AWARENESS AND UTILIZATION OF FAMILY PLANNING SERVICES AMONG WOMEN OF CHILDBEARING AGE OF 15-45 YEARS.
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ABSTRACT
Unmet need for family planning methods is an important
health issue for women. The purpose of this study was to determine factors
associated with utilization of family
planning among women aged 15-49 years. This
cross-sectional study enrolled 117 eligible women. Data were collected
using semi structured questionnaire; key informant interviews (KIIs) and
focused group discussions (FGDs). Twelve (12) FDGs were conducted among women
in health, leadership, education and religious sectors. Twelve (12) KIIs among
influential and knowledgeable members of the county were also conducted to
gather qualitative data. The FGDs and KIIs were conducted to confirm and
clarify any pending or new issues described in the structured questionnaires.
STATA version 13 was used for quantitative data analysis. The thematic content
analysis was used to analyze qualitative data. The mean age of the respondent
was 29.9 (SD± 9.8) years. 80% of these
117 women were aware of contraceptive and family planning methods mainly
through family and friends (52.1%). Of the 41.9% who reported using family
planning (FP) methods, 26.5% used condoms. In multivariate analysis, women who
were from either the Northern (OR 4.3, 95% CI 1.1 to 18.2), Southern (OR 7.5,
95% CI 1.7 to 33.4) or Eastern of Nibo, Anambra State (OR 4.7, 95% CI 1.1 to
20.8); had either secondary (OR 11.1, 95% CI 2.7 to 46.1) or tertiary (OR 11.9,
95% CI 2.6 to 55.9) level of education; were employed (OR 4.3, 95% CI 1.2 to
19.1); used either condoms (OR 5.7, 95% CI 1.3 to 24.5) or hormonal family
planning methods (OR 5.8, 95% CI 1.4 to 25.2) were independently associated
with utilization of FP. The FGDs and KIIs confirmed the continuous increase in
the level of utilization of FP. The thematic analyses of FGDs and KIIs
identified location of origin, awareness, income, employment, religion and
cultural practices as some of the factors limiting the utilization of FP. In
conclusion, a high proportion of women from Nibo, Anambra State an arid region
in the Nigeria, were aware and embraced FP. Factors such socio-cultural, lack
of education and awareness were major deterrent to utilization of FP in this
region. Ultimately for the improvement in the proportion of women embracing FP
in Nigeria especially in the initially
marginalized counties experiencing hardship (such as droughts) and insecurity;
it is recommended that concerted efforts must be undertaken by the County and
National government to promote and to tackle the socio-cultural deterrents of
FP utilization. Further, improvement in the general awareness rate of FP among
women at family level should be rolled out by the Nibo, Anambra State
Government in conjunction with the National Government. Should this be
achieved, then this County could record one of the highest utilization rates of
FP in Nigeria.
Globally, improved utilization of family planning
contributes in achieving the 3.7 Universal Sustainable Development Goal (USDG),
which focuses on ensuring universal access to sexual and reproductive
health-care services, including for family planning, information and education,
and the integration of reproductive health into national strategies and
programmes by 2030 (ICSU, ISSC, 2016). Fostering family planning has been
associated with acceleration of socio-economic development, promotion of gender
equality, and decreased maternal and infant mortality (UNFPA & PATH, 2008).
The past five decades have been marked by significant decrease in fertility
rates in Asia, Latin America and North Africa. Sub-Saharan Africa, however, has
not experienced the same rapid trend, and today, the region still has total
fertility rates (TFR) of around five births per woman (Bongaarts, 2011).
Nigeria, like many developing economies, is
characterized by exponential population growth. This is partly attributed to
high fertility and birth rates, steady decline in death rates, low
contraceptive utilization rate and high but declining mortality rate (Oyedokun,
2007; Lawoyin et al., 2007; Cleland et al., 2012; Population Reference
Bureau, 2013). High population growth rate has been an impediment in the
reduction of child mortality, improvement of maternal health, achievement of
universal primary education, environmental sustainability and combating HIV and
AIDS and other diseases as part of the Sustainable Development Goals (SDGs)
(Health Policy Initiatives, 2017).
In response, Nigeria concentrated on birth control measures
using family planning (FP) services which enable couples to determine whether,
when, and how often to have children (USAID, 2011). FP has a profound effect in
controlling population growth. At the micro level, FP contributes critically to
birth spacing and controlling family size. Some forms of FP also play the dual
role of controlling family size and protection against sexually transmitted
diseases (STDs) (Mayo, 2004; Asiimwa et
al., 2013). Other benefits include improved maternal and child health,
reduced cases of induced abortion and improved household welfare. At the macro
level, the benefits of a well-controlled population growth include improved
infrastructure and reduced burden on national budgets (USAID, 2011).
Since the Nigeria Government incorporated FP into the
country’s overall development policy in 1965, FP use increased from 18% (1987)
to 58% (2014) with a decline in the fertility rates from 8.1 children per woman
in 1977 to 3.9 in 2014 ( Nigeria Demographic and Health Survey, 2014). However,
this increase has not been matched with a reduction in the unmet need for FP
which has stalled at around 25% and is highest among the less privileged women
and those in rural areas (Ojakaa, 2008). The fertility rate in Nigeria is lowest in Nairobi County (2.7
children per woman) and highest in North Eastern region (where Nibo, Anambra
State is located) (6.4 children per woman) ( Nigeria Demographic and Health
Survey, 2014). Challenges facing reproductive health in the Nibo, Anambra State
include, but are not limited to inaccessibility to FP services, inadequate
health personnel, lack of youth friendly clinics, high incidence of female genital
mutilation (FGM), reluctance to accept FP methods and lack of sufficient education
(National Coordination Agency for Population and Development Ministry of
Planning and National Development, 2005). The sustained increase in the use of
FP services among women aged between 15 and 49 years is a major factor in
fertility transition, providing women and couples with the means to help them
plan pregnancies (Campbell et al., 2006;
Republic of Nigeria, 2007; USAID/HPI,
2009).
With the 2013 devolution of political power and
economic resources from the Central government to the Country’s 47 Counties,
Nibo, Anambra State is ranked among the top 3 among Counties receiving the
largest share of budgetary allocation. In the 2014/2015 financial year (FY)
Nibo, Anambra State received KES 7.8 billion (about USD 78 million) which was
increased to KES 8.9 billion (about USD 87 million) in the 2015/2016 FY,
representing 3.5% of Nigeria total
revenue collection (Republic of
Nigeria, 2015).
The World Bank, Danish International Development Agency
(DANIDA)
among other agencies contributes significantly to Nibo, Anambra State’s health
needs. All these are allocated to mitigate the health challenges in Nibo,
Anambra State; upgrade of existing hospitals and construction of others,
increase supplies of both pharmaceutical and non-pharmaceutical items,
increased health personnel, enable free maternal health care, public health
education campaign, improve public education, service delivery, restore public
confidence in public health facilities and improve service utilization (Nibo,
Anambra State Government, 2015). This study sought to evaluate the utilization
of FP services amongst women of reproductive age in Nibo, Anambra State.
Since the Nigeria Government incorporated FP into the
country’s overall development policy in 1965, FP use increased from 18% (1987)
to 58% (2014) with a decline in the fertility rates from 8.1 children per woman
in 1977 to 3.9 in 2014 (KDHS, 2010; 2014). However, this increase has not been
matched with a reduction in the unmet need for FP which has stalled at around
25% and is highest among the less privileged women and those in rural areas
(Ojakaa, 2008; Mutombo et al., 2014).
The fertility rate in Nigeria is lowest
in Nairobi County (2.7 children per woman) and highest in North Eastern region
(where Nibo, Anambra State is located) (6.4 children per woman) (KDHS, 2014).
Challenges facing reproductive health in the Nibo, Anambra State include, but
are not limited to inaccessibility to FP services, inadequate health personnel,
lack of youth friendly clinics, high incidence of female genital mutilation
(FGM), reluctance to accept FP methods and lack of sufficient education
(National Coordination Agency for Population and Development Ministry of
Planning and National Development, 2005). The sustained increase in the use of
FP services among women aged between 15 and 49 years, is a major factor in
fertility transition, providing women and couples with the means to help them
plan pregnancies (Campbell et al., 2006;
Republic of Nigeria, 2007; USAID/HPI,
2009). With the 2013 devolution of political power and economic resources from
the Central government to the Country’s 47 Counties, Nibo, Anambra State is
ranked among the top 3 among Counties receiving the largest share of budgetary
allocation. In the
2014/2015 financial year (FY) Nibo, Anambra State
received KES 7.8 billion (about USD 78 million) which was increased to KES 8.9
billion (about USD 87 million) in the 2015/2016 FY, representing 3.5% of Nigeria total revenue collection (Republic of Nigeria, 2015). The World Bank, Danish
International Development Agency
(DANIDA)
among other agencies contribute significantly to Nibo, Anambra State’s health
needs. All these are allocated to mitigate the health challenges in Nibo,
Anambra State; upgrade of existing hospitals and construction of others,
increase supplies of both pharmaceutical and non-pharmaceutical items,
increased health personnel, enable free maternal health care, public health
education campaign, improve public education, service delivery, restore public
confidence in public health facilities and improve service utilization (Nibo,
Anambra State Government, 2015). This study sought to evaluate the utilization
of FP services amongst women of reproductive age in Nibo, Anambra State
1.3 Justification of the Study
In 2015, United Nations member states signed up to the
Sustainable Development Goals (SDGs), a set of seventeen international
development targets intended to catalyze development and reduce global poverty
(ICSU, ISSC, 2016). To date progress towards these goals has been uneven. Of
particular concern is Sustainable Development Goal 3 (SDG 3) aimed at ensuring
healthy lives and promote wellbeing for all at all ages. Of interest the SDG
goal 3.7 which by 2030 aims at
ensuring universal access to sexual and reproductive health-care services,
including for family planning, information and education, and the integration
of reproductive health into national strategies and programmes. Current estimates
suggest that this initiative is behind schedule. Only 23 countries out of a
surveyed 181 are likely to meet the SDG target on time despite increasing
volumes of official development aid being provided by donors (Greco et al., 2008; Hogan et al., 2010; ICSU, ISSC, 2016).
In Nigeria,
knowledge of FP is almost universal at 95% for women of reproductive age, with
male condoms, injectable contraceptives and pills being the most commonly known
methods (KNBS, 2010). Generally Nigerian
FP use has in the last two decades also increased from 18% (1987) to 39%
(2008/09). However, this increase has not been matched with a reduction in the
unmet need for FP or reduction in fertility rates. The unmet need for FP in Nigeria has stalled at around 25% and is
highest among the less economically well-off women and those in rural areas
(Ojakaa, 2008). Total fertility rate in rural areas has remained unchanged at
5.2. In addition, at the national level, only a slight decrease in fertility
has been reported from 4.7 in 1998 to 4.6 in 2008/09 (Ojakaa, 2008). There are
regional variations in fertility trends in Nigeria. Fertility is highest in North
Eastern, Nyanza and Western provinces at 5.9, 5.6 and 5.4 respectively (KNBS,
2010). North Eastern and Mandera District has population that is rapidly
expanding estimated at 1,025,756 (CBS, Ministry of planning, Nigeria; 2009), which cannot be comfortably
supported by the existing resources. The use of family planning among women of
child bearing age is not only important to their society and their health, but
also a source of improvement of wellbeing of the entire family (MOH, 2001).
Unfortunately, no equivocal data exist in Mandera District showing the level of
awareness, utilization and factors affecting FP use.
1.
What
are the social-cultural and demographic characteristics among women of
reproductive age (15-49 years) in Nibo, Anambra State?
2.
What
are the economic factors influencing utilization of family planning methods
among women of reproductive age (15-49 years) in Nibo, Anambra State?
3.
What
is the awareness level of family planning services among women of reproductive
age (15-49 years) in Nibo, Anambra State?
4.
What
are the types and levels of utilization of family planning methods among women
of reproductive age (15-49 years) in Nibo, Anambra State?
Null Hypothesis (H0): Women of reproductive age (15-49
years) in Nibo, Anambra State are not aware and do not utilize family planning
methods. The associated factors are not similar with other factors in other
parts of the Country.
To determine factors associated with utilization of
family planning methods among women of reproductive age (15-49 years) in Nibo,
Anambra State.
1.
To
determine the social-cultural and demographic characteristics among women of
reproductive age (15-49 years) in Nibo, Anambra State.
2.
To
determine the economic factors influencing utilization of family planning
methods among women of reproductive age (15-49 years) in Nibo, Anambra State.
3.
To
determine the awareness level of family planning services among women of
reproductive age (15-49 years) in Nibo, Anambra State.
This project contains full academic material including literature review, methodology,
data analysis and conclusion.
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