ABSTRACT
Preventing mother and child morbidity and death is a critical component of family planning. It is an important part of primary health care as well as reproductive health. Despite the efforts of the government and other non-governmental family planning service providers, the fertility rate in suburban and rural Nigeria is rather high. This study looked on secondary school students’ acceptance and use of family planning services in Kakwalaka Village, Bendi, in the Obanliku Local Government Area of Cross River State. It is a descriptive cross-sectional study with 364 secondary school students (15 to 49 years old) who were sampled using a multi-stage sampling technique. 139 (37%) of the respondents were between the ages of 15 and 24, 100% of the respondents were married, and 135 (37%) had more than five children.
Few women were actively taking contraception; nevertheless, the majority of those who were not did so for a variety of reasons, including a lack of proper understanding about family planning, fear of negative effects, and lack of availability. Religion (p-value 0.01), family environment (p-value 0.001), age (p-value 0.01), and male involvement (p-value 0.001) were the most important socio-demographic factors of family planning service consumption. The use of family planning services was low among rural women, with religion, fear of adverse effects, and criticism from spouses among the primary reasons for non-use.
CHAPTER ONE
INTRODUCTION
Background to Study
Family planning is widely recognized as a key intervention in achieving MDGs four (4) and five (5) since it has been shown to lower maternal and child mortality. Unwanted pregnancies and risky abortions can be avoided through family planning. Some family planning strategies, such as the use of condoms, can protect people from sexually transmitted infections (STIs), such as HIV/AIDS. Gender equality, as well as women’s educational and economic empowerment, have all been found to benefit from family planning. Despite the numerous advantages of family planning services, uptake is still low in Sub-Saharan Africa. In Sub-Saharan Africa, including Nigeria, this has resulted in high incidence of undesired pregnancies, unexpected deliveries, unsafe abortions, and maternal mortality. Many reasons contribute to the poor use of family planning. It has been discovered that public awareness of the availability of family planning options has a significant impact on the use of these services. Furthermore, while some women are aware that family planning services are available, they are not well informed on the many types of family planning procedures and how they work. Some women seeking family planning services were not given appropriate information about the risks associated with certain procedures. In Uganda, for example, several women quit using contraceptives after experiencing what they thought to be negative side effects.
Despite the fact that most individuals are aware of the benefits of family planning services, they complain that they are difficult to obtain because they are given by health institutions that are far away from their homes. Furthermore, religious tendency has been identified as a significant barrier to the use of family planning services in Africa. Furthermore, some people believe that family planning services are only for married couples, while others believe that if they use family planning services after they are unable to conceive, they would become sexually promiscuous. The Nigerian government and non-governmental organizations have made some attempts to improve the coverage of family planning services in the country through the execution of several programs.
Despite some progress in raising awareness of family planning services in the country, the unmet need for family planning remains significant. According to the Nigeria Demographic and Health Survey (GDHS), a considerable percentage of women have unmet family planning needs because the acceptance rate for family planning services is still low.
Preventing mother and child morbidity and death is a critical component of family planning. It is an important part of primary health care as well as reproductive health. It contributes significantly to the reduction of maternal and newborn morbidity and mortality. Individuals, families, communities, and the nation as a whole benefit from it in terms of health and development. It assists women in avoiding unintended pregnancies and limiting the number of children they have, so improving reproductive health. As a result, it helps to meet the Millennium Development Goals (MDGs) and the Health for All Policy Target. 13 Between 1990 and 2015, the MDGs ask for a 75 percent reduction in maternal mortality and a two-thirds reduction in child mortality. As a result, effective use of family planning services is crucial for achieving these goals, resulting in improved health and faster growth across regions. 15 Access to family planning also has the potential to control population growth and in the long run reduce green gas house emission with it associated risk. 13 Similarly, it has been projected that using family planning to prevent undesired pregnancies would save 4.6 million Disability Adjusted Life Years. 16 Despite the necessity and benefits of family planning, it is estimated that roughly 17% of all married women worldwide would prefer to avoid pregnancy but will not use any kind of contraception. 17 As a result, around 25% of all pregnancies are unplanned, particularly in underdeveloped countries. As a result, an estimated 18 million abortions are performed every year, contributing to substantial maternal morbidity and injuries. 14,17 Only 10% of the world’s women live in Sub-Saharan Africa, which accounts for 12 million undesired or unplanned pregnancies and 40% of all pregnancy-related fatalities globally. Despite evidence of the critical importance of family planning, contraceptive prevalence in Sub-Saharan Africa is low, estimated at 13 percent, while in Nigeria, the estimate is 8.0 percent, with 17 percent unmet demand for family planning. This contributes significantly to the high percentage of unplanned pregnancies that result in induced abortion and its associated problems. Despite the fact that Nigeria has only 2% of the world’s population, it is responsible for 10% of maternal mortality. Despite the efforts of the government and other non-governmental family planning service providers, the fertility rate in suburban and rural Nigeria is rather high. Despite the high fertility rate, modern family planning technologies have received little acceptance and use for a variety of reasons. Poverty, poor program coordination, and limited donor funds all impede the provision of family planning services in Africa. Traditional attitudes favoring high reproduction, religious hurdles, fear of side effects, and a lack of male engagement have all played a role in women’s resistance to family planning methods.
Statement of Problem
Only 15% of currently married women in Nigeria use a contraceptive technique, according to the NDHS 2013, a two percentage point rise from the 2003 NDHS. The bulk of contraceptive users (10 percent of currently married women) utilize modern methods, while 5% use traditional methods. Injectables (3 percent), male condoms (2 percent), and the pill (2 percent) are the most popular current approaches. All other modern approaches are significantly less commonly used (under 1 percent). Surprisingly, 3% of people utilize withdrawal as a form of contraception. Contraception usage varies depending on a woman’s background. The percentage of currently married women who use some kind of contraception climbs with age, from 2% among women aged 15-19 to 22% among women aged 40-44. When women reach the age of 45, they are less likely to take contraception. Condoms are more common among women under the age of 35, whereas injectables are more popular among women aged 35 to 44. Currently, married women in cities are far more likely than women in rural areas to use any form of contraception (27 percent) (9 percent). Each of these strategies is used more frequently in cities than in rural regions.
Contraceptive use among currently married women aged 15 to 49 years is 4.3 percent in North West Nigeria, 3.2 percent in the North East, and 15.6 percent in the North Central. Southern Nigeria has the highest rate of use, including South East (29.3%), South South (28.1%), and South West (28.1%). (38.0 percent ). There are significant differences across the six (6) geopolitical zones as well as between states. In Kano State, only 0.6 percent of women utilize contraception (the lowest in the North), with only 0.5 percent utilizing any modern technique (pill- 0.2 percent , IUD- 0.2 percent , injectables- 0.1 percent while 0.0 percent use implants, male condom, LAM, standard days methods and female sterilization).
The result of a pregnancy and family planning are inextricably linked. According to the demographic transition theory, a family is more likely to accept family planning if fetal, newborn, and child mortality rates are reduced. 29 As a result, improving maternal and child health services is essential for family planning. As a result, child spacing is an important element that determines pregnancy outcomes. Prematurity is reduced when mothers follow the World Health Organization’s recommended minimum inter-birth interval of 33 months between two successive live births. As a result, preventing a rapid succession of many pregnancies increases the chances of lowering maternal, fetal, baby, and childhood mortality. 30 In general, child spacing allows for more opportunities to nurture each child individually, perhaps reducing issues such gastrointestinal infections and malnutrition. 30 By reducing the number of dependents who require intensive personal care, education, food, shelter, and clothes, among other things, family planning can improve the quality of life and boost the standard of living. However, where family planning services are accessible, their usage may be limited due to a variety of variables, including inadequate literacy, socio-cultural views promoting big families, and service unavailability due to dysfunctional health systems. 31 There has been less success in improving newborn and child survival and primary care use as a result of these changes in maternal care and contraceptive use patterns. In 2008, the North West and North East areas had the greatest numbers of children aged 12 to 23 months who had never been vaccinated, 48.7% and 48.7%, respectively. The four northern states of Zamfara, Katsina, Jigawa, and Yobe all had vaccination coverage rates of less than 5.4 percent. 27 Under half of all sick children were sent to a health center for treatment when they fell ill with pneumonia, malaria, or diarrhea. In the North West, infant mortality was 139 deaths per 1,000 live births, while in the North East, it was 126 deaths per 1,000 live births, while under five mortality was 217 and 222 deaths per 1,000 live births, respectively. As a result, this study on secondary school students’ acceptance and use of family planning services is a case study of Kakwalaka Village, Bendi, in Obanliku, Cross River state.
Research Objectives
The following precise objectives were set to assess the acceptance and use of family planning services among secondary school students in Kakwalaka Village, Bendi, in Obanliku, Cross River state, Nigeria:
1. To find out how much secondary school students know about family planning.
2. To find out how rural secondary school students feel about family planning.
3. Determine the extent to which secondary school students use family planning products and services.
4. To determine the characteristics that influence secondary school students’ use of family planning services.
Research Questions
1. How well do secondary school students in Kakwalaka Village, Bendi, Obanliku, Cross River state, know about family planning?
2. How do students in remote secondary schools feel about family planning?
3. What percentage of rural secondary school students use family planning goods, methods, and services?
4. What are the elements that influence rural secondary school students’ use of family planning services?
Scope of the study
During a six-month period, secondary school pupils in Kakwalaka Village, Bendi, Obanliku, Cross River state were studied. It investigated the determinants of family planning service utilization as well as the knowledge, attitude, and variables that work against family planning services.
Significance of Study
High mother and newborn mortality might result from a high fertility rate and insufficient spacing between deliveries. Every year, an estimated 600,000 maternal deaths occur worldwide, the vast majority of which occur in developing nations. According to the WHO, unsafe abortion is responsible for 13% of these deaths. Induced abortion is used by over 50 million women worldwide, and it frequently results in substantial maternal morbidity and mortality. Thus, family planning and birth spacing are two approaches for avoiding these deaths. The international community has embraced family planning and contraceptive use as one of the strategies for lowering maternal mortality and achieving the Millennium Development Goals.
Africa has a high prevalence of contraceptive access (57 percent), which leads to undesired pregnancies, increased demand for abortion, and death as a result of unsafe abortion. 37
In Nigeria, maternal mortality is unacceptably high. Furthermore, because abortion is legal, politically, and culturally controversial, effective contraceptive programming should be the current and future method to reducing risk and undesired pregnancies. There are few published data on the usage of family planning services in Nigeria, particularly in the north, where we have recently found increased maternal morbidity and mortality. This research will both educate the public and offer literature on the subject.
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