|Year : 2019 | Volume
| Issue : 2 | Page : 67-72
Knowledge, attitude and practice of modern contraception among women of reproductive age in urban area of kano, north-western nigeria
Auwal Umar Gajida1, Idris Usman Takai2, Iman Usman Haruna3, Khadija Abbati Bako4
1 Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
2 Department of Obstetrics and Gynaecology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Obstetrics and Gynaecology, Maitama Sule University/Muhammad Abullahi Wase Specialist Hospital, Kano, Nigeria
4 College of Health Sciences, Bayero University, Kano, Nigeria
|Date of Submission||22-Mar-2019|
|Date of Decision||22-May-2019|
|Date of Acceptance||19-Jun-2019|
|Date of Web Publication||13-Dec-2019|
Idris Usman Takai
Department of Obstetrics and Gynaecology, Bayero University Kano/Aminu Kano Teaching Hospital, Kano
Source of Support: None, Conflict of Interest: None
Background: The contraceptive prevalence is on the rise worldwide as more people have become informed and aware with a positive attitude toward its practice. This study, therefore, investigates the knowledge, attitude, and practice of modern contraception among women of reproductive age in Kundila Housing Estate, Kano Metropolis, Nigeria. Methods: A cross-sectional community-based study was conducted in Kundila Housing Estate, Tarauni Local Government Area of Kano State. Using a multistage sampling, 183 women of reproductive age were selected and interviewed using an interviewer-administered questionnaire with both open and close-ended questions. Results: The age of the respondents ranged from 15 to 49 years with a mean of 29.5 ± 8.0 years and majority 44 (24.0%) were aged 25–29 years. Most of the respondents (96.7%) were aware of the concept of modern contraception, and 85.8% of them had adequate knowledge. Majority of the respondents (70.5%) recommended the introduction of family planning lessons in schools, whereas 29.5% did not agree. Similarly, 60.7% of respondents were found to have good practice of modern contraception and majority of them obtained reproductive services from the primary health centers. Educational level, family structure, and duration from last childbirth were found to be significantly associated with the knowledge of modern contraception among the respondents. Conclusion: This study further affirms the positive attitude of women in Kano Metropolis toward the use and practice of contraception.
Keywords: Awareness, contraception, kano, knowledge, kundila, practice
|How to cite this article:|
Gajida AU, Takai IU, Haruna IU, Bako KA. Knowledge, attitude and practice of modern contraception among women of reproductive age in urban area of kano, north-western nigeria. J Med Trop 2019;21:67-72
|How to cite this URL:|
Gajida AU, Takai IU, Haruna IU, Bako KA. Knowledge, attitude and practice of modern contraception among women of reproductive age in urban area of kano, north-western nigeria. J Med Trop [serial online] 2019 [cited 2020 Apr 10];21:67-72. Available from: http://www.jmedtropics.org/text.asp?2019/21/2/67/272920
| Introduction|| |
Contraception is the prevention of conception by methods other than abstinence from coitus and may be natural or artificial. The contraceptive prevalence rate among married women varies with age, rising from 3% among women aged 15 to 19 years to a peak of 23% among women aged 35 to 39 years before declining to 13% among women aged 45 to 49 years. There has been a gradual decline in fertility rates in the last decade, from 5.7 births per woman in the 2008 Nigeria demographic and health survey (NDHS) to 5.5 births per woman in the 2013 NDHS and 5.3 births per woman in the 2018. Regional differences are known to exist in contraceptive prevalence rate even within the same countries and localities. Studies in developing countries have shown low frequencies of contraceptive use despite the high level of awareness as shown by Allagoa and Nyengidiki in PortHacourt and Aliyu et al. in Zaria. The main reasons for this were a desire for larger family size, pressure from husbands, religious concerns, and fear of side effects. Nigeria is the most populous country in Africa with a current population of over 150 million and a growth rate of approximately 2.4% per annum. Its rapid population growth poses more strain on its resources. This increase in population has been attributed to many factors that include low contraceptive use, high fertility rate accompanied by steady declines in death rates, and high but declining mortality rate. Utilization of modern methods of contraceptives varies with background characteristics such as age, marital status, education, religion, number of living children, desire for more children, ever use of contraceptives, urban–rural residence, and wealth or socioeconomic status. Hence, these background characteristics determine the person’s attitude toward the use of contraceptives and the ability to understand the mechanism of action and effective use of the methods. They may also affect the ability to access various types of contraceptives, hence, the type of contraceptive the individual is likely to use. Many factors come together to influence an individual’s decision to either use a particular contraceptive method or not; factors such as sociocultural beliefs and perception and practices may influence knowledge about contraceptives and contraception, and the use of contraceptives. For instance, people who perceive that they are at low risk for pregnancy may not use any contraceptive. Religious and cultural practices in some parts of the world deter women from using contraceptives. For instance, in Pakistan, it was found that 65% of women believed that contraception is prohibited in religion whereas 35% believed that contraception is permitted in religion in view of providing better resources for the child. And with regard to health, 57% of the women thought that contraceptive use affects their health considerably whereas 43% of them considered that the health was not affected by the contraceptive.
| Patients and methods|| |
This was a descriptive cross-sectional study carried out among 183 married women of reproductive age group in Kundila Housing Estate, Tarauni Local Government Area of Kano State, Nigeria. Information was obtained from respondents using an interviewer-administered questionnaire with open and close-ended questions. Multistage sampling technique was used for the selection of respondents. Selection of a ward from a list of the entire wards in the Local Government Area was done. The data collected were analyzed using Microsoft Excel and SPSS statistical software (version 16.0, Chicago, USA). Quantitative data were summarized using mean and standard deviation (SD), whereas qualitative variables were summarized using frequencies and percentages. The chi-square test was used to determine significant association between categorical groups and a P value of <0.05 was considered as statistically significant. Ethical clearance was obtained from Kano State Ministry of Health Research and Ethics Committee and clearance was obtained from the Local Government Chairman and the Ward Head, seeking their permission before the commencement of the study.
| Results|| |
A total of 183 respondents were interviewed giving a response rate of 100%. [Table 1] shows the sociodemographic characteristics of the respondents. Age ranged from 15 to 49 years with a mean of 29.5 ± 8.0 years, and almost one-fourth of them (24.0%) were aged 25 to 29 years. Majority (90%) of the respondents were Muslims, whereas the remaining (10%) were Christians. Most of the respondents (57.4%) were Hausas. Of the 183 respondents, 61.7% were currently married, with monogamy being the most common type of family structure (51.0%), whereas 29.0% were yet to get married and therefore did not respond to the type of family structure. Among the respondents, 53.7% were attending or had attended tertiary institutions and only 2.2% did not receive any form of education. About a quarter of the respondents were students (26.2%), housewives (29.5%), and up to 61.7% had delivered once and/or five times. Of those who had delivery, 43.7% had one to three surviving children whereas 29% were yet to give birth. Majority (55.2%) of the respondents desired to have between one and five children whereas 34.4% desired between six and 10 children.
|Table 1: Sociodemographic and reproductive characteristics of respondents|
Click here to view
Injectable was the most widely known method (32.8%); 21.9% of the respondents claimed that they were aware of all the methods of modern contraception, and intrauterine devices and sterilization were the least known methods, 3.8% and 1.1%, respectively. Among the respondents who were aware of modern contraception, 84.7% knew that condoms can prevent unwanted pregnancies, gonorrhea, and HIV, whereas 15.3% did not know [Table 2].
|Table 2: Distribution of respondents’ awareness of modern methods of contraception|
Click here to view
[Table 3] shows that a significant portion of the respondents (85.8%) had adequate knowledge of modern contraception based on the questions asked; only 14.2% had inadequate knowledge. Majority of the respondents (63.4%) had a positive attitude toward modern contraception. Majority of the respondents (60.7%) were found to have good practice of modern contraception, whereas 39.3% had bad practice.
A statistically significant association was found between respondents’ years since last childbirth, family structure, and educational status with knowledge of modern contraception whereas no association was found with age. There was also a statistically significant association between respondents’ type of family structure and educational level with attitude toward modern contraception. However, no significant association was found between age, family structure, ethnicity, and attitude toward use of contraception. A significantly statistical association was similarly found between type of family structure and age with the practice of modern contraception whereas no association was found between educational level and religion. These associations and the significant levels are shown in [Table 4].
|Table 4: Factors that affect knowledge, attitude, and practice of modern contraception among the respondents|
Click here to view
| Discussion|| |
This study involved a total of 183 women of reproductive age group (15–49 years). Majority of the respondents were within the age 25 to 29 years (24.0%). This is in keeping with the population pyramid of developing countries, of which Nigeria is a typical example. Ninety percent of the respondents were Muslims and 10% were Christians, which is typical of northern Nigerian setting, particularly far northern states where over 95% of the population are Muslims with the minority Christians mainly being immigrants from the Southern part of the country. The same explains the ethnic distributions where the indigenous Hausa and Fulani accounted for 57.4% and 27.3%, respectively. The Yoruba’s constitute 9.8%, Igbo 4.4%, whereas other minorities constitute 1.1%, also typical of northern Nigerian setting. The literacy level of the respondents was relatively high (88%), although it is yet to meet the national figure of 91%. This finding correlates with that of a study done in Panshekara, where 70% of the respondents had formal education. Majority of the respondents (73%) were married and in monogamous union (51%); this is much lower than the 72.2% of respondents in monogamous setting reported by Aliyu et al. in a study done in Sabon-Gari, Zaria, northern Nigeria. Sixty-five percent of the respondents had given birth to at least one child and 62% of them gave birth within the last 5 years. As found in a previous study, age, educational status, type of family structure, tribe, religious beliefs, and parity were important significant determinants of ever use of modern contraceptives. Knowledge of modern contraceptives among the respondents was almost universal (96.7%); this is higher than the 75% observed in a similar study. The most known method of modern contraception was injectable, and this is consistent with the earlier study. Majority of the respondents (57.9%) who were aware of modern contraception believed that the methods are used for child spacing whereas 14.8% believed that they are for sexual enjoyment. In addition, 84.7% of the respondents who were aware of modern contraception knew that condoms could prevent unwanted pregnancies and protect against sexually transmitted diseases like HIV and gonorrhea, whereas 15.3% did not know. This is similar to the finding of a study done in Sudan where better child healthcare, ease of financial burden, and better maternal health were reasons for approval of contraception. The high knowledge of modern contraception among respondents can be explained by increase in the creation of awareness of modern contraception, especially through media programs, and the availability of educational materials on modern contraception in health facilities. Although major source of information regarding modern contraception among the respondents was from healthcare providers, a significant number of the respondents also got information from spouses or friends and family. Unfortunately, caution is required as information obtained through friends or family may be either incomplete or wrong. Awareness of modern contraception was relatively higher among respondents who had tertiary education compared to those with secondary, primary, or no formal education at all, with a statistically significant association (χ2 = 6.3, P < 0.05) as educated respondents tend to be more exposed and more likely to come across information regarding modern contraception. A statistically significant association (χ2 = 5.1, P < 0.05) was also found between respondents’ last year of childbirth and knowledge of modern contraception, as those who delivered within the last 5 years were more aware than those whose last childbirth was more than 5 years ago. This can possibly be due to increasing awareness of modern contraception among those who have recently been in contact with health workers and health facilities. This also correlates with the findings of a study in Zaria, northern Nigeria, where a statistically significant association was found between respondents’ educational status and knowledge of contraceptive methods. Majority of the respondents (63.4%) had a positive attitude toward modern contraception, which is lower than that of a study conducted by Etokidem et al. in which most of the respondents’ reasons for not having a positive attitude ranged from desire for more children to spousal disapproval and cultural and religious beliefs. Thus, attitude is rather a variable that is affected more by religion, culture, educational level, and occupation among others. This study found a statistically significant association (χ2 = 19.0, P < 0.05) between respondents’ educational level and attitude toward modern contraception, as majority with good attitude had tertiary level of education. This is because education empowers women to seek for health information including contraception. The respondents’ family structure was also found to have a statistically significant association (χ2 = 13.0, P < 0.05) with attitude toward modern contraception, because those in monogamous settings had a positive attitude toward modern contraception, when compared to the respondents in polygamous settings. These findings correlate to those of a previous study. This study also found that male partners play a role in the decision-making process about contraceptive use in 50% of contraceptive users, which is in agreement with the findings in a previous study.
Among the respondents, a significant proportion of them (60.7%) had good practice of modern contraception as opposed to a study conducted by Allagoa et al. in which only 25.7% of the respondents had good practice. In this study, only 38.8% of respondents had not used any method of modern contraception. This differs from the findings of Allagoa et al., in which 72.7% of respondents had not used any method of contraception. The practice of modern contraception was relatively higher among respondents above 30 years, with a statistically significant association (χ2 = 32.1, P < 0.05) between respondents’ age and the practice of modern contraception. The reasons given by respondents below 30 years were mainly the desire to have more children and also fear of side effects. This was similar to the findings in a study in Jos in which uptake was mainly limited by the desire to have more children (58%) and fear of side effects (34%). Among the respondents who used a modern contraceptive method, 69.4% did not experience any side effects, 28.9% experienced abnormal menstrual bleeding, and 1.7% had other side effects like weight gain and headaches. This defers from a study done in Osogbo, in which 71.4% of respondents had menstrual abnormality and others had weight gain and nipple or abnormal vaginal discharge. When asked about side effects, most respondents (72%) confirmed that they would seek medical care if they experienced some, 24% said they would stop the method and never use any of them again, whereas 3.8% of the respondents said they would endure side effects. This is similar to the findings of a previous study, in which 22.4% of the respondents said that they would discontinue a method if they experienced side effects. Respondents in monogamous settings had good practice of modern contraception with a statistically significant association (χ2 = 13.0, P < 0.05), when compared to respondents in polygamous settings. This correlates to similar findings in a previous study.
In conclusion, the knowledge, attitude, and practice of modern contraception among women of reproductive age in Kundila Housing Estate were significantly found to be adequate, positive, and good, respectively. However, despite their adequate knowledge, a significant proportion believed that modern contraception promotes promiscuity and there is significant criticism of women who patronize contraceptive services. Of the social demographic factors assessed, educational level and type of family structure of the respondents were found to be significantly associated with their knowledge and attitude toward modern contraception, whereas respondents’ age and educational level had significant association with practice of modern contraception.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Tindall VR. Contraception. In: Jeffcoate’s Principles of Gynaecology. 5th ed., Vol. 40. London: Butterworth; 1987. pp. 598-616.
The Federal Republic of Nigeria, National Population Commission (NPC) [Nigeria] and ICF. Nigeria Demographic and Health Survey 2018 Key Indicators Report. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF 2019. pp. 13-7.
Ankomah A, Anyanti J, Adebayo S, Giwa A. Barriers to contraceptive use among married young adults in Nigeria: a qualitative study. Int J Trop Dis Health 2013;3:267-82.
Allagoa DO, Nyengidiki TK. KAP of contraception amongst antenatal patients at The University of Port Harcourt Teaching Hospital, Port Harcourt. Niger Health J 2011;11:89-92.
Aliyu A, Dahiru T, Oyefabi AM, Ladan AM. Knowledge, determinants & use of modern contraceptives among married women in Sabon-Gari Zaria-Northern Nigeria. J Med Biomed Res 2015;14:13-21.
Nigeria Demographic and Health Survey. Preliminary Report. National Population Commission Abuja, Nigeria. Measure DHS ICF International Calverton, Maryland, USA; October, 2013. pp. 10-8.
Atiemo M. Factors influencing utilization of contraceptives among women in reproductive age in the Ashanti-Mampong Municipality of Ashanti Region. Unpublished Thesis of Master Public Health, Department of Population, Family and Reproductive Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, 2015.
Aryeetey R, Kotoh AM, Hindin MJ. Knowledge, perceptions and ever-use of contraception among women in the Ga East District, Ghana. Afr J Reprod Health 2010;14:26-31.
Naqvi S, Hashim N, Zareen N, Fatima H. KAP of parous women regarding contraception in Sir Syed Hospital, Karachi. J Coll Phys Surg Pak 2011;21:103-5.
United Nations Population Division. World Population Prospects: The 2012 Revision. New York: United Nations 2013. pp. 1-118.
Kabir M, Iliyasu Z, Abubakar IS, Maje BS. The role of men in contraceptive decision-making in Fanshekara Village, Northern Nigeria. Trop J Obstet Gynaecol 2004;20:24-31.
National Population Commission. NDHS. Preliminary Report 2013;3:10-1545.
Khalifa M. Knowledge and attitude of family planning in Khartoum Province, Sudan, Egypt. Popul Fam Plann Rev 1982;16:20-38.
Ejembi CL, Alti-Muazu M, Chirdan O, Ezeh HO, Sheidu S, Dahiru T. Utilization of Maternal Health Services by rural Hausa women in Zaria environs, Northern Nigeria: has primary health care made a difference? J Commun Med Primary Health Care 2004;16:47-54.
Etokidem AJ, Ndifon W, Etowa J, Asuquo EF. Family planning practices of rural community dwellers in Cross River State, Nigeria. Niger J Clin Pract 2017;20:707-15.
] [Full text]
Ashimi AO, Amole TG, Ugwa EA, Ohonsi AO. Awareness, practice and predictors of family planning by pregnant women attending a tertiary hospital in a semi-rural community of North-West Nigeria. Afr J Basic Clin Reprod Sci 2016;5:6-11.
Chingle M, Banwat M, Lar L, Zoakah A. Contraceptive uptake among women of reproductive age in a semi-urban area in Jos South Local Government Area of Plateau State, North Central Nigeria. Niger Health J 2013;69-74.
Adeyemi AS, Adekanle DA. Progestogen-only injectable contraceptive: experience of women in Osogbo, South-western Nigeria. Ann Afr Med 2012;11:27-31.
] [Full text]
[Table 1], [Table 2], [Table 3], [Table 4]