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ABSTRACT

Family planning is an important preventive measure against maternal and child morbidity and mortality. It is an essential component of primary health care and reproductive health. There is relatively high fertility rate in suburban and rural Nigeria despite the efforts of government and other non-governmental family planning services providers. This study sought to investigate the acceptance and utilisation of family planning services amongst secondary school students in Kakwalaka Village, Bendi in Obanliku Local Government Area of Cross River state. It is a descriptive cross-sectional, conducted among 364 secondary school students (15 to 49 years), utilizing the multi-stage sampling technique.139 (37%) of the respondents were within the age group 15 to 24 years, all respondents were married (100%) and 135 (37%) had more than 5 children. About half of the respondents (48.7%) had no formal education. Few were currently using a contraceptive method, however, the majority whom were not using any method had main reasons being lack of appropriate knowledge on family planning, fear of side effects and availability. The most significant socio-demographic determinants of utilization of family planning services were religion (p-value 0.01), family setting (p-value <0.001),age (p-value 0.01) and male involvement (p-value <0.001) . The utilization of family planning services among the rural women was poor, with religion, fear of side effect and husbands’ disapproval among other reasons being the main reasons for non use.

CHAPTER ONE

INTRODUCTION

1.1 Background to Study

Family planning is widely acknowledged as an important intervention towards achieving Millennium Development Goals (MDGs) four (4) and five (5) as it has proven to reduce maternal and child mortality. Family planning can prevent unwanted pregnancies and unsafe abortions. Some family planning methods such as condom usage can protect individuals from Sexually Transmitted Infections (STIs) including HIV/AIDS. Family planning has also been found to promote gender equality as well as promote educational and economic empowerment for women. Despite the enormous benefits of family planning services, the uptake of the service still remains low in Sub-Saharan Africa. This has resulted into high rates of unwanted pregnancies, unplanned deliveries, unsafe abortions and maternal mortalities in Sub-Saharan Africa of which Nigeria is no exception. The low uptake of family planning is largely blamed on many factors. It has been observed that the awareness of the availability of family planning services has a great influence on the uptake of family planning services. Additionally, even though some women are aware of the availability of family planning services, they are not properly informed about the various forms of family planning methods and how they work. Some of the women who went for family planning services were not adequately counselled on the side effects of some of the family planning methods. For example, in Uganda, some women stopped using contraceptives after they experienced what they perceived were side effects of the contraceptives.

Although most people are aware of the benefits of family planning services, they complained that it was difficult to access family planning services as such services were provided by health facilities that were far from their homes. In addition, religious inclination has been noted to be a major constrain to the uptake of family planning services in Africa. Also, some individuals perceived that family planning services were meant for only married couples whilst others fear that they will become sexually promiscuous if they go for family planning services once they cannot become pregnant. In Nigeria, some efforts have been made by the government of Nigeria and non-governmental organizations through the implementation of various programmes to improve the coverage of family planning services in the country. Although some successes have been chucked in the area of awareness of family planning services in the country, the unmet need for family planning still remains high. The Nigeria Demographic and Health Survey (GDHS) observed that a large number of women have an unmet need for family planning as the acceptor rate for family planning services remains low.

Family planning is an important preventive measure against maternal and child morbidity and mortality. It is an essential component of primary health care and reproductive health. It plays a major role in reducing maternal and neonatal morbidity and mortality. It confers important health and development benefits to individuals, families and communities and the nation at large. It helps women to prevent unwanted pregnancies and limit the number of children, thereby enhance reproductive health. By this, it contributes towards achievement of Millenium Development Goals (MDGs) and the Target of the Health for all Policy.13 The MDGs call for 75% reduction in maternal mortality and two-thirds reduction in child mortality between 1990 and 2015. As such effective utilization of family planning services is critical for the attainment of these goals thus improving health and accelerating development across the regions.15Access 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 estimated that preventing unwanted pregnancies by the use of family planning would avert a total of 4.6million Disability Adjusted Life Years.16 Despite the importance and benefits of family planning, it has been estimated that about 17% of all married women globally would prefer to avoid pregnancy but are not willing to use any form of family planning.17 As a result, 25% of all pregnancies are unintended particularly in developing region of the world. This results to an estimated 18million abortion taking place each year, thereby contributing to high maternal morbidity and injuries.14,17 Sub-Saharan Africa which is home to only 10% of the world’s women, contributes annually, 12million unwanted or unplanned pregnancies and 40% of all pregnancy related deaths worldwide. The contraceptive prevalence in sub-Saharan Africa is low, estimated at 13%, in spite of the evidence of the pivotal role of family planning, while in Nigeria the estimation is 8.0% with 17% unmet need for family planning. This greatly contributes to the high rate of unintended pregnancies leading to induced abortion with its consequent complications. Despite the fact that Nigeria constitutes only 2% of the world’s population, it has been shown to account for 10% of the world’s maternal deaths. There is relatively high fertility rate in suburban and rural Nigeria despite the efforts of government and other non-governmental family planning services providers. Even though the fertility rate is high, acceptance and utilization of modern family planning methods has been low due to various reasons. In Africa, provision of family planning services is hindered by poverty, poor co-ordination of the programme and dwindling donor funding. Additionally, traditional beliefs favouring high fertility, religious barriers, fear of side effect and lack of male involvement have contributed significantly in weakening family planning interventions among women.

1.2 Statement of Problem

According to NDHS 2013, only 15 percent of currently married women in Nigeria are using a contraceptive method, indicating only a two percentage point increase from the 2003 NDHS. The majority of contraceptive users rely on a modern method (10 percent of currently married women), and 5 percent use traditional methods. Among the modern methods, injectables (3 percent), male condoms (2 percent), and the pill (2 percent) are the most common methods being used. The practice of all other modern methods is far less (under 1 percent). Interestingly, 3 percent use withdrawal as a method of contraception.

The use of contraceptives varies by women’s background characteristics. The proportion of currently married women who are currently using any method of contraception rises with age from only 2 percent among women age 15-19 to 22 percent among age 40-44. The use of contraception then decreases among women who are age 45 and older. Among modern methods, use of condoms is more popular among women under age 35, while injectables are more popular among women age 35-44. Currently married women in urban areas are considerably more likely to use any method of contraception (27 percent) than women in rural areas (9 percent). Use is higher in urban than in rural areas for each of these methods. Contraceptive use among currently married women aged between 15 to 49 years in North West Nigeria is 4.3% while that of North East and North Central are 3.2% and 15.6% respectively. Use is higher in Southern Nigeria with South East (29.3%), South South (28.1%) and South West (38.0%). Gross disparities occur among the six (6) geopolitical zones as well as among states. Kano State has contraceptive use of 0.6% (lowest in the North) with only 0.5% using any modern method (pill- 0.2%, IUD- 0.2%, injectables- 0.1% while 0.0% use implants, male condom, LAM, standard days methods and female sterilization).

There is a direct relationship between the outcome of pregnancy and family planning. The demographic transition theory states that only when fetal, infant, and child mortality rates are reduced it is likely that a family will accept family planning.29 Thus, improvement of maternal and child health services is a prerequisite for family planning. As a result, child spacing is a critical factor which influences the outcome of pregnancy. When women adhere to the World Health Organization recommended minimum inter-birth interval of 33 months between two consecutive live births, the incidence of prematurity reduces. Thus, prevention of rapid series of many pregnancies provides a greater possibility of reducing maternal, fetal, infant, and childhood mortality.30 In general, child spacing provides greater opportunities for nurturing the individual child thereby providing the possibility of preventing complications such as gastrointestinal infections and malnutrition during infancy and early childhood.30 Family planning may also improve the quality of life and raise the standard of living by decreasing the number of dependents requiring intensive personal care, education, food, shelter, and clothing, among others. Nevertheless, where family planning services may be available, its use may be limited due to a number of factors such as low literacy levels, socio-cultural beliefs favoring large families, and unavailability of services due to dysfunctional health services.31 Along with these dynamics in maternal care and contraceptive use patterns, there has been less progress in improving infant and child survival and primary care utilization. As of 2008, the North West and North East regions were the regions with the highest proportions of children 12-23 months who had never been vaccinated, 48.7% and 33.9%, respectively, and fewer than 15.0% had a vaccination card. Vaccination coverage rates in the four northern states of Zamfara, Katsina, Jigawa, and Yobe were all 5.4% and below.27 When their young children became sick with pneumonia, malaria or diarrhea, under half of all sick children were taken to a health facility for treatment. Infant mortality rate was 139 deaths per 1,000 births in the North West region and 126 deaths per 1,000 live births in the North East region, while under five mortality rate was 217 and 222 deaths per 1,000 live births, respectively. Hence, this study on acceptance and utilisation of family planning services amongst secondary school students a case study of Kakwalaka Village, Bendi, in Obanliku, Cross River state.

1.3 Research Objectives

To assess the acceptance and utilisation of family planning services amongst secondary school students in Kakwalaka Village, Bendi, in Obanliku, Cross River state, Nigeria, the following specific objectives were formulated;

1. To determine the level of knowledge of family planning among secondary school students.

2. To determine the attitudes of rural secondary school students towards family planning.

3. To determine the level of use of family planning products and services among secondary school students.

4. To determine the factors associated with utilization of family planning services among secondary school students.

1.4 Research Questions

1. What is the level of knowledge of family planning among secondary school students in Kakwalaka Village, Bendi, in Obanliku, Cross River state.?

2. What are the attitudes of rural secondary school students towards family planning?

3. What is the level of use of family planning products/methods and services among rural secondary school students?

4. What are the factors associated with utilization of family planning services among rural secondary school students?

1.5 Scope of the study

The study covered secondary school students residing in Kakwalaka Village, Bendi, in Obanliku, Cross River state during the period of 6 months. It determined the knowledge, attitude and factors militating against family planning services as well as assessed the determinants of utilization of family planning services.

1.6 Significance of Study

High fertility rate and inadequate spacing between births, can lead to high maternal and infant mortality. An estimated 600 000 maternal deaths occur worldwide each year; the vast majority of these take place in developing countries. WHO estimates that 13% of these deaths are due to unsafe abortion. Worldwide, where approximately 50 million women resort to induced abortion, frequently results in high maternal morbidity and mortality. Thus, family planning and spacing among births are one of the methods to avoid these deaths. Promotion of family planning and contraceptive use is highly adopted by the international community as one of the strategy to reduce the maternal mortality and to reach the Millennium Development Goals. Africa characterized by high rate of lack to contraceptive access reaching 57% and this lack lead to unwanted pregnancies, increased demand to abortion and death related to unsafe abortion.37

In Nigeria, there is unaccepted high maternal mortality. Moreover, legally, politically and culturally access to abortion create internal dispute, therefore effective contraceptive programming should be the current and future approach to reduce the risk and unwanted pregnancies. Few published data exist concerning use of family planning services in Nigeria especially northern part where we have recently observed high maternal morbidity and mortality in this setting. This study will educate the public as well as provide literature on the subject matter.