| Abstract|| |
Background: The use of modern contraceptive (MC) is a cost-effective public health measure for reducing maternal deaths due to unintended and high-risk pregnancies. In Nigeria, efforts have been made by government and nongovernmental organizations toward improving access to family planning services. The impact of this effort among rural women in Rivers State, Nigeria, however, is insufficiently documented hence the need for this study. Subjects and Methods: A total of 380 rural women of childbearing age in Rivers State, Nigeria, were recruited by a multistage random sampling method using a cross-sectional descriptive design. Respondents provided information on their socioeconomic background, sources of information and knowledge of MCs, contraceptive use, and the reasons for use or nonuse of contraceptives. Data were analyzed with SPSS version 15 and the level of statistical significance was set at P = 0.05. Results: Almost all (n = 378; 99.5%), the rural women had awareness of MCs, but only 238 (63.0%) had good knowledge of it. The most common known methods were the male condom (n = 255; 67.1%) and injectables (n = 190; 50.0%). Those in current use of any MC method were 140 (36.8%) while only 86 (22.6%) used it consistently. Male condom was the commonly used method. Conclusion: Although the awareness of MCs among rural women in Rivers State Nigeria is high, their uses are unacceptably low. Family planning education should be provided for community-based health-care givers; mass media efforts need to be intensified in local languages.
Keywords: Modern contraceptives, rural women, Rivers State Nigeria
|How to cite this article:|
Osaro BO, Tobin-West CI, Mezie-Okoye MM. Knowledge of modern contraceptives and their use among rural women of childbearing age in Rivers State Nigeria. Ann Trop Med Public Health 2017;10:1043-8
|How to cite this URL:|
Osaro BO, Tobin-West CI, Mezie-Okoye MM. Knowledge of modern contraceptives and their use among rural women of childbearing age in Rivers State Nigeria. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Nov 20];10:1043-8. Available from: http://www.atmph.org/text.asp?2017/10/4/1043/215893
| Introduction|| |
Modern contraceptives (MCs) and family planning information are some of the most cost-effective public health measures for improving reproductive health, and gender equity among women in developing countries,, its use improves maternal health by lowering cases of unwanted pregnancies and induced abortions, as well as reducing the proportion of high-risk births. It is estimated that 140,000–150,000 women are saved annually from pregnancy-related deaths in sub-Saharan Africa.,,,, In Nigeria, women often have one or more children than the number they desired, and women in rural areas with higher total fertility rates are therefore more at the risk of avoidable pregnancies and pregnancy-related deaths.
It is estimated that more than 60% of women with unintended pregnancies were not using any form of contraception., This is a common practice, especially in the rural areas, where reproductive health decisions are largely shaped by the norms and beliefs of the communities in which they live., Nevertheless, about 12.4% of these women rely on ineffective traditional methods for contraception.,,, In Nigeria, only 5.7% of rural women are currently using any method of modern contraception despite the adverse maternal mortality ratio of 576 deaths per 100,000 live births. This prevalence varies and ranges between 7% and 29% depending on the area of the country.,,,, Concerted efforts have, however, been made by various State governments in the country and other stakeholders such as nongovernmental organizations to increase contraceptive awareness through the mass media and ensuring its access by making available of family planning products and services. The impact of these efforts on the contraceptive behavior among rural women with persistent higher unmet contraceptive needs has not been sufficiently documented in Rivers State.
This study was, therefore, undertaken to assess the knowledge and utilization of MCs among women of childbearing age in Rivers State, with a view to identifying existing gaps which may form the basis for developing strategies that will improve contraceptive acceptance and utilization rates among rural women in the state.
| Subjects and Methods|| |
The study was carried out in Rivers State, one of the oil mineral producing States in the Niger Delta area of Nigeria. The State is comprised three urban and 20 rural Local Government Areas (LGAs). Each of the rural LGAs is delineated into 10 or more political wards. Family planning services in the LGAs are provided by government owned primary health-care centers, patent medicine vendors, and chemist shops. The female population in Rivers State is estimated at 2.5 million and women aged 15–49 years who are married/in union constitute 69%.,,
Study design and sampling
The study was of descriptive cross-sectional design carried out in August 2013 among women of reproductive age residing in rural communities of the State. The minimum sample size was determined using the formula:n = Z2pq/d2; where n = mimimum sample size; Z = Level of statistical significance = 95% (1.96); P = The prevalence of MC usage among rural women = 29% = 0.29; q = 1−p = 0.71; d = Precision/error tolerated (5%) = 0.05.
The determined minimum sample was 316; however, this was increased to 380 to accommodate for nonresponse of 20%. A multistage simple random sampling technique was used to select participants for this study. Two of the 20 rural LGAs (Etche and Tai LGAs) were first selected by a simple random method. There were 10 wards in each of the selected LGAs. In each ward, 20 households were selected by simple random sampling, and a woman of childbearing age in each household was then approached to participate in the study. Only women who were either married or single but in a union and gave consent were interviewed. The interviews were carried out in simple English language or Pidgin English widely spoken in the State, by the researchers and other research assistants after 1-day training on the administration of the questionnaire. Where participants could not understand English, the services of an interpreter were enlisted to collect information from the respondents.
Information collected was on sociodemography, educational level of participants and their partners, sources of family planning information and services, knowledge and utilization of any method of MCs, motivating factors for utilization, and reasons for nonuse. The information was generated using a structured questionnaire designed by the researchers. This survey instrument was pretested among 20 women in another rural LGA (Oyigbo LGA) which is different from the two selected for this study and was adjusted to ensure its internal validity.
Definition of terms:
- Awareness of MC was assessed as the proportion of women who have heard of MC methods
- Good knowledge was assessed as the proportion of women who have heard of MCs and can mention at least two methods correctly
- Use of MCs was determined as current use, if the respondent or her sexual partner used any of the MC methods at any time in the last 3 months before the survey
- Consistent use, if respondent or her sexual partner used only one MC method at all times in the last 3 months before the survey and state.
- Ever used contraceptives, if respondent or her sexual partner had used any MC method at one time or the other in the past except in the last 3 months before the survey.
Data were analyzed using Statistical Program for Social Sciences (SPSS) 15.0 for Windows Evaluation Version and the results presented in frequency tables. The level of significance was set at P = 0.05.
Ethical approval was obtained from the Ethics and Research Review Board of the University of Port Harcourt Teaching Hospital, Port Harcourt. Written informed consent was also obtained from all the participants after a clear explanation of the objectives of the study, and the proviso that information provided will be treated with strict confidence. Participants were also informed that participation is voluntary and participants were free to discontinue participation at any point in the interview process without sanctions.
| Results|| |
The majority of the respondents were young adults aged 25–34 years (n = 173; 45.5%), who are married (n = 316; 83.2%) and engaged in either trading (n = 131; 34.5%) or farming (n = 116; 30.5%). More than half of them and their sexual partners had secondary education [Table 1].
Almost all the women (n = 378; 99.5%) had awareness of MCs, but those with adequate knowledge were 238 (63.0%). Male condoms and injectable contraceptives were better known by the majority of the women [Table 2].
Health-care professionals (n = 261; 69.0%) were the most common sources of contraceptive information, followed by the mass media (n = 121; 32.0%). Other sources were the church (n = 36; 9.5%) and club meetings (n = 26; 6.9%) [Table 3].
|Table 3: Sources of information on modern contraceptives among respondent who have awareness (n=378)|
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Although 209 (55.0%) had ever used a MC, those currently using MCs were 140 (36.8%) while consistent users were 86 (22.6%). The male condom was the most commonly method used (n = 65; 46.4%) [Table 4].
|Table 4: Utilization pattern of modern contraceptive by respondents (n=380)|
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In addition, among current users, the most common reason for use was because it was effective in preventing unwanted pregnancies (n = 119; 85.0%) [Table 5].
|Table 5: Reasons for the choice of modern contraceptive by respondents (n=140)|
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The lack of knowledge on how to use contraceptives properly (n = 43; 30.7%), followed by the perception of side effects (n = 38; 27.1%) were the most common problems associated with the use of MCs [Table 6].
|Table 6: Problems associated with the use of modern contraceptive by respondents (n=140)|
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Among respondents who were currently not using any MCs, the fear of side effects (n = 115; 47.9%) and lack of awareness on where to get MCs were the most common reasons for nonuse [Table 7].
|Table 7: Reasons for nonuse of modern contraceptive by respondents who do not use modern contraceptive (n=240)|
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| Discussion|| |
This study showed a disparity between general awareness about MCs and the adequacy of knowledge required to make an informed decision about its usage. While nearly all the rural women have heard of MCs, only two out of three have good knowledge about the contraceptives. The gap between awareness and good knowledge on MCs may suggest that family planning messages as given to the women are not fully understood. For instance, one-third of the respondents who use MCs reported not knowing how to properly use them, while nearly half of those who do not, reported not knowing where to get the contraceptives. The gap in knowledge may either be due to inadequate information or method of communicating family planning messages or simply that the messages are not repeated enough to allow for internalization of the information. Although the level of awareness in this study was high and in conformity with others in some rural settings in Tanzania and Zambia,,, some studies among rural women in other parts of Nigeria reported a lower level of contraceptive awareness., This was, however, not the case with knowledge about contraceptives, as in-depth knowledge of MCs observed in this study was much lower than what has been reported in other States in Nigeria ,,, and elsewhere in Pakistan and Western Ethiopia., The higher prevalence of knowledge in those studies may be due to the lower benchmark used in the assessment by the researchers. Good knowledge was assessed in this study by respondents mentioning a minimum of two MC methods concurrently as against one method mentioned in those studies.
This study showed that health professionals were the most common source of information on MCs. Other common sources were the mass media and friends. This trio was similarly reported as the most common sources of contraceptive information among rural women in other related studies in Nigeria, Pakistan, Zambia, and Southern Ethiopia.,,,,,
The best-known contraceptive methods in this study were male condom, injectables, and combined oral pills. The knowledge of the long-acting contraceptives and sterilization was rather poor. In contrast, however, Oye-Adeniran et al. reported a reversed order in their study among sexually active Nigerian women as the oral contraceptive pill was the best known, even though injectables, male condoms, and intrauterine contraceptive device were also relatively well known. Similar finding was made among rural women in Northern Nigeria as the oral pills were also the best known MC, before female sterilization and injectables whereas among rural women in Southern Nigeria, the most widely known modern method was injectables followed by male condoms, emergency contraceptives, and last oral pills., Among rural women in Zambia, however, the best-known method was male condom followed by oral pills.
Evidence has shown that knowledge of MCs is a basic requirement for informed decision to adopt any method of contraception., It is also used as an indicator to assess the success of family planning programs by national and international organizations. Reports have also shown that rural women who had good knowledge of contraceptives were more desirous of contraception and readily accepted contraceptives., Longwe et al. found an increase in acceptance and use of contraceptives in districts where women had more knowledge on contraceptive methods and their effectiveness in preventing pregnancy. There is therefore need for better family planning education among rural women to increase their knowledge of MCs to achieve the goals of family planning programs.
More than one-third of the rural women in the study were current users of MCs. This level of contraceptive usage was higher than reported for Abia and Osun States., It was also higher than what was reported among rural women in Zambia.
The predominance of male condom, a short-acting contraceptive in our population may be due to the ease of sourcing of the product which most often are from patent medicine vendors and chemist shops that dot the communities and are most accessible, or because they are used with minimal supervision. It might also be that most of the young rural women who are <35 years, chose their contraceptives not only because of their effectiveness in preventing unwanted pregnancies, but also for the need to prevent sexually transmitted infections such as HIV or hepatitis B virus.
Lack of adequate information on how to source or use MCs and sometimes apprehension about the side effects are the more common issues presented as barriers encountered by the respondents. Improving family planning information and services were reported to enhance the desirability and acceptability of family planning among rural women in Rwanda and Nepal. The problems encountered by users and reasons for nonuse might be addressed by adequate counseling of clients at service points. According to the reports of the National Demographic and Health Survey of 2013, 60% of the contraceptive needs of women are supplied by the private medical sector. In rural settings, majority of MC users source their contraceptives from patent medicine vendors and chemist shops. These service providers might lack the necessary training and communication skills for effective family planning counseling services, with detriment to MC uptake. It becomes imperative, therefore, to improve on family planning information given to rural women. It is, therefore, advocated that continuing education and update programs on family planning be organized by officials of the State Primary Health Care Board and the Local Government Health Departments for private health services providers, including patent medicine vendors and traditional birth attendants in rural areas while mass media efforts on family planning should be intensified.
The authors are grateful to all the research assistants who helped in the collection of data and the rural women who participated in this study and whose cooperation during data collection made this study possible.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Benjamin O Osaro
Health Services Department, Rivers State University, Port Harcourt
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]