CHAPTER ONE
INTRODUCTION
BACKGROUND OF THE STUDY
Family planning is one of the most health-promoting and cost-effective public health initiatives, with the potential to prevent around 30% of maternal and 10% of child deaths. 1 As a result, FP helps to achieve the Millennium Development Goals (MDGs) by improving birth spacing and lowering pregnancy-related mortality and morbidity. 2 Decades of study and investment in family planning programs have produced in major improvements in program coverage and biomedical technologies, as well as large (although uneven) gains in contraceptive usage in most developing countries. Despite this, Demographic and Health Surveys (DHS) show that in many countries—including nations with high contraceptive prevalence—40 percent or more of women who recently gave birth said the pregnancy was desired later or not at all. 5 In a lot of countries, the proportion of married women with an unmet contraceptive need reaches 30 to 40 percent or more. 6 Both of these scenarios represent program and method shortcomings to varying degrees, including contraceptive failures for a variety of causes, as well as personal and situational variables such as partner opposition or women’s experiences or fears of side effects, which must be addressed. As male and female adolescents become sexually active before marriage or cohabitation (possibly with several partners) or at the time of their marriage, and as couples decide if and when to begin childbearing (if they have not already done so accidentally), they accumulate experiences with contraception (or its absence), pregnancy, and childbearing; think about spacing and stopping; and are influenced by their peers, contraceptive information, needs, and motivations evolve over time. Some women and men will divorce, remarry, and have another kid; others will have children (wanted or unwanted) outside of marriage or be motivated to avoid it.
Individual trajectories are as diverse as the environmental and contextual conditions. The challenge for the educational and health sectors is to provide complete knowledge on pregnancy risks, appropriate contraceptive alternatives, and proper and consistent usage in order to fulfill these evolving needs. Adolescents may already have acquired unrealistic anxieties about contraceptive side effects, thus interventions involve debunking beliefs in ineffective techniques and resolving unrealistic fears about contraceptive side effects.
Individuals and couples must be offered a long-term treatment package that is tailored to their personal and evolving requirements and linked to other sexual and reproductive health inputs.
The evidence base on how to create more user-friendly family planning environments, improve client-provider interactions and other aspects of quality of care, and include men as well as women in the discussion of contraceptive choices with respect to ease of use and the need for partner cooperation, possible effects on sexual expression (e.g., coitus-dependent or independent methods), safety, efficacy, side-effects, acceptability, accessibility, and a variety of other factors is now quite extensive.
Counseling guidelines have been devised for clients such as unmarried adolescents who require dual protection; couples who wish to adopt a natural technique; and unmarried adolescents who require dual protection.
The evidence base on the medical aspects of contraception for male and female users has also grown significantly. Medical eligibility requirements related to the method have been devised for women of all reproductive ages who have specific health issues, such as heavy smokers and those who are on long-term pharmacological treatments for chronic conditions (e.g. antihypertensive agents, antiretroviral drugs). Ongoing research is evaluating the protective and risk factors of various approaches in relation to specific diseases (e.g., breast, cervical or testicular cancers, cardiovascular disease, endometriosis).
In order to reduce mother and child morbidity and mortality, family planning is a crucial preventive approach. It is an important part of primary health care as well as reproductive health. 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. 15Family planning access has the ability to manage population increase and, in the long run, minimize greenhouse gas emissions and the risks that come with them. 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 relevance and advantages of family planning, it is estimated that roughly 17% of all married women around the world would prefer to avoid pregnancy but are unwilling to utilize it. As a result, an estimated 18 million abortions are performed every year, contributing to substantial maternal morbidity and injuries. 14,17 Sub-Saharan Africa, which has only 10% of the world’s women, accounts for 12 million undesired or unplanned pregnancies and 40% of all pregnancy-related fatalities per year. Despite evidence of the critical function 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 a 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 has been discovered that it accounts for 10% of the world’s maternal deaths. 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.
The use of contraceptives varies depending on a woman’s background. The proportion of currently married women who use some kind of contraception climbs with age, from only a third in their early twenties to over half in their fifties. 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 ). The result of a pregnancy and family planning have a direct correlation. 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, better maternal and child health care are a requirement for family planning. As a result, child spacing is an important element that determines the pregnancy’s prognosis. 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. In general, child spacing allows for more opportunities to nurture each child individually, perhaps reducing difficulties such gastrointestinal infections and malnutrition in infancy and early childhood. 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 progress in improving newborn and child survival and primary care as a result of these changes in maternal care and contraceptive usage 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, with 48.7% and 33.9 percent, respectively, and just 15.0 percent having a vaccination card. 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.
OBJECTIVES OF THE STUDY
The following precise objectives were set to analyze the variables mitigating against family planning among women in rural areas using a case study of Obibe Ezena village in Owerri North, Imo State, Nigeria:
Determine the level of family planning knowledge among women of childbearing age.
To find out how rural women of childbearing age feel about family planning.
To find out how many rural women of childbearing age use family planning goods and services.
Determine the characteristics that influence women of childbearing age’s use of family planning services.
RESEARCH QUESTIONS
What is the degree of family planning awareness among women of childbearing age in Obibe Ezena, Owerri North, Imo State?
What are rural women of childbearing age’s opinions regarding family planning?
What percentage of rural women of childbearing age use family planning goods, methods, and services?
What are the elements that influence rural women of childbearing age’s use of family planning services?
SIGNIFICANCE OF THE 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. As a result, 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 percentage of contraceptive access, with 57 percent of women lacking access, resulting in undesired pregnancies, increasing demand for abortion, and death from unsafe abortion. 37
In Nigeria, maternal mortality is at an unacceptably high level. 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.
SCOPE OF THE STUDY
During a 6-month period, the study included women of childbearing age (15-49 years) living in Obibe Ezena village, Owerri North, Imo state. It investigated the predictors of family planning service utilization as well as the knowledge, attitude, and factors that mitigate against family planning services.
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