|Year : 2022 | Volume
| Issue : 2 | Page : 99-105
Utilization of modern family planning methods among women of reproductive age group in North-Central Nigeria; rural – urban comparison
Ikrama Hassan1, Changkat Lucky2, Anazodo Michael1, Odonye Eselema Caleb1, Kwakipi Hellen3, Ezeala Adaku4, Lawal Abdulmumuni Ahmed5, Tomen Ezekiel4, Joshua Anna6, Bello Surajudeen Oyeleke7
1 Department of Community Medicine, Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State, Nigeria
2 Department of Obstetrics and Gynaecology, Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State, Nigeria
3 Department of Nursing Service, Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State, Nigeria
4 Department of Family Medicine, Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State, Nigeria
5 Department of Anatomy, Federal University, Lafia, Nasarawa State, Nigeria
6 Department of Planning, Research and Statistics, Ministry of Health, Nasarawa State, Nigeria
7 Department of Paediatrics, Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State, Nigeria
|Date of Submission||03-Aug-2021|
|Date of Decision||23-Jun-2022|
|Date of Acceptance||28-Jun-2022|
|Date of Web Publication||31-Dec-2022|
Dr. Bello Surajudeen Oyeleke
Department of Paediatrics, Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State
Source of Support: None, Conflict of Interest: None
Introduction: Contraception is one of the most successful developmental interventions, unique in women empowerment and population control. Family planning (FP) reinforces the right to determining the number and spacing of children. Hence, we determine the utilization of modern FP methods among urban and rural dwellers.
Material and Methods: This is a cross-sectional study of reproductive age women in Lafia, Nigeria. Ten primary healthcare centers (PHCs) each were selected from the urban and rural locations over 6 months using multi-staged sampling technique. Questionnaire was administered, and the data were analyzed using SPSS V 23. P < 0.05 was considered significant.
Results: Most participants were aged between 20 and 29 years. The prevalence of using modern methods of FP was 17.3%. More than three quarters of urban women are using contraceptives compared with one quarter of rural women. There was a difference between those who ever used measures to delay pregnancy and their locations, P = 0.049. Women in the rural areas use the cycle beads, while those in the urban areas use the injectables. Need for more children was the most common reason for discontinuing FP, others are FP failure, absence of spouse, and fear of side effects. Age of the participants was found to be a good predictor of using modern FP method, P = 0.022.
Conclusion: There is low prevalence of modern FP utilization in this study despite knowing where to access the services (PHCs). Three of four urban women are using FP compared with one out of four among rural women. The cycle beads and the injectables were the most common methods. Age is a major determinant of using FP.
Keywords: Family planning, Lafia, modern, practice, utilization
|How to cite this article:|
Hassan I, Lucky C, Michael A, Caleb OE, Hellen K, Adaku E, Ahmed LA, Ezekiel T, Anna J, Oyeleke BS. Utilization of modern family planning methods among women of reproductive age group in North-Central Nigeria; rural – urban comparison. Indian J Community Fam Med 2022;8:99-105
|How to cite this URL:|
Hassan I, Lucky C, Michael A, Caleb OE, Hellen K, Adaku E, Ahmed LA, Ezekiel T, Anna J, Oyeleke BS. Utilization of modern family planning methods among women of reproductive age group in North-Central Nigeria; rural – urban comparison. Indian J Community Fam Med [serial online] 2022 [cited 2023 May 28];8:99-105. Available from: https://www.ijcfm.org/text.asp?2022/8/2/99/366549
| Introduction|| |
Contraception is one of the most successful developmental interventions, unique in its range of potential benefits, encompassing economic development, maternal and child health, educational advances, and women's empowerment. Increased use of contraceptive methods can significantly reduce the costs of achieving selected Sustainable Development Goals and directly influence reductions in maternal and child mortality. Every year, more than 208 million pregnancies occur worldwide, of which 185 million occur in the developing world alone. Globally, almost two in every five women who become pregnant have either an abortion or an unplanned birth. More than 40% of pregnancies worldwide are unintended. An estimated 214 million women in developing countries would like to delay or stop childbearing but are not using any method of contraception. An estimated 18 million unsafe abortions take place each year in less developed countries, contributing to high rates of maternal injuries and deaths.
Family planning (FP) is one of the fundamental pillars of safe motherhood and a reproductive right as it poses risks to children's health and well-being and contributes to rapid population growth. Modern FP such as the barrier methods aids in prevention of sexually transmitted infections (STIs). Other examples of the modern FP method include the injectables, sterilization, intrauterine devices, pills, and the emergency contraception unlike the traditional rhythm and/or the withdrawal methods. FP reduces the need for unsafe abortion, and it reinforces people's right to determine the number and spacing of their children and population control. It prevents unintended pregnancy, thus preventing unnecessary premature maternal and infant death. Despite the attendant benefits of contraceptives, utilization has been poor. A report from the National AIDS and Reproductive Health Survey, 2012 in Nigeria indicated that while awareness of contraceptives was high, the proportion of females using any method and a modern method of contraception was 13% and 10%, respectively. Other studies have shown that more than 60% of women with unintended pregnancies were not using any form of contraception as most reproductive health decisions, especially in rural communities, are largely influenced by the cultures and beliefs of the communities in which they live.,
On the other hand, some studies show that about 12.4% of rural women rely only on ineffective traditional methods of contraception.,,, The World Health Organization Fact Sheet on FP of 2018 attributed the reasons for nonusage to include lack of knowledge, attitude of consumers and service providers, and lack of awareness by the affected group. Earlier studies on the subject in Nasarawa State showed contraceptive usage in 32.6% of women in 2014 and 22.7% in a more recent (2020) one, respectively., This research was embarked upon due to a paucity of data on this very important subject in this environment.
The consistent and correct use of modern FP methods will go a long way in curtailing unintended pregnancy, STIs, and other reproductive health problems among women of reproductive age in the nation, thus enhancing their health. However, knowledge, attitude, and use of modern FP among women of reproductive age in Nigeria are still low, and they vary by demographic and sociodemographic characteristics. This study aimed to assess the utilization of modern FP methods and compare it between urban and rural dwellers in the study population.
| Material and Methods|| |
Lafia is a local government area (LGA) and the capital of Nasarawa State. It covers an area of 2756 km2. The local government is bounded to the north by Nasarawa Eggon and Wamba LGAs and Plateau State, to the east by Plateau State and Awe LGA, to the south by Obi and Doma LGAs, and to the west by Kokona LGA. Lafia local government has 28 primary healthcare centers (PHCs), which are being supervised by the Nasarawa State Primary Healthcare Development Agency.
The study population is women of reproductive age between 15 and 49 years attending the selected PHCs in Lafia LGA. The study was done over 6-month period from October 2018 to March 2019.
The study is a cross-sectional survey between women of reproductive age attending PHCs at the urban and the rural populations of Lafia.
Sample size was calculated using formula:
n = (Zα/2 + Zβ) 2 × (P1 [1 − P1] + P2 [1 − P2])/(P1 − P2) 2,
where, Zα/2 is the critical value of the normal distribution at α/2 (e.g., for a confidence level of 95%, α is 0.05 and the critical value is 1.96), Zβ is the critical value of the normal distribution at β (e.g., for a power of 80%, β is 0.2 and the critical value is 0.84), and P1 and P2 are the expected sample proportions of the two groups, which is 74.0% and 58.2% among rural and urban population respectively. Considering a non-response rate of 10%, sample size was calculated to be 151 each in urban and rural areas.
All consenting women of reproductive age attending the selected PHCs in Lafia LGA North-Central Nigeria within the study period were included. While mentally deranged women, those who were very ill and therefore unable to withstand the process, and those from PHCs that are difficult to access due to bad road or for security reasons were excluded. A multi-stage sampling method was initially used in grouping the PHC facilities in Lafia into urban and rural, out of which 10 facilities were further selected randomly from each group. A convenience sampling procedure was then employed at the selected PHCs to recruit participants. All consecutive women who presented during the recruitment process at the selected PHCs who meet up with the inclusion criteria and gave consent were enrolled until the target number was achieved.
Sought and obtained from Nasarawa State Research Ethics Committee in the Ministry of Health headquarters. Confidentiality was ensured during and after the study. Written informed consent was obtained from participants, and all data were treated with the most assured security by pass-wording the computer in which the data are stored. De-identifiers were also used.
Twenty health facilities, 10 urban and 10 rural, were selected based on the following criteria:
- Submission of report on the District Health Information Software, at least once, between October 2018 and March 2019 to confirm service provision in the selected health facility
- Criteria for classifying as urban being the presence of facilities such as paved streets, schools, electric lighting, pipe-borne water, telecommunication access, internet connectivity, and modern sewerage system.
The rural communities in Lafia LGA selected for the study were Adogi, Agba, Ashangwa, Barkin Abdullahi, Bakin Rijiya, Agudu, Keffin Wambai, Angwan Rere, Wakwa, and Ashige, while the urban communities include Bukan Sidi, Doma Road, Tudun Kauri, Lafia East, Shabu, Tudun Gwandara, Kwandare, Azuba Centre, Akurba, and Bukan Kwato.
A structured interviewer-administered questionnaire adapted from Performance Monitoring and Accountability 2020 was used. It was designed in English language. At recruitment, prospective respondents were informed of what the study was about and their consent was sought and obtained. The researchers and trained research assistants administered the questionnaire. Research assistants who understood both English and Hausa were trained as these are the popular languages spoken in the study area. An interpreter was used for dialects other than these. Where no interpreter was found, the respondent was excluded from the study. The questionnaire consists of two sections, A and B. The information obtained in Section A was sociodemographic characteristics while in Section B was reproductive health data of the participants, knowledge of various types of modern contraceptives, women's perception about modern FP methods, source of information, willingness, and reasons for use or none use of the contraceptive methods. This process was terminated when the total number to be recruited was achieved. The questionnaires were then collated for safe keeping and further analysis.
Data collected were verified for completeness. Analysis was done using IBM Statistical Package for Social Sciences SPSS Inc. version 23 by Norman H. Nie. Results obtained were presented using descriptive statistics such as tables, percentages, mean, and median. Chi-square test was used to determine association between two categorical variables of the knowledge and use of the contraceptive methods. Student's t-test was used to compare the means of continuous variables such as age. Binary logistic regression was carried out to elicit the relationship between utilization of modern FP and other variables. P < 0.05 was considered statistically significant.
| Results|| |
Four hundred participants were recruited for the study. The mean age of the participants in the study was 27.8 ± 6.2 years. Most of the participants (59.8%) were aged between 20 and 29 years and about one-third (30.5%) were aged between 30 and 39 years. Similarly, a total of 349 (87.3%) were married. Likewise, level of education revealed that 106 (26.5%) had completed secondary school and 122 (30.5%) were into trading business. Religion of the participants showed that 221 (55.2%) practiced Islam and most of the participants (53.8%) resided in the urban locations compared to the rural [Table 1].
The mean parity of women was 3.4 ± 2.1 in the rural location and 3.4 ± 2.0 in the urban location. Majority of women with a higher parity and those with higher numbers of children alive (≥7) reside in the rural compared with the urban group, although not statistically significant (P = 0.209, P = 0.056). There was significant difference between those who ever used measures to delay pregnancy and location of participants, P = 0.049. Association between first used method of FP and location of participants was assessed and found to be significant, P = 0.010. More women in the rural area use more of the pills and the withdrawal methods, while those in the urban group essentially used the injectables, implants, and the cycle beads more than the other methods. More than three quarters of those at the urban admitted to using contraceptive to delay pregnancy compared with only a quarter of those at the rural area. Similarly, more than half (54.7%) of the rural participants admitted to being pregnant during the study period compared with only (17.7%) in the urban group, this was statistically significant with P = 0.000 [Table 2].
Even though more women in the urban compared to the rural were either currently using modern FP, knew the types of modern FP methods, knew where to obtain it, and were willing to use the modern FP methods (for those not already using it), none was statistically significant. There was no significant difference on whether they were told the method is permanent or not, P = 0.839. The most common reason for discontinuing FP was because of need for more babies. Others are husband not around, becoming pregnant while on FP, and fear of side effects. More women in the urban got the FP methods they had wanted, took the decision to use FP alone, and were willing to come back and even refer a relative compared with the rural women, but the differences were not statistically significant [Table 3].
|Table 3: Utilization of family planning methods by study participants in rural and urban areas|
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Age of the participants was found to be a good predictor as participants aged 30–39 years were 24 times more likely to use modern FP method with odds ratio = 24.79 and P = 0.022. Similarly, participants who have previously used any FP method before in delaying pregnancy were likely to use modern FP method currently, P < 0.001. Likewise, payment for FP was a significant predictor of using the modern FP method with P < 0.001 [Table 4].
| Discussion|| |
Most respondents in this study have two or more children. The mean parity and the mean age in this study were 3.4 ± 2.1 and 27.8 ± 6.2 years, respectively. The most common age groups in this study were similar to the report by Okeowo and Olujide, who, like us, equally reported that four out of every five respondents were married. The lower mean age implies that the women are still in the business of childbearing and will add more children with time. The lower parity may also be due to the greater proportion of study participants being urban dwellers, with those at the rural area noted for higher parity as seen in this study. The rural dwellers are more likely to be farmers, traders, or full-time homemakers with no restriction to having babies such as office work, schooling, and other hustling common with the urban communities.
More women in urban location have attempted delaying pregnancy, and they have done so at a relatively younger age group compared with their peers in the rural area. This may be due to the fact that the urban dwellers are likely to be more exposed to social life due to the presence of banks, higher institutions, industries, and government parastatal. Access to information through the social media, print, and media houses may also be an influencer. The most commonly used methods of delaying pregnancy in this study were use of pills and the withdrawal methods in the rural area unlike the urban dwellers who use more of the injectables and implants. The difference in the effectiveness of their preferred methods might explain why there are more pregnant women in the rural areas compared with the urban areas during this study.
Most participants know where to obtain FP methods with the most common place being the PHC. This may be due to the ubiquitous nature of the PHCs where there are more than 760 of them across the State. Affordability may also play a role with the average cost of getting a method estimated at #400.00.
In this study, less than a quarter of the women were currently using any FP method, while less than one-fifth were currently using a modern method of FP. This finding may be due to the low level of education of the participants in this study where only about one quarter completed secondary education. Our finding is similar to the report by Adeyemi et al. in Ogbomosho that found 25.4%. Our finding is lower than the 38.5% reported by Anate et al. in a study in Ibeju Lekki, Lagos. The educational difference where >40% of their participants had tertiary level of education may explain the finding. It is equally lower than the 51.9% reported by Envuladu et al. in Jos, Nigeria. The difference can be attributed to the clear educational difference between the two studies, the variation in study location, and a lower sample size used in theirs compared to ours. The finding in the present study is higher than the 7.5% found among Pastoralists in Ethiopia. The most commonly used modern methods were implants, injectables, and the male condom. This is comparable to the findings by Egenti et al. in Gwagwalada that reported more of injectables and male condom. The higher awareness concerning the male condom, the ease of purchase, as well as the convenient timing (once in 2–3 months) could make it a preferred method and enhances its acceptability.
More than three quarters of the urban population admitted to have used one form of contraceptives or the other compared with one quarter of the rural dwellers. This is a much improvement over the 32.7% reported by Ogbe et al. in the same location. The finding is not unexpected because the present study is very recent and with increasing globalization, awareness creation, increasing level of education and female education, the ugly trend is expected to change for the better. The observed differences in the levels of education in the current study, where only 11% of the women had no formal education compared to the 28.9% without formal education in the earlier study, could explain the improved use of contraceptive. This earlier study also reported a higher mean parity and most of the women were full-time homemakers compared with this present study; these observations might also be responsible for the improved contraceptive utilization. The 24.8% (about one quarter) utilization among rural women in this study is comparable to the 22.7% reported by OlaOlorun and Tsui equally among rural women.
The most common reason for discontinuing FP was due to the desire for more babies. This corroborated the lower mean age and parity of this study population. Other reasons were husband not around, becoming pregnant while on FP, and fear of adverse effects. Age is a major predictor of accepting to use modern FP methods. Those aged 30–39 years are 24 times likely to use modern FP methods. Other significant predictors are previous history of use of measures for delaying pregnancy and clients who paid for the service (modern contraceptive methods) offered; these are similar to earlier findings.,,
| Conclusion|| |
There is poor utilization of modern FP methods in this study, despite the awareness and of where to access it. FP methods are commonly accessed at the PHC. Desire for more children, becoming pregnant while on FP method, husband's unavailability, and fear of side effects have been identified as the barriers in continuing FP and it cut across both rural and urban divide. More urban women were using modern contraceptives compared to rural. The most commonly used modern methods are the injectables and male condom. More women in the rural area use the pills and the withdrawal methods (by their men) more, while those in the urban group utilizes more of the injectables and implants methods. More urban women have used measures to delay pregnancy, while most of the rural women admitted to being pregnant already during this study. Age, previous use of measures to delay pregnancy, and payment for FP methods were the significant predictors for the utilization of a modern FP method.
We appreciate Mr. Joseph Kolawole and all staffs working at the DASH Research unit for their technical assistance.
Financial support and sponsorship
This study was funded by the Saving One Million Lives Project for Results Nasarawa State.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]