|Year : 2013 | Volume
| Issue : 2 | Page : 107-112
Factors related to the uptake of contraceptive in a rural community in Plateau State Nigeria: A cross-sectional community study
Hadiza Abigail Agbo1, Chikaike Ogbonna1, Basil N Okeahialam2
1 Department of Community Medicine, Jos University Teaching Hospital, P.M.B. 2076 Jos, Nigeria
2 Department of Internal Medicine, Jos University Teaching Hospital, P.M.B. 2076 Jos, Nigeria
|Date of Web Publication||24-Dec-2013|
Hadiza Abigail Agbo
Department of Community Medicine, Jos University Teaching Hospital, P.M.B. 2076 Jos
Source of Support: None, Conflict of Interest: None
Background: Contraceptive widely known in most rural setting as family planning is the planning of when to have children and the use of birth control and other techniques to implement such plans. Socio-cultural status is a determinant of health; it also has an influence on women's knowledge and uptake of contraceptive, the study therefore assessed the family planning uptake rate, prevalence of family planning method and the relationship between the social status and the method used.
Methodology: A cross-sectional community survey was conducted among women of reproductive age residing in the community. Epi info version 3.4.3 and statistical package for the social sciences version 16.0 were used for the data entry and analysis respectively.
Results: Out of the 362 females studied, (85.4%) were married and (46.4%) had no formal education. Farming was their predominant occupation. Out of all the females respondents; (86.7%) have had deliveries out of which (42.2%) are multiparous and (44.6%) grand multiparous. Contraceptive use was found to be (18.0%); and the most used was injectables (58.5%). A statistically significant association (P = 0.001) was established between contraceptive use and age, religion and marital status.
Conclusion: Although contraception use was generally poor among the rural women in the studied community; married women, Christians and younger women were more likely to use a method compared to singles, Muslims and the older women respectively.
Keywords: community, contraceptive, family planning, prevalence, rural setting, social factors
|How to cite this article:|
Agbo HA, Ogbonna C, Okeahialam BN. Factors related to the uptake of contraceptive in a rural community in Plateau State Nigeria: A cross-sectional community study. J Med Trop 2013;15:107-12
|How to cite this URL:|
Agbo HA, Ogbonna C, Okeahialam BN. Factors related to the uptake of contraceptive in a rural community in Plateau State Nigeria: A cross-sectional community study. J Med Trop [serial online] 2013 [cited 2019 Jan 23];15:107-12. Available from: http://www.jmedtropics.org/text.asp?2013/15/2/107/123583
| Background|| |
Family planning is one of the ten great Public Health achievements of the 20th century. Family planning is the planning of when to have children and the use of birth control and other techniques to implement such plans ., Family planning is no synonymous with birth control; it is more than mere birth control. Family planning also refers to practices that help individuals or couples to avoid unwanted births, to bring about wanted births, to regulate the intervals between pregnancies, to control the time at which births occur in relation to the ages of the parents and to determine the number of children in the family.  Availability of family planning services allows individuals to achieve desired birth spacing and family size and contributes to improved health outcomes for infants, children, women and families .
Decades ago, family planning was seen as a taboo in Nigeria and indeed in many African countries. Children were seen as gifts from God and any attempt at birth control was considered sinful. The opinion has now changed drastically in favor of family planning such that individuals, families, communities now advocate and seek for it publicly; and of evolving interest is the male involvement in family planning though this is still low in African generally.
Family planning has been proven to save and enhance the lives of women, children and families. It reduces the number of unintended, unwanted and mistimed pregnancies though low rates of contraceptive use and high fertility rates persist in most countries of subSaharan Africa.  Women who control their fertility have fewer unsafe abortions, thereby saving mothers' lives. Family planning allows women to space births and longer birth intervals reduce maternal and infant mortality rates. ,, In addition to disparities in the uptake of family planning across subregions of Africa, wide variation also exists within the country. In particular, SubSaharan Africans living in rural areas tend to use fewer contraceptives and have more children than their urban counterparts. Differences in the knowledge and usage of family planning methods may be due to social factors such as those inherent in the individual's environment; these contribute to the sociocultural determinants of health; they include factors such as marital status, culture, religion, education, tribe and occupation.  Some of these factors impact synergistically on health and several of these factors are found in one's living and working conditions (such as the distribution of income, wealth, influence, power and cultural factors such as belief, custom and norms), rather than individual factors. 
Most women's contraceptive knowledge and practice are influenced by sociocultural norms such as male/husband dominance and opposition to contraception and low social status of women;  which makes it extremely difficult or impossible for these women to take decisions concerning their own health in the absence of their spouses.
The study sought to assess the family planning uptake rate, the prevalence and method of family planning used in the rural setting and the relationship between women's social status and the method of family planning used.
| Methodology|| |
A descriptive crosssectional community survey was conducted in Langai ward of Gindiri district in Mangu Local Government Area (LGA) of Plateau State from 3rd to 14th December 2007. This is a rural community whose main occupations are small scale farming, petty trading and cattle rearing. There are two Primary Health Care Centers and a Comprehensive HealthCare Centre (a rural outlet of the Jos University Teaching Hospital, Jos). The educational institutions in the district are College of Education, Gindiri, Boys' and Girls' High school Gindiri.
A multistage sampling technique was used to select the participants who were adults aged 18 years and above irrespective of their marital status and married women less than 18 years residing in the community. Mangu LGA located in the NorthCentral senatorial zone of Plateau state was selected out of the 17 LGAs in the state through a simple random sampling technique by balloting. Gindiri ward was then selected through a simple random sampling technique by balloting from the 14 political wards in Mangu LGA. Langai community was then selected from the list of seven communities in Gindiri ward.
All the households in the community were visited 1 week prior to research to intimate all the adult and married females about the purpose of research and the venue where the survey will take place (the only Primary Health Center in the community located centrally).
A list of all the female participants within the stipulated age range was compiled in the register in the order of their arrival and registration at the research venue. This formed the sampling frame; all women that consented and came for the survey were enrolled irrespective of their marital status; the women were ordered selected from the beginning of the list starting with the first name and data on 362 women was obtained.
Ethical clearance was sought and obtained from the Jos University Teaching Hospital Ethical Committee. Advocacies were paid to the traditional ward head of Langai; permission was also sought and obtained. Written and thumb printed consent (for the illiterate) were obtained from the participants.
The data was collected through semi structured interviewer administered questionnaire by ten research assistants who had been previously trained. Statistical software Epi Info version 3.4.3 and statistical package for the social sciences version 16.0 were used for data entry and analysis respectively and test of proportion done at P 0.05 significance level.
| Results|| |
A total of 362 females in their reproductive age were surveyed [Table 1]; Islam was the most practiced religion (61.9%). The reproductive age groups 3640 years had the highest frequency (25.7%); and among the women studied (85.4%) were married. The most common ethnic groups were Fyem (the indigenous tribe 50.3%), Bijim (9.9%), Fulani (8.8%), Kadung (3.3%), others (comprising of Hausa, Ngas, Igbo, Berom 27.6%). Persons with no formal education were (46.4%); the predominant occupations in the community were farming, fulltime housewife, civil servant and petty trading.
The main source (46.4%) of health information on family planning [Figure 1] is from friends/family, (19.1%) from health worker in the community health center, (7.2%) from the radio or television in the form of drama and health talk; while (27.3%) have never heard of family planning.
Parity, Prevalence and Type of Contraceptive Used in the Rural Community
Out of all the women who had delivered at one time or the other, (42.2%) of them were multiparous while (44.6%) were grand multiparous [Figure 2]. Contraceptive uptake was found to be (18.0%); while the most used were the oral tablets (24.6%), injectables (58.5%) and other methods like the intrauterine contraceptive device [Figure 3],
Norplant and natural/traditional method of family planning such as prolong breast feeding (16.9%).
One hundred and sixtyone women were grand multiparous (women that had been delivered of greater than four children); the multiparous women who had delivered between 1 and 4 children were 153 of which the primiparous (women who has had a delivery) were 32 constituting (8.8%).
The preference was more of the injectables with more than half of the women patronizing this method [Figure 3].
Contraceptive uptake was low (18.0%) in this community and with a common preference for injectables in all the age group [Figure 4]; which is more in the age groups 2630 years (28.9%) and 3640 years (26.3%).
| Discussion|| |
The vast farm land explains the sociodemographic features which portraits an agrarian community with close to half of them as farmers. Educational status was found to be low, this could have accounted for the high parity seen among the women. It has been demonstrated that, the higher the educational status the less likely is the parity of the woman.  Women with low education also tend to start giving birth at an early age because the period they would have being in school will now be used for conception and deliveries. A related concept that may explain the high parity may be due to the predominant Islamic faith in the community, which encourages polygamy on one side and the farming as the main occupation on the other. A farmer, as a means of getting more helping hands on the farm marries more women whom each invariably gives birth to children of her own, in addition, rivalry and competition in most polygamous setting might also have influence the high parity seen as each women will want to outnumber her counterpart in terms of the number of living children she has, the wife's ability to bear children is seen as a stabilizing influence on her marriage and in some cultures men have to prove their virility by the number of children they have. Another contributory factor, though salient but a major has an influence on high parity is male preference; though this study did not assess this.
It is assumed that the higher the educational status a woman attains, the more she may have acquired the knowledge of what/how to safe guard her own health, many among these benefits is the knowledge on the benefits of family planning and the likelihood of family planning uptake. The major source of information on family planning is from friends and family; which despite the other sources that if put together should have impacted positively on the women, the influence of family as a primary source of socialization was seen as family planning uptake was low.
In rural African settings, it is an established fact that certain social factors such as lack of education, low female economic empowerment all have a role to play in decision making even on issues pertaining to her own health such as the family planning uptake. [12,13] Some religious beliefs do not give women the opportunity to take certain decisions about their health, [14,15] this may be due to religious prohibition or women are considered not fit to take a decision on their own without the permission of the male breadwinner. These and many more may possibly explain the reason for the low contraceptive uptake in the community.
In the traditional African society most health interventions are sought for in the traditional way, but with the advent of modern medicine, many health concepts and beliefs are increasingly changing. One will expect that decades after the introduction of modern contraceptive methods, its prevalence ought to have been high. The prevalence of its utilization is still low in certain regions of the country especially in the rural areas.  In this study, a low prevalence was established in the surveyed community, which is similar to a studies carried out in Zambia. [5,17] In these studies, it found oral contraceptives to be the most practiced method as against the higher use of injectables found in this study. The inconvenience of daily swallowing of oral pills; the nonpermissive culture and religion of the women to family planning, which may deter the daily swallowing of oral pills; the acclaimed associated sideeffects to oral pills; influence by friends/families and timing and convenience of the injectable method; family planning methods more readily available in the community etc., may all have accounted for this difference in findings as compared with the other similar studies. In addition differences in the method used in this study when compared to other studies may be due to the fact that clients visiting family planning centers are educated on the different available methods and also counseled about the methods/perceived to be more suitable for her based on her health; but the client is at liberty to make a decision she so desires.
Government policies and legislations can also affect the type and prevalence of contraceptive uptake as is the case with another study in an Indian rural community where a predominance of female sterilization was found,  which is partially attributed to the government policy on birth control and partially due to the knowledge of the citizenry on the stiffer punishment on noncompliance of such policies; thus they adopt the permanent method out of the likely failure of the temporary methods. This scenario from Langai community, North central Nigeria was quite difference from the Indian findings, because no woman adopted the permanent method of family planning, which could partly be explained by the nonenforcement of the population policy of Nigeria though it stipulates a maximum of four children per woman.
Certain factors may influence a woman's decision to uptake contraception; this may be as an influence of her individual factor; due to her religious and cultural background; due to the contraceptive method itself and may also be due factors related to the altitude of the health personnel and other perceived constraints in the health services generally.
The individual factors are the woman's age, which if young she may want to get her desired number of children before she considers the uptake of a method of contraception and which may also be influenced by her educational level and vice versa, her parity, religious acceptability, sex distribution of the children she already had, the marriage setting (monogamy or polygamy), her occupation and her state of health; all collectively have an influence on her perception and uptake of family planning. From this study, a within group analysis of the parameters mentioned above produced a statistical significant relationship of P < 0.01 [Table 2]; buttressing the influence these factors have on family planning uptake as more women did not take to any contraceptive method. Contraceptive uptake was higher among the Christian women than their Muslim counterparts; this may be due to certain restrictions which the religion imposes on such women, such as the need to seek the spouse's consent before attending clinic, lack of financial resources and insufficient information about contraception; though even among the Christian faithful, some frown at the use of contraceptives, which could have accounted for the low percentage of uptake even among them. The low contraceptive uptake among the full time housewives may be due to their lack of employment thus their productive period will be geared toward child bearing and not contraception. None of the unmarried practiced contraception, could this likely be due to religious inclination to abstinence? This is a possibility as the two main religions prevalent in the community promote abstinence as a means of contraception in the unmarried.
|Table 2: Relationship between contraceptive uptake and social characteristics |
Click here to view
| Conclusion|| |
Contraceptive uptake was found to be low among the rural women. Adequate advocacy on the benefits of contraceptive use may improve knowledge because of the low literacy rate observed; and an improved knowledge and uptake may impact positively on health indices especially in the rural communities in Africa where decisions affecting health is influenced by many social and cultural factors.
| References|| |
|1.||Wikipedia. Family planning, 2010. Available from: http://www.en.wikipedia.org/wik. [Last cited on 2013 Jan 08]. |
|2.||World Health Organization. Family planning, 2013. Available from: http://www.who.int/topics/family_planning/en/. [Last cited on 2013 Jan 08]. |
|3.||Park K. Family planning. In: Park's Textbook of Preventive and Social Medicine. 18th ed. Jabalpur, Indian: M/s Banarsidas Bhanot Publishers; 2009. p. 3589. |
|4.||Centres for Disease Control and Prevention. Achievements in public health, 19001999: Family planning. MMWR Morb Mortal Wkly Rep 1999;48:107380. |
|5.||White JS, Speizer IS. Can family planning outreach bridge the urbanrural divide in Zambia? BMC Health Serv Res 2007;7:143. |
|6.||Rutstein SO. Effects of preceding birth intervals on neonatal, infant and underfive years mortality and nutritional status in developing countries: Evidence from the demographic and health surveys. Int J Gynaecol Obstet 2005;89 Suppl 1:S724. |
|7.||CondeAgudelo A, Belizán JM. Maternal morbidity and mortality associated with interpregnancy interval: Cross sectional study. BMJ 2000;321:12559. |
|8.||Kelly MP, Morgan A, Bonnefoy J, Butt J, Bergman V. The social determinants of health: developing an evidence base for political action. National Institute for Health and Clinical Excellence, 2007. Available from: http://www.who.int/final_report_102007. [Last cited on 2013 Jan 10]. |
|9.||Wikipedia. Social determinants of health, 2012. Available from: http://www.en.wikipedia.org/wiki/Social_determinants_of_health. [Last cited on 2012 Nov 21]. |
|10.||Beekle AT, McCabe C. Awareness and determinants of family planning practice in Jimma, Ethiopia. Int Nurs Rev 2006;53:26976. |
|11.||Korra A. Attitudes toward family planning, and reasons for nonuse amongwomen with unmet need for family planning in Ethiopia, 2002. Available from: http://www.martinslibrary.blogspot.com/2012/12/attitudestowardfamily. [Last cited on 2013 Jan 10]. |
|12.||Haile S, Stloukal L. Provision of reproductive health services in SubSaharan Africa: Lessons, issues, challenges and the overlooked rural majority. Sustainable Development Department (SD), Food and Agricultural Organization, 2000. Available from: http://www.fao.org/sd/wpdirect/wpan0044.htm. [Last cited on 2013 Jan 14]. |
|13.||Nankwanga A. Improving the lives of girls and women in Nigeria. Gender in Nigeria report, 2012. Available from: http://www.dfid.gov.uk/Documents/publications1/GenderNigeria2012. [Last cited on 2013 Jan 14]. |
|14.||Nakiboneka C, Maniple E. Factors related to the uptake of natural family planning by clients of catholic health units in masaka diocese, Uganda. Vol. 6. Kampala: UMU Press; 2008. p. 12641. |
|15.||Bogale B, Wondafrash M, Tilahun T, Girma E. Married women's decision making power on modern contraceptive use in urban and rural southern Ethiopia. BMC Public Health 2011;11:342. |
|16.||Adinma ED, Adinma JI, Eke NO, Iwuoha C, Akiode A, Oji E. Awareness and use of contraception by women seeking termination of pregnancy in south eastern Nigeria. Asian Pac J Trop Dis 2011;1:715. |
|17.||Monjok E, Smesny A, Ekabua JE, Essien EJ. Contraceptive practices in Nigeria: Literature review and recommendation for future policy decisions. Open Access J Contracept 2010;1:922. |
|18.||Murarkar SK, Soundale SG, Lakade RN. Study of contraceptive practices and reasons for not accepting contraceptives in rural India: Chanai village as a case study. Indian J Sci Technol 2011;4:915-6. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]