THE ACCEPTANCE AND USAGE OF CONTRACEPTIVE AMONGST WOMEN OF CHILDBEARING AGE ATTENDING ANTE-NATAL CLINIC AT CENTRAL HOSPITAL
The study of the pattern of contraceptive use among women of child bearing age at Central Hospital, Sapele.
A cross sectional descriptive study approach was used which involved both quantitative and qualitative method. A simple random method was used to select 30 respondents for the study. The results indicated knowledge about family planning services at 57% while those women who had ever used any contraceptive methods were 67%.
The findings exposed myths and misconceptions in relation to pattern of use as well as long distance travelled, few methods offered at H/Cs, rejection by men, poor services and poor attitude by the health providers, drug stock out and influence of church teachings as main factors contributing to low utilization of contraceptives in Central Hospital, Sapele.
Therefore, a number of socio cultural factors limited utilization of oral contraceptives notably lack of support from men, inadequate knowledge, myths and misconceptions about contraception, over bleeding, weight loss and restriction by the Catholic Church remained key barriers. While facility related factors such as long distance that requires transport money, negative attitude of some of the health workers, long waiting hours, drug stock out, few clinic days, limited choices of methods offered contributed to low utilization of contraception use.
There is need for advocacy and health education by district health workers through the local radio talk shows and social gatherings eg. market places on importance of family planning services and the available services with emphasis on addressing the myths and misconceptions plus information education communication materials .
Besides, the district health office and other stake holder service providers like Mariestopes International plus the use religious leaders.
Nigeria should organize outreach programs to overcome the challenges of long distance and limited methods.
This chapter highlights about the background of the study, statement of the problem, purpose of the study, specific objectives, research question and justification of the study.
1.1 Background of the Study
Global health has improved considerably over the last four decades (Andreea, et. al, 2011). However, everywhere the health status of the poor compares unfavorably with that of the more affluent sectors of society. In Africa, one in 26 women of reproductive age die of child birth related complications, as opposed to one in 9400 in Europe. Parallel disparities in fertility and in contraceptive use are found between poor and wealthy countries (Andreea, et. al, 2011).
Out of the 7.4 billion world’s population, half (3.7 billion) are entering their child bearing age. Consequently there is tremendous need for contraceptive use, especially in areas with high fertility rate like Nigeria. Nigeria has a persistent high fertility of (6.7 children per woman) that contributed to the high maternal morbidity and mortality Rate (435/100,000 live births), as well as the rapidly growing population at 3.2% (Nalwadda et. al., 2010). This fertility is high compared to neighboring countries like Kenya and Zimbabwe with an average of 4.5 and 2.8 children respectively. Maternal mortality is further increased by unplanned pregnancies resulting in unsafe abortions, drug abuse or costs incurred during labour as well as the upkeep of a child. High fertility rate and high maternal morbidity and mortality not only strain individuals, families, and public resources, but also hinder opportunities for economic growth and development of a poor country like Nigeria with low per capita income. Use of modern contraception has the potential to avert unplanned births, decrease maternal morbidity and mortality, and increases welfare of families and protect future generations against over population growth (Nalwadda et. al., 2010).
Contraceptive services widely known in most rural setting as “family planning” is the method of choice when and how to have children as birth control measures.
Nigeria young population of 15 (52% who are below the age as 15 years, and 17% are between age 15–24 years) and a high total fertility rate (TFR), at 6.7 children per woman (Asiimwe, 2014). As this large cohort of young people enter the childbearing years, their reproductive behavior will determine the growth and size of Nigeria’s population for decades to come. Nigeria still struggles with as low as (30%) contraceptive prevalence rate (CPR), which is lower than that of her neighbors, Kenya, Rwanda, and Tanzania, which had a CPR of 46%, 52%, and 34% (Asiimwe, 2014).
Additionally, young women face barriers like fear of side effects, costs, and lack of knowledge on contraception services. In the Nigerian context, only 24% of all Nigerian sexually active are married women. Early marriage exposes these young women to frequent and unprotected sexual intercourse, that leads to early and risky child birth. In Nigeria, the median age at first marriage is at risk of unwanted pregnancies. This study focused on women of reproductive age (age 15– 45) because, in Nigeria, the majority of the population is in reproductive age. Given the context of high fertility in Nigeria, this study will establish factors contributing to low utilization of contraceptives among women of reproductive age.
1.2 Statement of the problem
Globally, utilization of modern contraceptive like condom and IUD have increased in the recent past years – from 54% in 1990 to 57% in 2012 (WHO, 2012). However, the estimates in Africa remain persistently low at 23% and 24%, respectively. Of the 210 million pregnancies that occur each year, almost 80 million are unplanned. Each year, approximately 42 million pregnant women seek termination of their unplanned pregnancy whereby 20 million undergo unsafe abortions 67,000 die annually. Almost all of these deaths (99%) occur in under developed countries e.g DR Congo (Kangale, et. al., 2014).
A study carried out in Nigeria (Okech, et al, 2011) found out that only 51% of the respondents were using family planning services. Besides, Nigeria has one of the highest total fertility rates (6.7) worldwide (Hladik, et al., 2009). The same study revealed that, the most commonly used contraceptives methods were condoms (35%), pills (33%), injection (19%), and IUD (4%). Nigerias’ contraceptive prevalence rate is lower than that of Kenya (46%), Tanzania (34%) and Rwanda (52%) (ICF International, 2012). It is for this reason that the researcher is prompted to assess the factors contributing to low utilization of oral contraceptives among women of reproductive age, as the recommendations of the findings can be documented to increase utilization of family planning services among women especially of reproductive age.
1.3 Purpose of the study
The purpose of the study is to establish factors influencing utilization of contraceptives among women of child bearing age in Central Hospital, Sapele, so that the findings will be documented to improve provision of family planning services by the health centre.
1.4 Specific Objectives
- To identify socio-economic factors contributing to low utilization of contraceptives among women of child bearing age in Central Hospital, Sapele.
- To assess socio-cultural factors contributing to low utilisation of contraceptives among women of child bearing age in Central Hospital, Sapele.
- To identify health facility related factors contributing to low utilisation of contraceptives among women of child bearing age in Central Hospital, Sapele.
1.5 Research questions
- What are the socio-economic factors contributing to low utilization of oral contraceptives among women of child bearing age in Sapele?
- What are the socio cultural factors contributing to low utilization of oral contraception among women of child bearing age in Sapele?
- What health facility related factors contribute to low utilization of oral contraceptives among women of child bearing age in Central Hospital, Sapele?
1.6 Significance of the study
The findings contribute to formulation of guidelines and policies to improve on utilization of contraception services among women of reproductive age in the district and the country at large.
The findings of the study will be documented into a report and submitted to Kampala International University Institutional research review committee as well as guide future researchers.
The report on factors contributing to low utilization of family planning services in Central Hospital, Sapele will give the general picture of the utilization of contraceptives in Sapele.