ABSTRACT

Family planning is an important preventive measure against maternal and child illness and death, and it is an essential part of primary health care and reproductive health. Fertility remains relatively high in suburban and rural Nigeria despite the efforts of government and non-governmental family planning providers, and acceptance and use of modern family planning methods remain low for a variety of reasons. This study aimed to determine the factors associated with the use of family planning services among women in rural areas of Akwa Ibom State, Nigeria.

It was a descriptive cross-sectional study of 364 women of childbearing age (15 to 49 years), selected by multi-stage sampling. Of the respondents, 139 (37%) were aged 15 to 24 years, all (100%) were married, and 135 (37%) had more than five children. About half (48.7%) had no formal education. Few respondents were currently using a contraceptive method. Among those not using any method, the main reasons were lack of appropriate knowledge of family planning, fear of side effects and availability of services. The most significant socio-demographic determinants of use were religion (p = 0.01), family setting (p < 0.001), age (p = 0.01) and male involvement (p < 0.001). Use of family planning services among the rural women was poor, and religion, fear of side effects and husbands’ disapproval were among the main reasons for non-use.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Family planning allows individuals and couples to decide whether and when to have children and how far apart to space them. It is widely regarded as one of the most cost-effective health interventions, and use of contraception reduces maternal and child deaths (Cleland et al., 2012; Fadeyibi et al., 2022). An analysis of 172 countries estimated that contraceptive use averts a substantial share of maternal deaths (Ahmed et al., 2012), and by preventing unintended pregnancies, contraception also reduces the need for abortion, which is often unsafe (Cleland et al., 2012). Birth spacing matters for children too: it has been estimated that an interval of at least two years between births would reduce infant mortality by about 10% and child mortality by 21% (Fadeyibi et al., 2022). Family planning therefore contributes directly to the health-related Sustainable Development Goals, including the target of fewer than 70 maternal deaths per 100,000 live births by 2030, which the world is not on course to meet (World Health Organization et al., 2025).

A wide range of methods is available, including hormonal methods (pills, injectables and implants), intrauterine devices, male and female condoms, emergency contraception, fertility awareness-based methods and permanent methods. Not all of these are accessible in many low-income settings, however, and large unmet needs remain. Globally, meeting the unmet need for modern contraception would avert tens of thousands of maternal deaths each year (Guttmacher Institute, 2017). Women who have an unmet need for modern contraception account for most unintended pregnancies in developing regions (Guttmacher Institute, 2017).

Nigeria is central to this problem. In 2023 it recorded the highest number of maternal deaths in the world, about 75,000, or 28.7% of the global total, and sub-Saharan Africa as a whole accounted for 70% of global maternal deaths (World Health Organization et al., 2025). Fertility is also high: the total fertility rate was 5.3 children per woman in 2018 (National Population Commission [NPC] & ICF, 2019). According to the 2018 Nigeria Demographic and Health Survey, only 17% of married women were using any contraceptive method, 12% a modern method, and 19% of married women had an unmet need for family planning (NPC & ICF, 2019). The use of modern methods rose from 4% to 12% over 28 years, from 1990 to 2018, while the average contraceptive prevalence for Africa is much higher, at about 36% (Fadeyibi et al., 2022). Modern method use among married women is also much higher in urban areas (18%) than in rural areas (8%) (NPC & ICF, 2019).

The reasons for low uptake are many. A systematic review of studies in Nigeria identified a range of challenges that keep family planning use sub-optimal among Nigerian women (Akamike et al., 2020). Studies show that education, household wealth, religion, residence, household composition and decision-making power all affect use. Women in polygynous households, in rural areas and in poorer households are less likely to use contraception, and women with more education and more say in household decisions are more likely to use it (Fadeyibi et al., 2022). Culture, myths and misperceptions about contraception are important barriers, as research in northern Nigeria has shown (Sinai et al., 2020). Husbands also matter: in northwestern Nigeria, women who approved of family planning and those who had talked about it with their husbands were about three times as likely to use modern contraception (Hutchinson et al., 2021). In rural Akwa Ibom State, contraceptive use among married couples has been significantly influenced by spousal communication about family planning (Asa et al., 2018).

It is against this background that the present study examines the factors affecting family planning services among women in rural areas of Akwa Ibom State.

1.2 Problem Statement

The number and timing of a woman’s pregnancies affect her risk of dying from pregnancy-related causes. Risk is higher when births are very closely spaced, when women have many children, or when pregnancies are unintended and end in unsafe abortion. By preventing unintended pregnancies, contraception lowers the risk of death for the mother and the child (Cleland et al., 2012; Ahmed et al., 2012). In Nigeria, abortion is restricted, and in 2017 an estimated 1.8 million abortions occurred, more than six in ten of them under the least safe conditions, with women who live in rural areas, have no education or are poor most likely to have the least safe abortions (Nigeria Health Watch, 2018).

The burden of poor maternal outcomes in Nigeria remains very heavy (World Health Organization et al., 2025), while uptake of family planning stays low, especially in rural areas (NPC & ICF, 2019). Where family planning services are available, their use may still be limited by low literacy, socio-cultural beliefs that favour large families, fear of side effects, religious objections, husbands’ disapproval and weak health services (Akamike et al., 2020; Fadeyibi et al., 2022; Sinai et al., 2020). Few studies describe use of family planning services among rural women in southern Nigeria, where high maternal illness and death have recently been observed. This study therefore assesses the factors affecting family planning services among rural women in Akwa Ibom State.

1.3 Significance of the Study

High fertility and short intervals between births contribute to high maternal and infant mortality. An estimated 260,000 women died from pregnancy-related causes worldwide in 2023, and almost all of these deaths occurred in low- and middle-income settings, with sub-Saharan Africa accounting for 70% (World Health Organization et al., 2025). Family planning and birth spacing are among the most effective ways of preventing these deaths (Cleland et al., 2012; Ahmed et al., 2012).

In Nigeria, maternal mortality remains unacceptably high. Access to abortion is legally, politically and culturally contested, so effective contraceptive programming is the more practical way of reducing unintended pregnancy and its consequences. Evidence on family planning use among women in rural Akwa Ibom State is limited, and this study will help programme planners, health workers and policy makers to design interventions suited to the rural setting. It will also provide data for future researchers.

1.4 Research Questions

1. What is the level of knowledge of family planning among women in rural areas of Akwa Ibom State?
2. What are the attitudes of rural women towards family planning?
3. What is the level of use of family planning products, methods and services among rural women?
4. What factors are associated with the use of family planning services among rural women?

1.5 Research Objectives

The main objective of the study is to assess the factors affecting family planning services among women in rural areas. The specific objectives are to:

1. determine the level of knowledge of family planning among rural women;
2. determine the attitudes of rural women towards family planning;
3. determine the level of use of family planning products and services among rural women; and
4. determine the factors associated with the use of family planning services among rural women.

1.6 Scope of the Study

The study covered women of childbearing age (15 to 49 years) living in three rural local government areas of Akwa Ibom State. It determined their knowledge, attitude and use of family planning services and assessed the determinants of use.

1.7 Definition of Terms

Family planning: the use of contraceptive methods and related services that allow individuals and couples to decide the number and spacing of their children.

Modern contraceptive method: a method such as the pill, injectable, implant, intrauterine device, condom or sterilisation.

Unmet need for family planning: the situation in which a woman wants to delay or avoid pregnancy but is not using any contraceptive method.

Utilisation of family planning services: current or past use of family planning methods or services by a woman or couple.

References

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Akamike, I. C., Okedo-Alex, I. N., Eze, I. I., Ezeanosike, O. B., & Uneke, C. J. (2020). Why does uptake of family planning services remain sub-optimal among Nigerian women? A systematic review of challenges and implications for policy. Contraception and Reproductive Medicine, 5, 30. https://doi.org/10.1186/s40834-020-00133-6

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