1. I. INTRODUCTION
any authors raised the alarm that a stage would reach in the world when food supply would not match its population growth. (Braddocks, 1977;Huxley, 1951;Malthus, 1798;Moor, 1976) While most of the developed countries have managed to overcome this, the issue of population growth and consequent food shortage in developing countries is overwhelming. (Jones, 2004;Nwachukwu & Obasi, 2008) This expansive population growth rate has been attributed to some factors, the major of which is low contraceptive usage. (Bongaarts, 1978;Bongaarts, 1982;Osheba, 1992) In industrialized countries, virtually all married women resort to contraception at some time in their reproductive period. In contrast, the proportion reporting such use in developing countries is extremely low. (Henry & Piotrow, 1979; Khalil, Atta, Kamel & Youssef, 1996; Morris L et al, 1981).
Nigeria which has a pop n of 140 million and an Author : Department of Community Medicine, Faculty of Clinical Sciences, College of Health Sciences, Ladoke Akintola Universit y of Technology (LAUTECH), PMB 4400, Osogbo, Osun State, Nigeria. Author : Department of Community Medicine, Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, PMB 5000, annual growth rate of 3.2 % (NPC, 2007) is the most populous country in Africa. Nigeria, according to Khurfeld (2006), is already facing a population explosion with the resultant effect that food production cannot match the growing population. In Nigeria today, the birth rates are higher than the world averages. ( Nwachukwu & Obasi, 2008) Contraceptive Prevalence Rate (CPR) is still embarrassingly low in Nigeria, according to the report released by the International women's health coalition, the CPR among married women aged 15-49 years was 8% for modern methods and 12% for all methods. Also, other studies have reported a similarly low adoption rate of Modern Birth Control Methods (MBCM). (Haub & Yangishila, 1992 Like many other developing nations, majority of Nigeria's population (about 70%) live in the rural communities. (Ekong, 2003) These rural communities have very high fertility rate and the CPR is also considerably lower in rural areas with CPR of 8% as compared with 18% in the urban areas in Nigeria. (Ekong, 2003;) Many rural women are reportedly reluctant to accept any artificial method of contraception. (Gaur, Goel M.K, Goel M, 2008) Several studies also revealed that rural women who were unwilling to accept family planning methods were concerned about child survival and viewed children as a source of support in old age. (Kartikeyan & Chaturvedi, 1995). Adopting MBCM is a very complex sociological issue in Africa, and African women draw on a complex social repertoire in making contraceptive choices. (Johnson-Hanks, 2002) Decision-making concerning fertility control is, for many people, a deeply personal and sensitive issue, often involving religious or philosophical convictions. (Burkman, 2002) Results : Majority of the respondents, 538(87.8%) were within the age group 20 years and above and married (86.3%). More than half 406(66.3%) were currently using a modern contraceptive method, 41(6.7%) and 4(0.7%) were using natural and traditional methods respectively, however, 161(26.3%) were not using any method, main reasons being affordability and availability 184(41.2%), and reliability (20.1%). The most significant socio-demographic determinants of ever use of contraceptives were religion and family setting, p-value 0.001 and 0.001 respectively.
2. Conclusion :
The point prevalence rate of contraception among the rural women was 66.3%, with fear of side effect and husbands' disapproval among other reasons being the main reasons for non use. (Srikanthan & Reid, 2008).
The introduction and acceptance of MBCM are therefore crucial in controlling the population growth in Nigeria. (Nwachukwu & Obasi, 2008) The UNFPA(2006) has pointed out that meeting the contraceptive needs of about 201 million women around the world who do not have access to effective Family Planning Methods, would prevent 23 million unplanned births, 22 million abortions, 1.4 million infant deaths, 142,000 pregnancy related deaths and 505,000 children losing their mothers due to pregnancy related deaths. This research was therefore carried out to study the current status of contraceptive use and the determinants among women in rural communities in Osun State, Nigeria with a view to making necessary recommendations that would help improve utilization of family planning services.
3. II.
4. RESOURCES AND TECHNIQUES
This descriptive cross sectional study was carried out in the rural communities of Osun state, Nigeria and the target population was the women of reproductive age group in these communities with an estimated population of 1,048,456.
A multi-stage sampling technique was used to select the respondents from a total of 12 rural communities from 12 local government areas in the state. Stage 1, from a sample frame of 30 local government and 1 area office, 12 local government areas were selected using simple random sampling method. In stage 2, a list of rural areas in each local government was made and one rural community selected randomly from each list. In stage 3, numbers were given to all the houses in the community, and only the houses with odd numbers were selected while in stage 4, all women of reproductive age group within the age 15-49 years, who consented, were interviewed or self administered the questionnaires. A sample size of 384 was arrived at using the Leslie Fischer's formula for population greater than 10,000, but to increase representativeness and to make up for non-response, a total of 612 pre-tested semi-structured questionnaires were administered.
There was scoring of outcome variables for the knowledge of respondents about contraception with correct answers scored 1 point and wrong answers scored 0. After adding the scores and finding the mean, respondents who scored below the mean were regarded to be having poor knowledge and those with scores up to or above the mean to be good knowledge. Similarly for attitude, using the 5 point Likert scale, with strongly agreed and agreed scoring 1 point and disagreed, strongly disagreed and I don't know scoring 0 for correctly answered questions, and vice versa for incorrectly answered questions. Scores that are up to or more than the mean were regarded as positive attitude and those below the mean as negative attitude.
The questionnaires were manually sorted out and analyzed using statistical package for social sciences (SPSS) version 15 on the computer. Appropriate cross tabulations and test statistics were applied and the p-value set at p=<0.05 III.
5. RESULTS
More of the respondents were in the age range of 35 years and above, 179(29.2%) followed by 20 to 29 years 155(25.3%), with a mean age of 29.59 ± 8.57 years. Most of them were married 528(86.3%), Muslims 359(58.7%), and had secondary school education 310(50.7%), while trading is the major vocation, 259(42.3%) among the respondents (Table 1). In table 2, some of the respondents understood contraception to mean prevention of unwanted pregnancy 297(48.5%) and limiting the family size 199(32.5%), their source of information was mainly the health personnel, 322(52.6%). Majority of the women, 548(89.5%) did not know any side-effect of Contraceptive Practices Among Women In Rural Communities in South-Western Nigeria
In table 6, majority of the respondents 406 (66.3%) were currently using a modern contraceptive method, 41(6.7%) were using natural methods, 4(0.7%) were using traditional methods and 161(26.3%) were not using any method. The main reason given for choice of contraceptive methods was affordability and availability, 184 (41.2%), followed by reliability by 20.1% of the respondents. Most of the non-users 142(86.4%) did not have any reason for not using any method. Most of the users had used the method of choice between 1-5 Years (44%), followed by 6-10 years by 26.6% of the respondents.
Table 7 shows that the significant sociodemographic determinants of ever use of contraceptives was religion and family setting, p-value 0.001 and 0.001 respectively, but no significant associations between age, marital status, tribe and educational status with ever used family planning methods.
6. DISCUSSION
The awareness about contraceptive methods was generally high among the respondents with about 9 in 10 respondents knowing male condoms and 8 in 10 knowing injectables as methods of contraception and almost all of them being aware of one method or the other. This high level of awareness has been similarly reported by previous studies within and outside Nigeria. The knowledge of respondents about contraception/family planning was also high with about three-quarters having good knowledge of contraception. This was also corroborated by Moronkola et al (2006) in their study carried out in south western Nigeria. This pattern should be expected in light of much enlightenment that is on-going on the issue of family planning in the country. It is however still worthy of note that some contraceptive methods were very unpopular among the respondents. Only about a quarter knew about the diaphragm and implants and not up to 1% of the respondents knew about female condoms as methods of contraception. This is most likely due to the fact these methods are not readily available and are relatively more expensive than the other commoner methods like the male condoms.
The most popular contraceptive method from this study is the male condom with more than 9 in 10 respondents knowing about it. This is similarly reported by other studies. (Kalambayi, 2006;Nwachukwu & Obasi, 2008) and is probably due to the fact that it is cheap and readily available and it is much more advertised probably also because of its dual function as a means of preventing sexually transmitted infections and also as a family planning method. Unlike in other studies where the media was the predominant source of Centre. This is a pointer to the importance of enhanced primary health care services in the rural communities, though the media would still need to do much more work on public enlightenment about contraception. Also, an appreciable number (20%) heard about contraceptives from friends and relatives, and this underscores the need for peer educators in ensuring correct and adequate information about contraceptives/family planning.
Most of the respondents were favourably disposed towards contraception with more than fourfifths having a positive attitude towards contraception. However about 3 in 10 respondents felt contraception encourages promiscuity. This may be due to the conservative nature of typical African societies and could be one of the complex sociological factors (Johnson-Hanks, 2002) affecting contraceptive usage in African communities. Furthermore, nearly 90% of the respondents felt the husbands should be involved in family planning decisions and this is important because man approval and decision making has been said to be very important in utilizing family planning services, (Donati, Hamam & Medda, 2000;Shah et al, 2008;Shahin & Shahin, 2003) and this further stresses the need to carry men along in family planning campaigns.
The prevalence of modern contraceptive methods usage among the respondents was 66.3% with cost and availability being the predominant reason for choice of contraceptive methods. This prevalence is higher than the findings of other studies in rural areas in Nigeria (Nwachukwu & Obasi, 2008) and other developing countries. A study by Ndiaye, Delaunay and Adjamagbo (2003) in rural Senegal reported a prevalence rate as low as 1.5% for modern contraceptives, another study among females in predominantly rural Muslim area of North India (Gaur et al, 2008) reported prevalence of 34.9% and about half were using modern family planning techniques in the study carried out among married Sudanese women. (Ibnouf, van den Borne & Maarse, 2007) This may be due to the high literacy rate among the respondents with about two-thirds having post-primary school education, because education has been said to play an important role in women's life and assist in decision-making. (Gage, 1995; Marchant, Mushi, Nathan, Mukasa, Abdullah, Lengelen, et al, 2004) There was however no significant association between the use of contraception and educational status in this study.
The unmet need for contraception was high among the respondents with about a quarter not on any contraceptive method. This corroborates the work of Westoff (2006) that reported about one in five married women of childbearing age (22%) in Africa has an unmet need for contraception, with a higher percentage among rural women. It is even more disturbing that more than 3 out of 10 of the respondents had an unmet need for modern contraception, because other methods failure rates. (Westoff, 2006) There is therefore a need for more work to be done to reduce the unmet need for contraception among women because reduced unmet need for contraception is an indicator of progress toward two of the United Nations Millennium Development Goals-reducing maternal mortality and reversing the spread of HIV/AIDS-and contributes directly or indirectly to achieving all eight goals. (Population Division, United Nations, 2009) Nearly 9 out of 10 respondents who did not use contraception had no reason for not using it. The reasons given by others are the fear of side effects, husbands' disapproval and the desire for more children, which is similar to what has been reported by other studies. (Donati, Hamam & Medda, 2000;Nwachukwu & Obasi, 2008;Shahin & Shahin, 2003).
The relationship between religion and family planning has been documented by previous studies and religion has been recognized as a very important determinant of contraceptive usage. (Gaur et al, 2008;Nwachukwu & Obasi, 2008;Shah, Pradhan, Reddy & Joseph, 2006) This may explain the significant association between religion and ever used family planning methods with the Christians having a higher uptake of family planning methods than the Muslims in this study. There was also a significant relationship between family setting and ever used family planning with more women in monogamous family settings using family planning methods as compared to those from polygamous family settings. This may be a reflection of the insecurity that exists among women in polygamous family settings with the women trying to outwit each other in the number of children in other to secure their positions in the family and in the will when the husband dies.
7. V. CONCLUSION AND RECOMMENDATIONS
The use of any modern contraceptive method was high among women of child bearing age in the rural communities of Osun State, with the prevalence rate of 66.3%, and the un-met need was 26.3%. The main reasons for non-use contraceptive were the fear of side effects, husbands' disapproval and the desire for more children, with religion and family setting having a significant association with the use of modern contraceptive methods. It is therefore necessary for religious leaders to be targeted and carried along in the
| (n=612) |
| (n=612) | |
| Prevention of unwanted pregnancy 297(48.5) | |
| Child spacing | 99(16.2) |
| Limit family size | 199(32.5) |
| Prevent sexually | 17(2.8) |
| Friends / Relatives | 124(20.3) |
| Health personnel | 322(52.6) |
| Printed medial | 26(4.2) |
| Electric media | 140(22.9) |
| Knowledge of Side -effects | |
| None | 548(89.5) |
| Weight gain | 8(1.3) |
| Weight loss | 5(0.8) |
| Condom | 20(3.3) |
| Extra marital affairs | 7(1.1) |
| Amenorrhea | 6(1.0) |
| Secondary infertility | 6(1.0) |
| Heavy menses | 3(0.5) |
| Dislodgement | 5(0.8) |
| Irregular menses | 4(0.7) |
| Husband | 229(37.4) |
| Wife | 131(21.4) |
| Both | 252(41.2) |
| (Multiple Response; n = 612) | |
| ) | |
| Armlet | 178 (29.1) |
| Ring | 359(58.7) |
| Pad lock | 224(36.6) |
| Waist band | 218(35.6) |
| Natural | |
| Periodic Abstinence | 527(86.1) |
| Rhythm | 344(56.2) |
| Lactational amenorrhoea | 287(46.9) |
| Coitus interruptus | 336(54.9) |
| Barrier | |
| Male condom | 571(93.3) |
| Female condom | 3(0.5) |
| Diaphragm | 180(29.4) |
| Hormonal | |
| Injectable | 491(80.2) |
| about Contraceptives (n=612) | ||
| Poor | 148 | 24.2% |
| Good | 464 | 75.8% |
| Poor | 86 | 14.0% |
| Good | 526 | 86.0% |
| Variable | Frequency (Percentage) | |||||||
| Strongly | Agree | Agree I don't know Disagree Strongly | Disagree | |||||
| It is against culture and religion | 11(1.8) | 33(5.4) 161(26.3) 25(4.1) | 382(62.4) | |||||
| Only females should use contraceptives | 34(5.6) | 33(5.4) | 80(13.1) 54(8.8) | 411(67.1) | ||||
| Contraceptives are ineffective | 13(2.1) | 28(4.6) | 80(13.1) 175(18.8) | 376(61.4) | ||||
| 2011 | It encourages promiscuity Diminishes sexual pleasure It is only for the literate | 96(15.7) 51(8.3) 21(3.40) | 90(14.7) 111(18.1) 82(13.4) 167(27.4) 97(15.8) 189(3.1) 16(2.60) 67(10.9) 19(3.2) | 140(22.8) 201(32.8) 489(79.9) | ||||
| July | Husbands should be involved in family decision | planning | 476(77.7) | 49(8.0) | 33(5.4) 36(6.0) | 18(2.9) | ||
| Support national policy of 4 children per family | 487(79.6) 110(17.9) | 6(1.0) | 5(0.8) | 4(0.7) | ||||
| 4 | ||||||||
| Volume XI Issue II Version I | Table 6 : Prevalence of Contraceptive usage FREQUENCY(PERCENTAGE) Currently used contraceptive methods (n = 612) VARIABLE None 161(26.3) Natural 41(6.7) Traditional 4(0.7) Modern methods 406(66.3) | |||||||
| Main Reasons for choice of Contraceptive Methods (n = 447) | ||||||||
| Medical Research | No reason Affordable and available Little or no side effect Suitable effective / reliable Main Reason for not using any method (n = 165) No reason Side effect | 98(21.9) 184(41.2) 75(16.8) 90(20.1) 142(86.4) 13(2.6) | ||||||
| Global Journal of | Husband's disapproval Desire for more children Duration of Contraceptive use(in years)(n=467) 1 -5 6 -10 11 -15 16 -20 | 6(6.2) 4(4.7) 205(44.0) 124(26.6) 107(22.9) 28(5.9) | ||||||
| 21 -25 | 3(0.7) | |||||||
| Methods. |