ABSTRACT
Although the intrauterine device is one of the safest and
surest methods of contraception and family planning, many studies have
continued to report observed low utilisation of the method by women in Nigeria.
Therefore,
this study was carried out to ascertain the factors that influence the
utilisation of intrauterine contraceptives among women attending antenatal
clinics in Ujoelen Primary Healthcare Centre. Ekpoma, Esan West Local
Government Area of Edo State. Three
research questions, reflecting the study objectives, were raised to guide the
study. The study employed a descriptive research design. The population of the
study consisted of 4000 women of reproductive age (15-45) in Ujoelen primary health care centre, Esan
West Local Government Area, Edo State from which a sample size of 120
participants was randomly selected. The instrument for the study was a
self-structured questionnaire (validated by the supervisor. Responses were
analysed using SPSS. The results of the study were presented in descriptive
statistics through frequency count and simple percentages. Following the
analysis of responses from participants the study found among others that the
respondent’s knowledge and awareness of IUDs came mostly from clinics (58%) and
mass media (25%), the common misconceptions among women on the intrauterine device
include infertility as a consequence of IUD use (45%), irritation of the
genital area (25%), pain during sex (20%), and the possibility of pregnancy
(8%), and that most women (62%) who opted out of IUDs did so because their
partners rejected the idea of IUDs as the choice method of family Planning. Following the
findings of this study, it is recommended that family planning clients should
be empowered with information regarding the availability, and benefits of
intra-uterine contraceptive devices to increase the utilisation of this method,
efforts should be made to increase IUD
utilisation by focusing on educating women
about the importance of IUDs, improving counselling of mothers, and
strengthening the health systems, including allocating more resources to
increase access to IUDs among the service users, and the provision of
on-the-job training to the health care providers to avoid the shortage of
trained health care providers.
TABLE OF CONTENTS
Title page i
Declaration iii
Certification iv
Abstract
v
Dedication vi
Acknowledgement vii
Table of Contents viii
List of Table x
CHAPTER ONE
1.1
Background to the study 1
1.2 Statement of the Problem 3
1.3 Objective of the Study 6
1.4 Research Questions
6
1.5 Significance of Study 7
1.6 Scope of the Study 7
1.7 Operational Definition of Terms
7
CHAPTER
TWO
2.0 Introduction
9
2.1 Concept of Intrauterine Device 9
2.2 Types of Intrauterine Devices 12
2.3 Side effect of intrauterine device 13
2.4. Barriers of intrauterine device 14
2.4.1 Misconceptions of intrauterine
device 14
2.4.2 Partners Influence 14
2.4.3 Healthcare Provider Influence 16
2.5. Theoretical Review 17
2.6. Empirical Review 19
2.7 Summary of Review 23
CHAPTER
THREE
3.0 Introduction 24
3.1 Research Design 24
3.2 Setting of the Study 24
3.3 Target Population 25
3.4. Sample Size Determination 25
3.5 Sampling Technique 26
3.6 Instrument for Data Collection 26
3.7 Validity of Instrument 26
3.8 Reliability of Instrument 27
3.9 Method of Data Collection 27
3.10 Method of Data Analysis 27
3.11 Ethical Consideration 28
CHAPTER
FOUR
4.1 Presentation of Result 29
4.2. Specific findings of the study 35
CHAPTER
FIVE
5.1 Identification of Key Findings 36
5.2 Discussion of Findings 36
5.3 Conclusion 38
5.4 Recommendation 38
REFERENCES 40
QUESTIONNAIRE 43
APPENDIX 1 48
CHAPTER ONE
INTRODUCTION
1.1 Background of Study
The Family Planning (FP) program began six decades ago to control the population. It initially focused on increasing contraceptive uptake among non-users. Currently, the outcome of the FP program has spread its wings to such an extent that access to FP services has been recognized as critical to women's health, well-being, and choice.
According to UNFPA, the world's population in 2019 reached 5.2 billion and then every year it increases to more than 90 million people. Therefore, it is necessary to overcome it using family planning. Overall contraceptive use is much higher in developed countries than in developing countries (70% versus 40%). In 2015, the proportion of women choosing IUCDs as a contraceptive method was 21% worldwide. However, the rates of women using IUCDs in some higher-income countries are relatively low. For example, the prevalence of IUCD use is 5.2% in the United States of America (USA), 10.3% in the United Kingdom (UK), 13.4% in France and 19.0% in Sweden. In Australia, the proportion of women using IUCDs is just 6.1% (Ouyang et al, 2019.) China has the largest proportion of IUD users among married women (33%), while its lowest use is reported in sub-Saharan Africa (0.8%) (Staveteig et al., 2015). An intrauterine device (IUD) is a highly effective long-acting and reversible contraceptive method widely available around the world. However, only a small proportion of women are currently using the method.
A survey undertaken in Australia to investigate perceived barriers to the use of IUCDs by healthcare providers reported the following concerns: difficulties inserting IUCDs (63%), risk of pelvic inflammatory disease (53%), insertion pain (45%) and infertility (34%). However, from) From 2005 to 2019 in Ethiopia, the utilization of all types of contraception except IUDs, have increased from 14 to 41% respectively, in all women of reproductive age. A study conducted in Ethiopia showed that women’s awareness and poor knowledge about IUDs were the main determinants of the low utilization of IUDs (Woldeyohannes, 2022, p.2).
Uptake of IUD in developing countries has been declining progressively over the last decade. The use of the IUD about other contraceptive methods is reported to have either stagnated or declined (WHO, 2010). The use of IUDs was just % in Kenya and 4.8 Ethiopia, as reported in the Ethiopian Demographic and Health Survey 2016. Among currently married Indian women ages 15–49, female sterilization remains the most popular modern contraceptive method (used by 36% of clients), followed by male condoms (6%), and oral contraceptives (4%). The use of long-acting reversible contraceptives remains particularly low, with only 1.5% of currently married women using an intrauterine device (IUD). (Arnab et al, 2022). Since 2009, the national and state governments have worked continuously to increase access to high-quality IUD services in the country. Furthermore, evidence illustrates that Indian women are less aware of IUDs compared to other modern methods, and myths and misconceptions related to IUD side effects are high.
Increasing IUD uptake is particularly important in sub-Saharan Africa, as the rate of population growth in Sub-Saharan Africa (SSA) continues to rise. In Africa, the modern contraceptive prevalence rate (mCPR) varies by geographical location, being as high as 62% in Southern Africa to as low as 9% in Senegal while in Nigeria is 12%. Health Survey showed that only 10% of currently married women of reproductive age (15 - 49 years) are using a modern contraceptive method, with wide disparities among the regions in Nigeria (24.9% in South West, 16.4% in South, 12.4% in North Central, 11% in South East, 3.6% in the North West and 2.7% in the North East.
Among the most commonly used contraceptives in Nigerian informal settlements, IUD is the least used when compared with other methods. In 2016, 15.1% of women 15–49 years old living in rural areas were using implants, 2.7% were using IUDs, and 82.3% were using other contraceptive methods. Among women living in urban areas, 7.0% were using implants, 3.5% were using IUDs, and 89.5% were using other contraceptive methods. In 2017, of the women 18–49 years old residing in rural areas using contraception, 16.0% were using implants, 1.6% were using IUDs, and 82.5% were using other methods (Ujah, 2022). So many women believe that an IUD (Intra Uterine Device) is used to dry their blood, and cause heavy menstrual flow, Women who haven’t had children so far cannot use an IUD because it causes infertility, it acts as an abortifacient, it might travel through the women’s body, maybe to her heart or even to her brain, it interferes with sex, it may rust in women’s body, it always causes women to have an ectopic pregnancy. These misconceptions are not only from the clients but also from family planning providers.
Opposition to acceptance of IUDs due to partners’ attitude toward future childbearing and concerns about the device hinder uptake. Nearly all of the participants who reported partner opposition did not use the device (Melissa et al, 2012) majority of women say that their spouse complained of disturbance of IUD string during sexual intercourse and that it limits them from having their desired number of children.
This trend, therefore, creates a need to understand the misconceptions, barriers and partners' influence toward IUD acceptance. Primary health facilities in the country have been reported to be lacking grossly both in commodities and supplies as well as lack of trained personnel to offer IUD services and this has led to a declining trend in IUD acceptance in the region (Okoro, 2019) but level four and above public health facilities have regular supplies and are ideal for provision of IUD. The study was carried out to determine the factors influencing the utilization of intrauterine contraceptive devices among women of reproductive age in Ujoelen Primary Health Care Centre Ekpoma, Edo State.
1.2 Statement of the Problem
Nigeria remains one of the countries with high total fertility rates (TFR). This found socio-cultural explanations in the practice of polygyny in most regions of the country and having a large family which is culturally symbolic as a proof of social standing (Izugbara et el 2018). The strong desire for large families could motivate couples to continue reproduction and replace dead children until the desired family size is attained. High fertility remains one of the problems of development in Nigeria. In Nigeria, fertility rates are among the highest (5.237 %) in the world because of high fertility desires and unmet needs for contraception (Odunsina, et al, 2019).
The government believe the revised policy will be beneficial for Nigeria. According to, United Nations Resident & Humanitarian Coordinator, Mathias Schmale, ‘The successful implementation of the National Policy will very likely have positive implications on women of reproductive age by providing free access to IUD. Despite the Federal government's implementation of programs to increase the use of IUDs by Procurement and distribution of family planning commodities,” insertion and removal kit” for IUCD, building the capacity of healthcare providers by organizing seminal, promoting demand by making the device available and affordable, organizing a campaign to create awareness on the device coordination and monitoring of all supply chain activities to ensure prompt distribution and making the device available for non-governmental organization. Though contraceptive prevalence has been on the rise from 46% in 2009 to the current 58%, only 3.4 per cent of married women are currently using the IUD (NMH, 2015).
Among the factors, comprehensive counselling about contraceptive usage, awareness creation about IUDs at the health facility level and focused messages to dispel misconceptions in the communities were identified as necessary strategies used by healthcare workers to increase IUD acceptance. (Demelash et al, 2022), Still, there was low use of IUDs.
According to a recent study in 2016, 15.1% of women 15–49 years old living in rural areas were using implants, 2.7% were using IUDs, and 82.3% were using other contraceptive methods. Among women living in urban areas, 7.0% were using implants, 3.5% were using IUDs, and 89.5% were using other contraceptive methods. In 2017, of the women 18–49 years old residing in rural areas using contraception, 16.0% were using implants, 1.6% were using IUDs, and 82.5% were using other methods ( Ujah, 2022). IUD is the most effective reversible modern contraceptive. It is very cheap (compared to hormonal implants), highly effective, has fewer side effects, is not client-dependent with robust eligibility criteria. Despite these advantages, it was observed that IUD uptake is very low in many urban and rural parts of Nigeria. The same situation has been documented in some parts of Africa. Of all the reversible modern contraceptives, the IUD is the most surrounded by myths and misconceptions, particularly in Nigeria. These misconceptions are not only from the clients but also from family planning providers.
Therefore this study aims to determine the factors influencing the utilization of intrauterine contraceptive devices among women of reproductive age in Ujoelen Primary Health Care Centre Ekpoma, Edo state.
1.3 Objectives
The research study seeks to ascertain the factors that influence the utilization of intrauterine contraceptive devices among women attending antenatal clinics in Ujoelen Primary Healthcare Centre. Ekpoma, Esan West Local Government Area of Edo State.
Specifically, the study aims to:
1. Ascertain the level of misconception of intrauterine devices among women of reproductive age coming to Ujoelen Primary Healthcare Centre Ekpoma
2. Determine partner influence towards the use of intrauterine devices among women of reproductive age coming to Ujoelen Primary Healthcare Centre Ekpoma
3. Determine the level of health provider’s influence of intrauterine devices among women of reproductive age coming to Ujoelen Primary Healthcare Centre Ekpoma
1.4 Research Question
1. What are the misconceptions of intrauterine devices among women of reproductive age in Ujoelen Primary Healthcare Centre Ekpoma?
2. How do partners influence the use of intrauterine devices among women of reproductive age in Ujeolen Primary Healthcare Centre? Ekpoma?
3. How do health providers influence the use of intrauterine devices among women of reproductive age in Ujoelen Primary Healthcare Centre Ekpoma?
1.5. Significance of Study
The purpose of this research was to determine the factor influencing the utilization of intrauterine contraceptives among women of reproductive age in Ujoelen Primary Healthcare Centre Ekpoma
1. It would enlighten women on the benefits of intrauterine devices by healthcare workers.
2 The findings will be used by decision-makers in the development of strategies to increase the level of accessibility of intrauterine device
3. The findings are useful to the Ministry of Health Management team in their future planning to increase IUD uptake as a method of contraception
4. Lastly, findings from the study will contribute to knowledge, provoke further research on this area and consequently lead to the production of more empirical data that would be of benefit to prospective researchers in the future.
1.6 Scope of Study
This study focuses on the factors influencing the utilization of IUDs among women. The study was limited to all women (married, single, divorced, widowed) of reproductive age in Ujoelen Primary Healthcare Centre Ekpoma, Esan West Local Government Area of Edo state.
1.7 Operational Definition of Terms
Factors influencing: These are agents that hinder the use of intrauterine contraceptives such as- misconceptions, partners' influence and, health providers' influence, among women of reproductive age in Ujoelen Primary Healthcarecontraceptives, Centre Ekpoma
Utilization of intrauterine contraceptive device: This is the acceptance of intrauterine devices among women of reproductive age in Ujoelen Primary Healthcare Centre Ekpoma
Women of reproductive age: these are women between the ages of 18 to 49 in Ujoelen Primary Healthcare Centre Ekpoma for family planning.
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