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Full Project – FACTORS MILITATING AGAINST FAMILY PLANNING AMONGST WOMEN IN RURAL COMMUNITIES

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Abstract

Family planning is an important preventive measure against maternal and child morbidity and mortality. It is an essential component of primary health care and reproductive health. There is relatively high fertility rate in suburban and rural Nigeria despite the efforts of government and other non-governmental family planning services providers. Even though the fertility rate is high, acceptance and utilization of modern family planning methods has been low due to various reasons. The objective of this study aims to determine the factors militating against family planning amongst women in rural communities in Imo state, Nigeria. It is a descriptive cross-sectional, conducted among 364 women of childbearing age (15 to 49 years), utilizing the multi-stage sampling technique.139 (37%) of the respondents were within the age group 15 to 24 years, all respondents were married (100%) and 135 (37%) had more than 5 children. About half of the respondents (48.7%) had no formal education. Few were currently using a contraceptive method, however, the majority whom were not using any method had main reasons being lack of appropriate knowledge on family planning, fear of side effects and availability .The most significant socio-demographic determinants of utilization of family planning services were religion (p-value 0.01), family setting (p-value <0.001),age (p-value 0.01) and male involvement (p-value <0.001) . The utilization of family planning services among the rural women was poor, with religion, fear of side effect and husbands’ disapproval among other reasons being the main reasons for nonuse.

CHAPTER ONE

INTRODUCTION

1.1. Background Information

Familyplanningis one of themost―health-promotingand cost-effective activitiesin public health promotion and has the potential to avert approximately 30% of maternaland10% of child deaths. Thus, FP contributes to achieving the Millennium Development Goals (MDGs) through healthier birth spacing and by reducing mortality and morbidity associated with pregnancy. Decades of research and investment in family planning programmes have resulted in dramatically improved programme coverage and biomedical technologies as well as signiﬁcant (although uneven) increases in contraceptive uptake throughout most of the developing world. Contraceptive options—not all of which are available in many developing countries; include a variety of hormonal regimens and modes of delivery for women (e.g., pills, injectables, implants, patches, vaginal rings, medicated intrauterine devices) as well as improved male and female condoms, spermicides, cervical caps and other vaginal barriers, post-coital (emergency) contraception, improved fertility awareness-based methods, and simpler and more effective surgical techniques for tubal ligations and vasectomies.

Nevertheless, Demographic and Health Surveys (DHS) reveal that in many countries- including some with quite high rates of contraceptive prevalence -40% or more of women who recently gave birth reported that the pregnancy was wanted later or not at all. Proportions of married women with an unmet need for contraception also range up to 30 to 40% or more in a number of countries.⁶ Both of these situations reﬂect, to variable degrees, programme- and method-related inadequacies, including contraceptive failures due to a variety of reasons, as well as personal and situational factors such as partner’s opposition or women’s experiences or fears of side-effectsthat need to be addressed. Contraceptive information, needs and motivations evolve through the life course as male and female adolescents become sexually active before marriage or cohabitation (perhaps with several partners) or at the time of their marriage, and as couples decide if and when to begin childbearing (if they have not already accidentally done so); accumulate experiences with contraception (or its absence) and with pregnancy and childbearing; think about spacing and stopping; and are potentially faced with 10 or 20 more reproductive years at risk. Some women and men will divorce, remarry and decide to have another child; others will bear children (wanted or unwanted) outside of marriage or be motivated to avoid it. The environmental and contextual scenarios are many; the individual trajectories even more diverse. The challenge for educational and health sectors is to meet these changing needs with comprehensive information about pregnancy risks, acceptable contraceptive options, and correct and consistent use. Interventions include countering beliefs in ineffective methods and overcoming unrealistic fears about contraceptive side-effects that adolescents may already have acquired.

Family planning is an important preventive measure against maternal and child morbidity and mortality. It is an essential component of primary health care and reproductive health. It plays a major role in reducing maternal and neonatal morbidity and mortality. It confers important health and development benefits to individuals, families and communities and the nation at large. It helps women to prevent unwanted pregnancies and limit the number of children, thereby enhance reproductive health. By this, it contributes towards achievement of Millenium Development Goals (MDGs) and the Target of the Health for all Policy.The MDGs call for 75% reduction in maternal mortality and two-thirds reduction in child mortality between 1990 and 2020. As sucheffectiveutilizationoffamilyplanningservicesiscriticalfortheattainmentofthesegoalsthus improving health and accelerating development across the regions.Access to family planning also has the potential to control population growth and in the long run reduce green gas house emission with it associated risk. Similarly it has been estimated that preventing unwanted pregnancies by the use of family planning would avert a total of 4.6million Disability Adjusted Life Years.¹⁶ Despite the importance and benefits of family planning, it has been estimated that about 17% of all married women globally would prefer to avoid pregnancy but are not willing to use any form of family planning. As a result, 25% of all pregnancies are unintended particularly in developing region of the world. This results to an estimated 18million abortion taking place each year, thereby contributing to high maternal morbidity and injuries. Sub-Saharan Africa which is home to only 10% of the world’s women, contributes annually, 12million unwanted or unplanned pregnancies and 40% of all pregnancy related deaths worldwide. The contraceptive prevalence in sub-Saharan Africa is low, estimated at 13%, in spite of the evidence of the pivotal role of family planning, while in Nigeria the estimation is 8.0% with 17% unmet need for family planning. This greatly contributes to the high rate of unintended pregnancies leading to induced abortion with its consequent complications. Despite the fact that Nigeria constitutes only 2% of the world’s population, it has being shown to account for 10% of the world’s maternal deaths. There is relatively high fertility rate in suburban and rural Nigeria despite the efforts of government and other non-governmental family planning services providers. Even though the fertility rate is high, acceptance and utilization of modern family planning methods has been low due to various reasons. In Africa, provision of family planning services is hindered by poverty, poor co-ordination of the programme and dwindling donorfunding.Additionally,traditionalbeliefsfavouringhighfertility,religiousbarriers,fear of side effect and lack of male involvement have contributed significantly in weakening family planning interventions.

1.2 Problem Statement

The number and timing of pregnancies in a woman’s reproductive lifespan affects the maternal mortality risk; other factors include the presence of co morbidities, and obstetric care. The effect of these factors is quantifiable by four measures: the number of maternal deaths, the maternal mortality rate (MMRate), the maternal mortality ratio (MMRatio), and the lifetime risk of maternal death.

The MMRate is the yearly number of maternal deaths per 1000 women of childbearing age (15– 49 years). The MMRatio has the same numerator, but is expressed per 100,000 live births. Lifetime risk of maternal death is the cumulative probability of a woman dying of maternal causes during her reproductive life, and is a measure of pregnancy-related female death. Both the MMRate and lifetime risk of maternal death respond directly to fertility rates and thus quantify the risk of maternal death per woman, whereas the MMRatio is indicative of risk per pregnancy due to poor access to and quality of obstetric services. A fall in the number of pregnancies lowers the number of maternal deaths because, self-evidently, in the absence of pregnancy, the risk of maternal death is non-existent.

In Nigeria, there is unaccepted high maternal mortality. Moreover, legally, politically and culturally access to abortion create internal dispute, therefore effective contraceptive programming should be the current and future approach to reduce the risk and unwanted pregnancies. Few published data exist concerning use of family planning services in Nigeria especially northern part where we have recently observed high maternal morbidity and mortality in this setting. Thus, this study will be conducted to investigate use of family planning methods among child-bearing women in Imo, Northern Nigeria.

1.3 ResearchQuestions

What is the level of knowledge of family planning among women of child-bearing age in rural areas of ImoState?
What are the attitudes of rural women of child-bearing age towards familyplanning?
What is the level of use of family planning products/methods and services among rural women of child-bearingage?
What are the factors associated with utilization of family planning services among rural women of child-bearingage?

1.4 General and SpecificObjectives

1.4.1 GeneralObjective

To assess the determinants of utilization of family planning services among women of child bearing age in rural areas of Imo state, Northern Nigeria.

1.4.2 Specific Objectives

To determine the level of knowledge of family planning among women of child-bearing age.
To determine the attitudes of rural women of child-bearing age towards familyplanning.
To determine the level of use of family planning products and services among rural women of child-bearingage.
To determine the factors associated with utilization of family planning services among women of child-bearingage.

1.5 Scope of the study

The study covered women of child bearing age (15-49 years) residing in Obibe Ezena community, Owerri North, Imo state during the period of 6 months. It determined the knowledge, attitude and factors mitigating against family planning services as well as assessed the determinants of utilization of family planning services.

1.6 Significance of Study

High fertility rate and inadequate spacing between births, can lead to high maternal and infant mortality. An estimated 600 000 maternal deaths occur worldwide each year; the vast majority of these take place in developing countries. WHO estimates that 13% of these deaths are due to unsafe abortion. Worldwide, where approximately 50 million women resort to induced abortion, frequently results in high maternal morbidity and mortality. Thus, family planning and spacing among births are one of the methods to avoid these deaths. Promotion of family planning and contraceptive use is highly adopted by the international community as one of the strategy to reduce the maternal mortality and to reach the Millennium Development Goals. Africa characterized by high rate of lack to contraceptive access reaching 57% and this lack lead to unwanted pregnancies, increased demand to abortion and death related to unsafe abortion.

In Nigeria, there is unaccepted high maternal mortality. Moreover, legally, politically and culturally access to abortion create internal dispute, therefore effective contraceptive programming should be the current and future approach to reduce the risk and unwanted pregnancies. Few published data exist concerning use of family planning services in Nigeria especially northern part where we have recently observed high maternal morbidity and mortality in this setting. This study will educate the public as well as provide literature on the subject matter.

1.6 Limitations

Cultural influences and beliefs may hinder the respondents from giving clearresponses.

Therefore, research assistants were recruited from these communities in order to respect their culture and to ease acceptance by the community members.

Perception by respondents that the interviewers want to impose the idea of contraception use on them may arise. Hence, the research assistants were adequately trained on conducting interviews thereby minimally reducing the chances of perception of contraception imposition amongrespondents.

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