 25- 34 [6]. And another cross-sectional study design with a quantitative approach has been conducted in Ghana in 2019 on 206 married couples, which is equal to the cur- rent results of the study [7]. A recent study shows that most of the participants in the level of education hold a secondary school, 27.8% for husbands and 31.3% for the wife shows in (Table 1). Agreeing with a cross-sectional study conducted in Egypt in 2017 on 284 showed the highest level of education for both wives and husbands: 39.1% had a secondary level [8]. The result of the present study illustrated that most husbands and wives were in the category of under 20 years regarding the family planning history related to age at marriage as shown in (Figure 1), for both husbands and wives. A descriptive cross-sectional design was utilized in Egypt in 2020 among 176 married couples which showed that most of the husbands and wives in the study were >25 years old which is in con- trast to the current study [9].Regarding the sources of spouse's information to- ward the FP methods, the current study showed the information source about the wives' family planning was friends, family and relatives as seen in (Figure 3), similar to a cross-sectional study performed on 547 women in Mumbai, India in 2016 showing the highest percentage of mar- ried women got information from the so- cial circle (10).According to the same re- sult of the current study, the sources of information about the family planning of husbands were the media (TV, radio, newspaper, and journal), and friends. Simi- lar to a study done in Egypt in 2020 on 176 married couples shows that the husbands got the information from television [11]. 166 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. DISCUSSION https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.15 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article women and showed a highly significant association between the socio- demographic values and wife’s attitudes toward family planning [20]. Also, an oppo- site quantitative study done in India in 2019 among 92 participants (married women) showed an alpha value of more than (P-value 0.05) [21]. Apart from sociodemographic data, the results suggest that more than half of the couples obtained their contraceptives through pharmacies as a source of availa- bility. The spouses used contraceptive methods for 1-5 years, and they visited primary health care centers and clinics every six months. According to the statisti- cal data, the assessment of the husband's knowledge of contraceptive techniques was fair when compared to the wife's knowledge of the same variable, which passed in the assessment. The findings are based on statistical analysis of the hus- band's awareness of contraceptive meth- ods. Both partners' attitudes were positive, and a wife's overall practices regarding FP approaches were positive. Regarding the association between the sociodemograph- ic characteristics and the knowledge of the spouses, the study indicated that there was a significant association between the husband’s sociodemographic variables (occupation), and knowledge regarding the FP methods is in contrast to the wife’s knowledge regarding the FP methods; there was no significant association. Fur- thermore, there was no association be- tween the husband's attitude and knowledge of FP methods, while there was an association between the wife's attitude and sociodemographic characteristics (years of marriage), and finally, there was no significant association between the so- ciodemographic characteristics and the wife's practices regarding FP methods. India among 200 married women in 2021 showed that there is a non-significant as- sociation between socio-demographic characteristics and knowledge of husbands regarding the family planning methods the value; was more than (P-value 0.05) [16]. The current study shows there is a non- significant association between all varia- bles of the socio-demographic characteris- tics, and the husband's attitudes regarding family planning, as demonstrated in (Table 7). A similar study has been done in Gangwadi, India among 320 married men in 2014 which showed that statistically there was a non-significant association be- tween the attitude of the husbands and the variable of the socio-geographic char- acteristics [17].Along with the present study, a cross-sectional study done among 150 married men in 2015 in Nigeria showed that there was a non-statistically significant association among the hus- band’s attitude with socio-demographic characteristics [18].There is a significant association between the wife's age at mar- riage and section three items of the ques- tionnaire related to the wife's attitudes regarding family planning, where the sig- nificance value was (P-value 0.016) as shown in (Table 8). Similar to the current study regarding the significant association of wife practices regarding the FP methods with socio-demographic variables, a cross- sectional study was done in Al-Amara city, Iraq in 2020 among 270 married women showed there were a highly significant as- sociation between the attitudes of wives and socio-demographic characteristics) [19].While, there was a non-significant as- sociation between other variables of socio -demographic characteristics, age group of the wife, religion, education level, and wife's as demonstrated in (Table 8). In contrast to the current research, a cross- sectional study has been conducted in Al- Amara, Iraq in 2020 among 270 married 167 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. CONCLUSION https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.15 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article REFERENCES [11] Shaukat F, Naeem Z, Ahmed Z. Family plan- ning: knowledge, attitudes and practice among married couples. International jour- nal of health sciences. 2011;5(2 Suppl 1):45. [12] Hamed ZF, EL-Gazzar AF, Moftah FM. Knowledge, attitude and practice of family planning methods among husbands in a vil- lage of Assiut Governorate. The Egyptian Journal of Hospital Medicine. 2018;73 (4):6489-93. [13] Hameed S, Haq NU, Haque N, Nasim A, Riaz S, Tahir M, et al. Knowledge, attitude and practices (KAP) regarding family planning services among married women of Quetta Pakistan. Family Planning Services. Interna- tional Journal of Research and Reports in Gynaecology 2019;2:1-12. [14] Subba M, Devi B, Devi R. Knowledge, prac- tice and barriers in utilization of family plan- ning methods among married couples of urban and rural areas of Sikkim. Internation- al Journal of Advance Research in Communi- ty Health Nursing 2022;1(4):19-28. [15] Subba M, Devi B, Devi R. Knowledge, prac- tice and barriers in utilization of family plan- ning methods among married couples of urban and rural areas of Sikkim. Internation- al Journal of Advance Research in Communi- ty. 2022;4(1):19-28. [16] Subba M, Devi B, Devi R. Knowledge, prac- tice and barriers in utilization of family plan- ning methods among married couples of urban and rural areas of Sikkim. Journal of Advance Research in Community Health Nursing. 2022;1(4):19-28. [17] Chaudhary BK, Wantamutte A, Sah JK. Knowledge, attitude and practices regarding family planning methods among married men in urban field practice area of Ramna- gar urban health center. Belagavi-A cross- sectional study. US National Library of Medi- cine enlisted journal 2015;8:212-9. [18] Owopetu C, Chukwuma S, Nwozichi C. Knowledge and attitude of men about vasec- tomy as a method of family planning among married men working in Babcock University, Ogun state, Nigeria. International Journal of Nursing Midwifery. 2015;7(3):30-5. [19] hussein Al Abedi GA, Arar AA, Alridh MSA. Assessment of Knowledge, Attitude and Practices for Women’s toward Family Plan- ning in Primary Health Care Centers at Al- Amara city/Iraq. International Journal of Psychosocial Rehabilitation. 2020;24(09). [1] Manandhar N, Amatya I, Gautam A, Kumar G, Ahlawat H, Adhikari N, et al. Knowledge, attitude and practice regarding family plan- ning among the reproductive age women of Khopasi, Kavrepalanchowk. Journal of Chit- wan Medical College. 2020;10(3):53-6. [2] Bekele D, Surur F, Nigatu B, Teklu A, Getinet T, Kassa M, et al. Knowledge and attitude towards family planning among women of reproductive age in emerging regions of Ethiopia. Journal of Multidisciplinary Healthcare. 2020;13:1463. [3] Semachew Kasa A, Tarekegn M, Embiale N. Knowledge, attitude and practice towards family planning among reproductive age women in a resource limited settings of Northwest Ethiopia. BMC research notes. 2018;11(1):1-6. [4] Asadisarvestani K, Khoo SL, Malek NM, Yasin SM, Ahmadi A. Determinants of contracep- tive usage among married women in Shiraz, Iran. Journal of Midwifery Reproductive Health. 2017;5(4):1041-52. [5] Ebrahim SM, Nihad. Knowledge, attitude and practice of family planning among wom- en in Basrah city South of Iraq. The Medical Journal of Basrah University. 2011;29(1):70- 6. [6] Sultan S, Ali M, Bardai S, Kanpuralla M, Womens Health IC. Knowledge, attitude, and practice of family planning methods among married men and women. 2018;7(3):2. [7] Fellah AF. Knowledge, attitudes and practice of family planning among married partners in Ledzokuku Krowor municipality in the Greater Accra region of Ghana. Science and Technology. 2021. [8] Hamed ZF, EL-Gazzar AF, Moftah F. Knowledge, attitude and practice of family planning methods among husbands in a vil- lage of Assiut Governorate. The Egyptian Journal of Hospital Medicine. 2018;73 (4):6489-93. [9] Ali S, Hassan S, El-Nemer A. Assessment Of Family Planning Knowledge And Practice Among Married Couples. Mansoura Nursing Journal. 2020;7(2):214-26. [10] Shukla M, Fonseca M, Deshmukh P. A study on contraceptive knowledge, attitudes and practices among women in the reproductive age group. International Journal of Repro- duction, Contraception, Obstetrics and Gy- necology. 2017;6(8):3560-3. 168 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.15 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article 169 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. [20] hussein Al Abedi GA, Arar AA, Alridh MSA. Assessment of Knowledge, Attitude and Practices for Women’s toward Family Plan- ning in Primary Health Care Centers at Al- Amara city/Iraq. International Journal of Psychosocial Rehabilitation. 2020;24(09). [21] Wani RT, Rashid I, Nabi SS, Dar H. Knowledge, attitude, and practice of family planning services among healthcare work- ers in Kashmir–A cross-sectional study. Journal of family medicine primary care. 2019; 8(4):1319. https://creativecommons.org/licenses/by-nc-sa/4.0/