ABSTRACT
The study investigated awareness, access and utilization of family planning information among women in Abia State, Nigeria. Specifically, the study described the level of awareness of family planning among the respondents, identified the sources of family planning information accessible to the respondents, ascertain the level of utilization of different methods of family planning among the respondents, identify reasons for contraceptive choice, counselling of respondents and satisfaction with services received, identify the perceived benefits of family planning methods utilized by the respondents and examined the perceived side effects of the family planning methods utilized by the women. Multistage sampling procedure was used in the selection of 360 women as the sample size. Data collected were analysed using simple descriptive and inferential statistics. Result from the study showed that most of the women 49.3% were between the ages of 20 – 24 years of age with 46.3% having a household size of 11 – 15 members. Many are aware of family planning activities but very few of them were aware of the benefits of family planning in Abia State. Radio, (77.8%), doctors (74.1%), television (62.2%) and churches (62.2%) respectively were the major sources of family planning information in the study area. Inferential results revealed that, attitude towards family planning (2.795**), sex of the children (2.505***), education (3.282***), employment (0.644***), accessibility of facility (2.705**), religion (-3.983***), husbands approval (5.853***), cultural factors (5.027***) and knowledge on family planning methods (5.043***) were all significant and related to utilization of family planning information. Access to information source of the respondents with a t-ratio of 4.691 was significant and positively related to the use of family planning methods by the respondents. At P <0.05, it was shown that there is a significant difference in the mean rating on the utilization of family planning methods across the three zones of Aba, Umuahia and Ohafia with a F-cal (19.432***) higher than the tabulated F value at 5% probability level. It was recommended that Government both Federal, State and Local and Non-Governmental organizations should fully participate and increase funding and logistic support to ensure that family planning activities covers every nooks and crannies of Abia State. Family planning service providers should carry out audience analysis to prepare messages that should be comprehensive and compatible with the culture of the people.
TABLE
OF CONTENTS
Title Page i
Declaration ii
Certification iii
Dedication iv
Acknowledgments v
Table of
Contents vi
List of
Tables viii
List of
Figure ix
Abstract x
CHAPTER 1: INTRODUCTION
1.1
Background Information 1
1.2
Statement of Problem 8
1.3 Research Questions 10
1.4 Objectives
of the Study 10
1.5 Hypotheses
of the Study 11
1.6 Significance
of the Study 11
1.7 Scope of the Study 12
CHAPTER 2: LITERATURE REVIEW
2.1 Concept
of Family 14
2.2 History
of Family Planning 15
2.2.1 Family
planning as a concept 17
2.3 Concepts
of Contraceptive Use 18
2.4 Family
Planning Method 18
2.4.1 Traditional
approaches of family planning 19
2.4.2 New
modern methods 19
2.5 Benefits
of Family Planning 22
2.6 Factors
Determining Utilization of Family Planning Services 28
2.7 Challenges
Facing the Choice of Contraceptive Methods among Women 29
2.8 The
Role of Education in Family Planning 31
2.9 Theoretical
Framework 32
2.9.1 The
health belief model (HBM) 33
2.9.2 Theory
of reasoned action 34
2.10 Conceptual Framework 36
CHAPTER 3: MATERIALS AND METHODS
3.1 Study
Area 38
3.2 Population
of the Study 40
3.3 Sample
and Sampling Procedure 40
3.4 Method
of Data Collection 40
3.5 Validity
of the Instrument 40
3.6 Test
of Reliability 41
3.7 Measurement
of Variables 41
3.8 Method
of Data Analysis 43
3.8.1 Hypothesis
testing 43
CHAPTER 4: RESULTS AND DISCUSSION
4.1 Socio-Economic
Characteristics of the Respondents 46
4.2 Level of Awareness/Knowledge of the
Family Planning Methods in
Abia State 49
4.3 Assessment of Sources of Family Planning
Information 52
4.4 Level of Utilization of Family Planning
Methods 54
4.5 Assessment of Respondents Reasons for Contraceptive
Use 58
4.6 Assessment of Counselling Received by
Respondents on Family Planning 60
4.7 Assessment of Perceived Benefits of
Family Planning 61
4.8 Assessment of Side effects of Family
Planning Experienced by
Respondents 63
CHAPTER 5
SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Summary
72
5.2 Conclusion 73
5.3 Recommendations
74
References 75
Appendices 80
LIST OF TABLES
4.1: Distribution of Respondents based on Socio-Economic
Characteristics 47
4.2: Distribution
based on level of awareness of family planning methods 50
4.3:
Level of knowledge about family
planning methods in the 3 agricultural 51
zones
4.4:
Distribution of respondents based on
sources of family planning 53
information
4.5:
Distribution based on utilization of
family planning method (FPM) 55
4.6: Distribution
based on reasons for contraceptive choice among respondents 58
4.7:
Distribution based on counselling
received by the respondents on family 59
planning
4.8: Distribution
of respondents based on perceived benefits of family planning 62
4.9:
Distribution based on side effects of
family planning experienced by the 64
women
in the study area
4.10: Probit Regression estimates of determinants
of utilization of family
planning
methods in the study area 65
4.11 Simple
regression table of the test of relationship between utilization of 69
Family
planning methods and access to family planning information
LIST OF FIGURES
2.1 Conceptual framework showing awareness,
access and 37
utilization
of family planning information by women in
Abia
State.
3.1 Map
of Abia State showing the 17 local government areas 39
and their
headquarters
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND
OF THE STUDY
The
place of information in all aspects of human existence is a necessity. Family
planning information is an important factor in having a meaningful life both
for the individual family and the country as a whole, because it is rightly
said that a stable country is a prosperous country. Data, according to
Owusu-Ansah (Anunobi and Udem, 2014), is "factual data, ideas, and other
facts originating from any society that are known as being of importance, often
gathered on a regular basis, organized in some way, transmitted to others, and
used in some meaningful way." They claim that knowledge is force.
It
has the power to change people's lives. However, you can only make an educated
decision if you have the right facts. The person who has the right knowledge
and knows how to use it effectively will still be ahead of the person who does
not. Any person of legal age should have access to family planning information.
Family planning revolves around birth control.
The
term "birth control" was first used to refer to family planning.
Family planning, also known as Planned Parenthood, is a broad term that
encompasses policies, initiatives, and facilities aimed at assisting women in
using birth control. Family planning allows people to space their pregnancies
to have the number of children they like, and that is done by the use of
multiple contraceptive methods WHO (World Health Organization), (2015).
Controlling
fertility with successful contraception has social and health benefits for
individuals, households, and society as a whole UNPF (2013). 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 (Federal Ministry of Health,
2001).
It
prevents pregnancies-associated health problems, reduces abortion, unintended/
unwanted pregnancies, and infant's death, slow rapid growth in population,
improves women's economic and social status and enables their full
participation in the society WHO, (2015). Family planning is one of the most
health-promoting and cost-effective public health initiatives, with the ability
to prevent nearly 30% of maternal and 10% of infant deaths (Kothari, 1990). As
a result, family planning aids in the achievement of the Millennium Development
Goals (MDGs) by allowing for healthier birth spacing and lowering
pregnancy-related mortality and morbidity (Cleland et al., 2012).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 (UNICEF, 2009).
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, Olatunji et al., (2012).
Proportions of married women with an unmet need for contraception also range up
to 30 to 40% or more in a number of countries, Women Advocates Research and
Documentation Center and Center for Reproductive Rights (2008). 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-effects that need to be addressed, NPC and
ICF Macro (2009).
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.
Adolescents
may also have acquired irrational concerns about contraceptive side effects, so
interventions include debunking misconceptions in ineffective approaches and
overcoming unrealistic fears about contraceptive side effects. Dr. Jumoke
Adekogbaa, a Reproductive Health and Family Planning Advisor with Engender
Health, says that Family Planning is the implementation and use of natural or
modern contraceptive methods to postpone, space, or restrict potential
pregnancies, and that it allows couples to choose the number and spacing of
their children, according to Obinna (2017) in Vanguard online. Healthy
pregnancy spacing improves the health of both the mother and the infant, she
said.
Family
planning experience allows women and men to do more than just monitor their
family size, contrary to common belief. It protects citizens' health and
rights, as well as the quality of life of their communities and, by extension,
society as a whole. For a long time to come, the axiom that a stable nation is
a prosperous nation would hold true. Family planning (FP) is one of the most
cost-effective ways to reduce maternal, baby, and child mortality, according to
the Federal Government of Nigeria (2014). It argued in its blue print document
that by reducing the amount of unwanted pregnancies, abortions, and the
proportion of high-risk births, it can minimize maternal mortality. Meeting
women's needs for modern contraception is expected to prevent one-quarter to
one-third of all maternal deaths, saving 140,000 to 150,000 lives each year.
Family planning, according to FGN (2014), has a number of additional health,
social, and economic benefits, including the ability to minimize HIV transmission,
encourage gender equality, reduce poverty, accelerate socioeconomic growth, and
protect the environment.
Control
of human fertility has been the desire of most individuals and societies over
the years. That is to say that the whole essence of fertility control or family
planning is to put the population under control and enhances living condition.
Families' need for power and wealth in those days necessitated a large
population, which led to polygamy, but the desirability of large family
populations is in question these days, particularly in developing countries
like Nigeria and in the face of the global economic crisis. Large populations
are supposed to be beneficial to nations, just as they were to families in the
past, but the opposite is true for economic reasons, as previously mentioned.
Access to secure, voluntary family planning is a human right, according to the
United Nations Population Fund (UNFPA, 2017), and family planning is
fundamental to gender equality and women's empowerment, as well as a key factor
in poverty reduction.
Despite
this, 214 million women in developed countries do not use safe and reliable
family planning strategies for a variety of reasons, including a lack of access
to information or facilities, religious beliefs, or lack of support from their
husbands or communities. This jeopardizes their ability to improve themselves,
their families, and their societies in the future. The right of women and
adolescents to contraceptive knowledge and services is based on fundamental human
rights, according to the UNFPA. In addition, the International Conference on
Population and Development (ICPD) acknowledged men and women's right to be
educated and to have access to family planning methods of their choice that are
secure, convenient, accessible, and appropriate.
National
Population Commission (NPC) and ORC Macro recommend providing a long-term
service plan that is tailored to the unique and evolving needs of individuals
and couples and connected to other sexual and reproductive health inputs
(2004). The evidence base on how to build more user-friendly family planning
environments, improve client-provider relationships, and other aspects of care,
quality is now very comprehensive, and involve men as well as women in the
discussion of contraceptive choices with respect to ease of use and need for
partner cooperation, possible effects on sexual expression (e.g., coitus-
dependent or independent methods), safety, efficacy, side-effects,
acceptability, accessibility and cost, Kirk (1996).
Unmarried
adolescents who need dual protection; couples desiring to use a natural method;
couples desiring to postpone their first pregnancy or space subsequent
pregnancies; women or men desiring to use a method without their partners'
knowledge; postpartum and breastfeeding women; women receiving post-abortion
care; women desiring to use a method without their partners' knowledge; women
desiring to use a method without their partners' knowledge (1969).
The
evidence base for the medical aspects of contraception for male and female
users has also grown significantly. Women of all reproductive ages who have
particular health issues, such as heavy smokers and those with chronic
illnesses undergoing long-term drug therapies (e.g. antihypertensive agents,
antiretroviral drugs), must meet method-specific medical eligibility
requirements, according to Addai (1999). Ongoing research is evaluating the
protective and risk factors of various approaches in relation to specific
diseases (e.g., breast, cervical or testicular cancers, cardiovascular disease,
endometriosis). In order to reduce maternal and infant morbidity and mortality,
family planning is an effective preventive step.
It
is an essential part of primary health care as well as reproductive health. It
contributes significantly to the reduction of maternal and neonatal morbidity
and mortality. Individuals, families, neighborhoods, and the country as a whole
profit from it in terms of health and growth. It aids women in avoiding
unintended pregnancies and limiting the number of children they have, thus
improving reproductive health, according to WHO (2005). As a result, it leads
to the achievement of the Millennium Development Goals (MDGs) and the Health
for All Policy's Aim (Ahmed, 2003). Between 1990 and 2015, the MDGs call for a
75 percent reduction in maternal mortality and a two-thirds reduction in infant
mortality, according to Chen et al
(1994). As a result, successful use of family planning programs is crucial for
achieving these targets, which will improve health and accelerate growth across
the regions, according to the Disease Control Priorities Project (2007).
Access
to family planning is the ability to limit population growth and, in the long
run, reduce greenhouse gas emissions and the risks that come with them (Ahmed,
2003). Similarly, it has been reported that using family planning to avoid
unintended births would save 4.6 million Disability Adjusted Life Years
(Winikoff and Sullivan, 1987). 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 (Cates, 2010). As a result, 25% of all pregnancies are unintended
particularly in developing region of the world. This leads to an estimated 18
million abortions per year, leading to high maternal morbidity and injuries
(Chen et al., 2004).
Cates,
2010 and 1994). Only 10% of the world's women live in Sub-Saharan Africa, which
accounts for 12 million unwanted or unplanned pregnancies and 40% of all
pregnancy-related deaths worldwide (Chen et
al., 1994). 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 (Cates, 1994 and Cincotta, 2008). This greatly contributes to
the high rate of unintended pregnancies leading to induced abortion with its
consequent complications (Cates, 2010). Despite the fact that Nigeria
constitutes only (2%) of the world's population, it has been shown to account
for 10% of the world's maternal deaths. Despite the efforts of the government
and other non-governmental family planning service providers, the fertility
rate in suburban and rural Nigeria is relatively high. Despite the high
fertility rate, modern family planning approaches have received little
acceptance and use for a variety of reasons. Poverty, weak program
coordination, and declining donor support all impede the provision of family
planning services in Africa (Duze and Mohammed, 2006). Traditional values
favoring high fertility, religious barriers, fear of side effects, and a lack
of male participation have all played a role in the failure of family planning
measures (UN 2004).
1.2 STATEMENT
OF PROBLEM
Owing
to its role in demographic decision-making, family planning has gotten a lot of
attention around the world growth and development issues. Contraceptive use is
still low in many developing countries, including Nigeria, where (23.7%) of
currently married women had ever used one. Despite, the campaign on the
usefulness of family planning in having smaller and healthier family, studies
by NPC (2009) and Adeleye et al.,
(2010) indicate that contraceptive use is still low in many developing
countries. Over the past four decades, there have been numerous publications on
contraceptives and other family planning methods. Proper family planning has a
significant effect on a person's development and well-being. Nigeria's national
development trajectory cannot be described as a success. According to Prof.,
there are high rates of out-of-school children, a maternal death rate, and our
population is increasing at an alarming rate of 3.3 percent per year. Hadiza
Shehu Galadanci as reported in Muhammad (2018). A higher proportion of the
population lives on less than one dollar per day. Many of these anomalies are
expected to be verified by family planning. This is a major problem for the
rest of the country, as well as well-intentioned Nigerians. Over the last five
years, two major summits on family planning have been held, with the Nigerian
government playing an active role. Following the 2012 London Summit, the
Nigerian government released a Blueprint with the goal of achieving the
following by 2018: a 36 percent rise in contraceptive prevalence rate (CPR)
compared to the current CPR of 15 percent; aversion of infant death by 400,000;
aversion of child death by 700,000; and aversion of maternal death by 400,000.
1.6 million unintended pregnancies. At the most recent Summit of July 2017,
they only made a recommitment of their earlier stand, an indication that they
have no result to show from their earlier promise. When will all these promises
be achieved? Some stakeholders including the National Population Commission have
argued that there is not enough information on family planning. The
effectiveness or otherwise of the Federal Ministry of Health's Family Planning
blueprint should not be measured by how well it was articulated but how well it
becomes a house hold issue in all nook and crannies of this country. Adeleye et al., (2010) outline culture, poverty
and poor access to some of the factors militating against the use and
acceptance of family planning.
As
a result, in Nigeria, the acceptance and use of family planning among married
women has become a contentious issue. Married women have a tendency to have a
large family, overlooking the value and benefits of family planning. Other
contributing factors include ignorance, illiteracy, African social values and
norms, and husband domination, to name a few. As a result, the study looked
into women's knowledge, access, and use of family planning information in Abia
State, Nigeria.
1.3 RESEARCH
QUESTIONS
The
following study questions were answered in the study:
i.
What are the participants' socioeconomic features in the research
area?
ii.
What is the respondents' level of knowledge of family planning
methods?
iii.
What are the sources of family planning information?
iv.
What is the level of utilization of family planning methods among the
respondents?
v.
What are the reasons for contraceptive choice, counselling of
respondent and satisfaction with service received?
vi.
What are the perceived benefits of family planning methods utilized
by the respondents?
vii.
What are the perceived side effects of the family planning methods?
1.4 OBJECTIVES
OF THE STUDY
The
overall goal of this study was to look into the knowledge, access, and use of
family planning information among women in Abia State, Nigeria. The basic goals
were as follows:
i.
characterize the socioeconomic features of the people who responded
to the survey in the research area.
ii.
describe the level of awareness/knowledge of family planning among
the respondents.
iii.
identify the sources of family planning information accessible to
the respondents.
iv.
ascertain the level of utilization of diverse approaches of family
planning among the respondents.
v.
identify reasons for contraceptive choice, counselling of
respondents and satisfaction with services received.
vi.
identify the perceived benefits of family planning methods utilized
by the respondents.
vii.
examine the perceived side effects of the family planning methods
utilized by the women.
1.5 HYPOTHESES OF THE STUDY
The
following hypotheses were tested:
H01: No important association
exists among participants' socioeconomic features and their use of family
planning methods.
H02: There
is no connection between the use of family planning strategies and their access
to knowledge about family planning.
H03: There
is no important correlation between the use of family planning strategies by
women in different zones.
1.6 SIGNIFICANCE OF THE
STUDY
This research, which looked into women's
understanding, access, and use of family planning knowledge in Abia State,
Nigeria, is extremely important for parents, government, non-governmental
organizations, health workers, and family guidance counselors. The importance
of family planning cannot be overstated since it benefits parents, their
children, and their education while also enhancing the socio-economic and
political growth of society. To maintain good health, socio-economic, and
political endeavors, government and non-governmental organizations have made it
important to implement family planning at the federal, state, and local
government levels.
However,
guidance counselor will benefit from this study since it beholds on them to
inform the public, parents as well as society on the importance of family
planning. Family guidance counselor gives information related to child spacing
and likewise encourage on the number of children one can carter for. Since
government and other agencies had made effort to control the situation, the
researcher was therefore interested in awareness, access and application of
family planning information by the married women in Abia State, Nigeria.
The
study will therefore help parents, health workers and most specifically
guidance counselors to know the right steps to take in creating awareness on
the appropriate method of family planning that is good for different individual
and society at large. Theoretically, the study will add to the body of
knowledge in the step that had been taken so far in the implementation of
family planning. This body of knowledge will be disseminated through
publication in journals, workshop, conferences and seminars.
1.7 SCOPE
OF THE STUDY
The
study covered the three agricultural zones in Abia State. The study analyzed
the socio-economic characteristics of the women among which are age,
educational level occupation, monthly income, number of pregnancies, age of
last child, gap between the last two children, distance of health care. It evaluated
the predictors of family planning information use as well as the knowledge,
access, and use of family planning information.
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