Abstract – Objective : This
study aims to determine the prevalence and determinants of choice
of contraceptive methods among
rural women in Osun state, Nigeria.
Materials and Methods :
Descriptive cross-sectional, conducted among 612 women of reproductive age
group, utilizing the multistage sampling technique.
Results : Majority of the
respondents, 538(87.8%) were within the age group 20 years and above and
married (86.3%). More than half 406(66.3%) were currently using a modern
contraceptive method, 41(6.7%) and 4(0.7%) were using natural and traditional
methods respectively, however, 161(26.3%) were not using any method, main
reasons being affordability and availability
184(41.2%), and reliability
(20.1%). The most significant socio-demographic determinants of ever use of
contraceptives were religion and family setting, p-value 0.001 and 0.001
respectively.
Conclusion : The point
prevalence rate of contraception among the rural women was 66.3%, with fear of
side effect and husbands’ disapproval among other reasons being the main
reasons for non use.
Keywords : Prevalence;
determinants; contraceptives; family planning; rural communities; reproductive
age-group; women; practices; choice; methods.
RELATED INFORMATION
Contraceptive Practices Among Women
in Rural Communities in South-Western Nigeria
Strictly as per the compliance and
regulations of: © 2011 Olugbenga-Bello AI ,
Abodunrin OL , Adeomi AA. This is a research/review paper, distributed under
the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported
License http://creativecommons.org/licenses/by-nc/3.0/), permitting all
non-commercial use, distribution, and reproduction in any medium, provided the
original work is properly cited.
Contraceptive Practices Among
Women In Rural Communities In South-Western Nigeria
Olugbenga-Bello AI α, Abodunrin
OL Ω, Adeomi AA β Keywords : Prevalence; determinants; contraceptives; family
planning; rural communities; reproductive age-group; women; practices; choice;
methods.
I. INTRODUCTION
Any authors raised the alarm that
a stage would reach in the world when food supply would not match its
population growth. (Braddocks, 1977; Huxley, 1951; Malthus, 1798; Moor, 1976)
While most of the developed countries have managed to overcome this, the issue
of population growth and consequent food shortage in developing countries is
overwhelming. (Jones, 2004; Nwachukwu & Obasi, 2008) This expansive
population growth rate has been attributed to some factors, the major of which
is low contraceptive usage. (Bongaarts, 1978; Bongaarts, 1982; Osheba, 1992) In
industrialized countries, virtually all married women resort to contraception
at some time in their reproductive period. In contrast, the proportion
reporting such use in developing countries is extremely low. (Henry &
Piotrow, 1979; Khalil, Atta, Kamel & Youssef, 1996; Morris L et al, 1981).
Nigeria which has a pop n of 140
million and an Author : Department of Community Medicine, Faculty of Clinical
Sciences, College of Health Sciences, Ladoke Akintola University of Technology
(LAUTECH), PMB 4400, Osogbo, Osun State, Nigeria. Author : Department of
Community Medicine, Ladoke Akintola University of Technology (LAUTECH) Teaching
Hospital, PMB 5000, annual growth rate of 3.2 % (NPC, 2007) is the most
populous country in Africa. Nigeria, according to Khurfeld (2006), is already
facing a population explosion with the resultant effect that food production
cannot match the growing population. In Nigeria today, the birth rates are
higher than the world averages. ( Nwachukwu & Obasi, 2008) Contraceptive Prevalence
Rate (CPR) is still embarrassingly low in Nigeria, according to the report
released by the International women’s health coalition, the CPR among married
women aged 15-49 years was 8% for modern methods and 12% for all methods.
Also,
other studies have reported a similarly low adoption rate of Modern Birth
Control Methods (MBCM). (Haub & Yangishila, 1992; Makinwa-Adebusuyi, 2001;
Population Reference Bureau, 2002; UNFPA, 2007). Like many other developing
nations, majority of Nigeria’s population (about 70%) live in the rural
communities. (Ekong, 2003) These rural communities have very high fertility
rate and the CPR is also considerably lower in rural areas with CPR of 8% as
compared with 18% in the urban areas in Nigeria. (Ekong, 2003;) Many rural women
are reportedly reluctant to accept any artificial method of contraception.
(Gaur, Goel M.K, Goel M, 2008) Several studies also revealed that rural women
who were unwilling to accept family planning methods were concerned about child
survival and viewed children as a source of support in old age. (Kartikeyan
& Chaturvedi, 1995).
Adopting MBCM is a very complex
sociological issue in Africa, and African women draw on a complex social
repertoire in making contraceptive choices. (Johnson-Hanks, 2002) Decision-making
concerning fertility control is, for many people, a deeply personal and
sensitive issue, often involving religious or philosophical convictions.
(Burkman, 2002) Studies carried out in Nigeria have shown that lack of adequate
information and ignorance are key factors militating against family planning
practice in Nigeria. (Adinma & Nwosu, 1995; Moronkola, Ojediran &
Amosun, 2006) The socio-economic characteristics of women, notably educational
levels have been argued to explain differences in reproductive behaviour and
contraceptive choices. (Anju, Vanneman & Kishor, 1995; Caldwell, 1982;
Dyson & Moore, 1983; Kazi & Sathar, 2001) The perceptions and the
behaviour related to reproduction have also been said to be strongly determined
by M Global Journal of Medical Research Volume XI Issue II Version I July 2011
Osogbo, Osun State, Nigeria.
Correspondence : Dr. Olugbenga-Bello AI. P.O. Box 1734 Osogbo, Osun State,
Nigeria. Tel : 0803383928 2
Abstract – Objective : This
study aims to determine the prevalence and determinants of choice of
contraceptive methods among rural women in Osun state, Nigeria. Materials and
Methods : Descriptive cross-sectional, conducted among 612 women of reproductive
age group, uutilising the multi-stage sampling technique. Results : Majority of
the respondents, 538(87.8%) were within the age group 20 years and above and
married (86.3%). More than half 406(66.3%) were currently using a modern
contraceptive method, 41(6.7%) and 4(0.7%) were using natural and traditional
methods respectively, however, 161(26.3%) were not using any method, main
reasons being affordability and availability 184(41.2%), and reliability
(20.1%). The most significant socio-demographic determinants of ever
use of contraceptives were
religion and family setting, p-value 0.001 and 0.001 respectively. Conclusion :
The point prevalence rate of contraception among the rural women was 66.3%,
with fear of side effect and husbands’ disapproval among other reasons being
the main reasons for non use.
(Srikanthan & Reid, 2008).
The introduction and acceptance
of MBCM are therefore crucial in controlling the population growth in Nigeria.
(Nwachukwu & Obasi, 2008) The UNFPA(2006) has pointed out that meeting the
contraceptive needs of about 201 million women around the world who do not have
access to effective Family Planning Methods, would prevent 23 million unplanned
births, 22 million abortions, 1.4 million infant deaths, 142,000 pregnancy
related deaths and 505,000 children losing their mothers due to pregnancy
related deaths. This research was therefore carried out to study the current
status of contraceptive use and the determinants among women in rural
communities in Osun State, Nigeria with a view to making necessary
recommendations that would help improve utilization of family planning
services.
II. RESOURCES AND TECHNIQUES
This descriptive cross sectional
study was carried out in the rural communities of Osun state, Nigeria and the
target population was the women of reproductive age group in these communities
with an estimated population of 1,048,456. A multi-stage sampling technique was
used to select the respondents from a total of 12 rural communities from 12
local government areas in the state. Stage 1, from a sample frame of 30 local
government and 1 area office, 12 local government areas were selected using
simple random sampling method. In stage 2, a list of rural areas in each local
government was made and one rural community selected randomly from each list.
In stage 3, numbers were given to all the houses in the community, and only the
houses with odd numbers were selected while in stage 4, all women of
reproductive age group within the age 15-49 years, who consented, were
interviewed or self administered the questionnaires. A sample size of 384 was
arrived at using the Leslie Fischer’s formula for population greater than
10,000, but to increase representativeness and to make up for non-response, a
total of 612 pre-tested semi-structured questionnaires were administered. There
was scoring of outcome variables for the knowledge of respondents about
contraception with correct answers scored 1 point and wrong answers scored 0.
After adding the scores and finding the mean, respondents who scored below the
mean were regarded to be having poor knowledge and those with scores up to or
above the mean to be good knowledge. Similarly for attitude, using the 5 point
Likert scale, with strongly agreed and agreed scoring 1 point and disagreed,
strongly disagreed and I don’t know scoring 0 for correctly answered questions,
and vice versa for incorrectly answered questions. Scores that are up to or
more than the mean were regarded as positive attitude and those below the mean
as negative attitude.
The questionnaires were manually
sorted out and analyzed using statistical package for social sciences (SPSS)
version 15 on the computer. Appropriate cross tabulations and test statistics
were applied and the p-value set at p=<0.05
III. RESULTS
More of the respondents were in
the age range of 35 years and above, 179(29.2%) followed by 20 to 29 years
155(25.3%), with a mean age of 29.59 ± 8.57 years. Most of them were married
528(86.3%), Muslims 359(58.7%), and had secondary school education 310(50.7%),
while trading is the major vocation, 259(42.3%) among the respondents (Table
1).
Table 1 : Socio-Demographic
Characteristics
Contraceptive Practices Among Women
In Rural Communities in South-Western Nigeria
In table 6, majority of the
respondents 406 (66.3%) were currently using a modern contraceptive method,
41(6.7%) were using natural methods, 4(0.7%) were using traditional methods and
161(26.3%) were not using any method. The main reason given for choice of
contraceptive methods was affordability and availability, 184 (41.2%), followed
by reliability by 20.1% of the respondents. Most of the non-users 142(86.4%)
did not have any reason for not using any method. Most of the users had used
the method of choice between 1- 5
Years (44%), followed by 6-10 years
by 26.6% of the respondents. Table 7 shows that the significant
sociodemographic determinants of ever use of contraceptives was religion and
family setting, p-value
0.001 and 0.001 respectively, but
no significant associations between age, marital status, tribe and educational
status with ever used family planning methods.
Table 7 : Association between
Socio-Demographic Characteristics of Respondents and Methods.
Socio-Demographic Characteristics
Ever Used Family p-value Planning Methods Total (%) Chi square df No (%) Yes (%)
Age Group (Years)
19 and less 18(24.3) 56(75.7)
74(100.0) 20 – 24 24(26.7) 66(73.3) 90(100.0) 25 – 29 37(23.9) 118(76.1)
155(100.0) 0.717 4 0.949 30 – 34 25(21.9) 89(78.1) 114(100.0) 35 and above
41(22.9) 138(77.1) 197(100.0) Total 145(23.7) 467(76.3) 612(100.0)
Marital Status Single 17(22.1)
60(77.9) 77(100.0) Married 128(23.9) 407(76.1) 535(100.0) 11.264 6 60.753 Total
161(26.3) 451(73.7) 612(100.0)
Religion
Christianity 45(17.9) 206(82.1)
251(100.0) Islam 98(27.3) 261(72.7) 359(100.0) 13.636 2 0.001 Traditional
2(100.0) 0(0.0) 2(100.0) Total 145(23.7) 467(76.3) 612(100.0)
Family Setting
Monogamy 71(19.7) 290(80.3)
361(100.0) Polygamy 57(32.8) 117(67.2) 174(100.0) 11.52 2 0.001
Educational Status No formal
education 20(28.6) 50(71.4) 70(100.0) Primary School 32(21.5) 117(78.5)
149(100.0) Secondary School 74(23.9) 236(76.1) 310(100.0) 1.361 3 0.715
Tertiary 19(22.9) 64(77.1) 83(100.0) Total 145(23.7) 467(76.3) 612(100.0)
IV. DISCUSSION
The awareness about contraceptive
methods was generally high among the respondents with about 9 in 10 respondents
knowing male condoms and 8 in 10 knowing injectables as methods of
contraception and almost all of them being aware of one method or the other.
This high level of awareness has been similarly reported by previous studies
within and outside Nigeria. (Barrett & Buckley, 2007; Ndiaye, Delaunay
& Adjamagbo, 2003; Nwachukwu & Obasi, 2008; Touati, Abdelaziz, Mtiraoui
& Marzouki, 2001) The knowledge of respondents about contraception/family
planning was also high with about three-quarters having good knowledge of
contraception. This was also corroborated by Moronkola et al (2006) in their
study carried out in south western Nigeria. This pattern should be expected in
light of much enlightenment that is on-going on the issue of family planning in
the country. It is however still worthy of note that some contraceptive methods
were very unpopular among the respondents. Only about a quarter knew about the
diaphragm and implants and not up to 1% of the respondents knew about female
condoms as methods of contraception. This is most likely due to the fact these
methods are not readily available and are relatively more expensive than the
other commoner methods like the male condoms.
The most popular contraceptive
method from this study is the male condom with more than 9 in 10 respondents
knowing about it. This is similarly reported by other studies. (Kalambayi,
2006; Nwachukwu & Obasi, 2008) and is probably due to the fact that it is
cheap and readily available and it is much more advertised probably also
because of its dual function as a means of preventing sexually transmitted
infections and also as a family planning method. Unlike in other studies where
the media was the predominant source of Total Global Journal of Medical
Research July 2011
Contraceptive Practices Among Women
In Rural Communities in South-Western Nigeria
Ever Used Family Planning information,
(Bassey, Abassattai, Asuquo, Udoma & Oyo-ita, 2005; Onwasigwe, 2001) more
than half of the respondents knew about contraception through health personnel,
which is similar to the finding of a study done in Pakistan by Shah, Nisar and
Qadri (2008) on the 128(23.9) 407(76.1) 535(100.0) Centre. This is a pointer to the
importance of enhanced primary health care services in the rural communities,
though the media would still need to do much more work on public enlightenment
about contraception. Also, an appreciable number (20%) heard about contraceptives
from friends and relatives, and this underscores the need for peer educators in
ensuring correct and adequate information about contraceptives/family planning.
Most of the respondents were favourably disposed towards contraception with
more than four-fifths having a positive attitude towards contraception. However
about 3 in 10 respondents felt contraception encourages promiscuity. This may
be due to the conservative nature of typical African societies and could be one
of the complex sociological factors (Johnson-Hanks, 2002) affecting
contraceptive usage in African communities. Furthermore, nearly 90% of the
respondents felt the husbands should be involved in family planning decisions
and this is important because man approval and decision making has been said to
be very important in utilizing family planning services, (Donati, Hamam &
Medda, 2000; Shah et al, 2008; Shahin & Shahin, 2003) and this further
stresses the need to carry men along in family planning campaigns. The
prevalence of modern contraceptive methods usage among the respondents was
66.3% with cost and availability being the predominant reason for choice of
contraceptive methods. This prevalence is higher than the findings of other
studies in rural areas in Nigeria (Nwachukwu & Obasi, 2008) and other
developing countries.
A study by Ndiaye, Delaunay and Adjamagbo (2003) in rural
Senegal reported a prevalence rate as low as 1.5% for modern contraceptives,
another study among females in predominantly rural Muslim area of North India
(Gaur et al, 2008) reported prevalence of 34.9% and about half were using
modern family planning techniques in the study carried out among married
Sudanese women. (Ibnouf, van den Borne & Maarse, 2007) This may be due to
the high literacy rate among the respondents with about two-thirds having
post-primary school education, because education has been said to play an
important role in women’s life and assist in decision-making. (Gage, 1995;
Marchant, Mushi, Nathan, Mukasa, Abdullah, Lengelen, et al, 2004) There was
however no significant association between the use of contraception and
educational status in this study.
The unmet need for contraception
was high among the respondents with about a quarter not on any contraceptive
method. This corroborates the work of Westoff (2006) that reported about one in
five married women of childbearing age (22%) in Africa has an unmet need for
contraception, with a higher percentage among rural women. It is even more
disturbing that more than 3 out of 10 of the respondents had an unmet need for
modern contraception, because other methods failure rates. (Westoff, 2006)
There is therefore a need for more work to be done to reduce the unmet need for
contraception among women because reduced unmet need for contraception is an
indicator of progress toward two of the United Nations Millennium Development
Goals—reducing maternal mortality and reversing the spread of HIV/AIDS—and
contributes directly or indirectly to achieving all eight goals. (Population
Division, United Nations, 2009) Nearly 9 out of 10 respondents who did not use
contraception had no reason for not using it. The reasons given by others are
the fear of side effects, husbands’ disapproval and the desire for more
children, which is similar to what has been reported by other studies.
(Donati,
Hamam & Medda, 2000; Nwachukwu & Obasi, 2008; Shahin & Shahin,
2003). The relationship between religion and family planning has been
documented by previous studies and religion has been recognized as a very
important determinant of contraceptive usage. (Gaur et al, 2008; Nwachukwu
& Obasi, 2008; Shah, Pradhan, Reddy & Joseph, 2006) This may explain
the significant association between religion and ever used family planning
methods with the Christians having a higher uptake of family planning methods
than the Muslims in this study. There was also a significant relationship
between family setting and ever used family planning with more women in
monogamous family settings using family planning methods as compared to those
from polygamous family settings. This may be a reflection of the insecurity
that exists among women in polygamous family settings with the women trying to
outwit each other in the number of children in other to secure their positions
in the family and in the will when the husband dies.
V.CONCLUSION AND RECOMMENDATIONS
The use of any modern
contraceptive method was high among women of child bearing age in the rural
communities of Osun State, with the prevalence rate of 66.3%, and the un-met
need was 26.3%. The main reasons for non- use contraceptive were the fear of side
effects, husbands’ disapproval and the desire for more children, with religion
and family setting having a significant association with the use of modern
contraceptive methods. It is therefore necessary for religious leaders to be
targeted and carried along in theGlobal Journal of Medical Research July 2011
Contraceptive Practices Among Women
In Rural Communities in South-Western Nigeria
campaign for modern contraceptive
methods. The mass media should also be encouraged to do more in public (eg
traditional method) have been associated with high enlightenment on the
benefits of modern contraceptive methods.
awareness and pattern of
utilizing family planning services among women attending Urban Health Care
VI. AKNOWLEDGEMENT
The authors wish to acknowledge
the cooperation of the members of staff of the state office of population
commission, and local government affairs, for helping the researchers in
providing necessary information, and the medical students who helped in the
data collection.
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