ABSTRACT
The empowerment and autonomy of women to enable
them to take active part in their child-bearing decisions, decide as to when to
marry and give birth and either to space or limit their births have been given
much prominence at major international and national seminars and conferences on
population, women and Development over the years. This study this
assess the child bearing decisions made by nursing mother attending post natal
care at Alex Ekwueme Federal University Teaching Hospital Abakaliki of Ebonyi
state.The study revealed that women of the study
communities do not independently make decisions in their Family planning issues
and most women are not educated hence education is a pre- requisite for
effective reasoning and informed decision making.Therefore midwives have a role
to play by health educating women on the need for their involvement in decision
making with regards to their fertility and also the need for family planning as
an effective way to reduce their family size, unsafe abortion, maternal mortal
and achieve their MDG 4 $ 5 target.
CHAPTER
ONE
INTRODUCTION
Background to the study
The ability of women to take decisions in
family planning issues such as family size, when to have a baby, choice of
spacing period and the use of family planning services may not only enhance
their bargaining power in family matters but will also reduce their
vulnerability to sexually transmitted infections (STIs) (Tavory&Swidler,
2009) Fertility and its decisions in the family is influenced by ideas and
changes that occur in the life of the individual associated with such
characteristics as education and income levels. Thus as women climb the
educational ladder and men are faced with economic challenges of life, coupled
with the pressure from the family to provide and satisfy their physiological
needs, women are faced with the need to make choices with respect to the number
of children they should give birth to and the size of their families (Weeks,
2010) and many others. In developed and industrialized societies, the trend
towards smaller family sizes has emerged due to the spread of formal education,
medical and health advancements and the enhanced status of women (Miller,
2010).
Education, for example, is a very powerful
indicator of involvement in fertility decision making among women globally
(United Nation, 2005). It has been widely recognized as a key concept in
understanding fertility behaviour (Miller, 2010). This is in line with Weeks
(2010), who asserted that women who delay marriage are more likely to stay in
school and then upon attaining higher education, are also more likely to find
suitable employments ,they are able to compete effectively with their male
counterparts in family building and lower parities than their less educated
female counterparts that give birth to larger number of children.
In
as much as women have been empowered through education and economic employment
to be assertive in family life decisions gender inequality, is a universal
phenomenon which largely confronts women. The UN World Conference held in
Mexico City, Copenhagen and Nairobi in 1975, 1980 and 1985 respectively for the
advancement of women underscored the peculiar problems facing women (Pietila,
2007).Globally, women do not enjoy equality with men in terms of political,
legal, social and economic rights. It has been observed that in every country,
jobs that were predominantly done by women were the least well-paid and had the
lowest status (Marger, 2008).The 1995 World Bank report acknowledged the same
fact that gender inequality also manifests itself in family planning
decision-making hence gender inequality in decision-making constitutes the
major concern in this study. Family planning decision of women is a global
concern because of the social and environmental impacts of population growth
and maternal mortality (Ronsmans& Graham, 2006) .Furthermore, Marger,
(2008) admitted the gender differences in family planning decision making and
attributed to power relation and traditional gender roles. This view was
surported by Vaessen, (2004) who argued that women lack control over
decision-making in reproductive health especially with regards to their family
planning. They commented that women are often pressured by husbands and
relatives to have large families and maintained that society had not recognized
and made use of women’s knowledge and capabilities. In most developing
societies, most women have no option than to succumb to the dictates of their
spouses, friends and kinsmen with no control allowed over their family planning
decisions (May, 2014). Of great concern is the high value traditionally placed
on children, which has sustained the high fertility rate at Alex Ekwueme
Federal University Teaching Hospital Abakaliki and made it resistant to the
forces that brought about decline in fertility in the developed countries. The
cultural and national traits of women of some geo- political regions of the
world do influence their family planning decisions to the extent that the
family planning preferences of these women even in the developed nations
reflect what obtains in their home regions as revealed by Woollett, Matwala and
Hadlow ( UN, 2009). Human reproductive behaviour which is the result of a
complex interplay of economic, social, cultural, religious and biological
factors influence the family planning decisions of women in the developing
world (Caldwell, 2009). Family planning decisions within the traditional family
system are based on factors such as children as old age security for parents,
prestige attached to large family size, labour force for agricultural practices,
as security against high infant mortality and the social benefits of having
children and grandchildren. Children are, therefore, cherished as sources of
labour in the agrarian and traditional societies. This has led many women into
having many children as a result of many child births which have effects on the
mother, children in such families and the nation at large. The effects include:
maternal, neonatal and child mortality and morbidity; over population, social
ills, poverty and lack of community development hence the family is the
building block of the community. The low status accorded to women made them
desire for larger family sizes. They felt secure in the number of children they
had, as a woman’s value and status were linked to her reproductive efficiency
and this also give them support in the event of unexpected vicissitudes of life
such as widowhood, divorce and physical incapacitation. How applicable are
these global gender inequalities with respect to child bearing decision-making
of women in the 21st century Nigeria especially in Nsit Ibom-North Local
Government, Ebonyi state. This is what the researcher seeks to investigate.
STATEMENT OF PROBLEM
More than half a million women, nearly all of
them in developing world die each year in pregnancy or childbirth, amounting to
one death every minute (Ronsmans& Graham, 2006). Another million suffer
serious, and sometimes permanent pregnancy – related injuries such as – vesico
vaginal fistula etc. Much of this suffering and death could be prevented through
appropriate maternal and child health services including ANC, labour and
delivery services as well as family planning services. 4 In Nigeria traditional
attitudes towards gender relations have affected the power of decision- making
both within and outside the house hold. Buor, (2004) observed that women,
especially in traditional families were subservient to the man in marital
relationship, so the man assumes a key position in decision making which is
evidenced in the area of Family planning. Some of the result of such
subservient role in decision making include; a situation where a pregnant
woman’s life is in danger on presenting to the hospital required immediate
surgical intervention but will refuse to give her consent until the husband
comes. This was observed severally by the researcher and most times when the
husband comes, he might decide to take the woman out of the hospital putting
the woman’s life in great danger and many others scenario that the researcher
personally observed in Nsit Ibom – North LGA hence the women cannot solely make
decision on their own even on issues that affect their health during Family
planning which sometimes result to maternal death due to delay in decision
making. It was suggested that traditional attitudes towards gender relations
might reduce effective communication between couples and restrain a wife’s
freedom to make chilbearing decisions (May, 2014). The effect of the inferior
role of women in decision- making is that they have traditionally been
suppressed in taking decision even on matters that affect them such as
childbirth. The National Population commission (2014) reported that Ebonyi
state in Nigeria demographic and health demographic and survey (NHDS, 2013)
recorded a total fertility rate of 5.7 and there existed fertility
differentials between the rural and urban communities of the state of 7.0 and
4.7 respectively. The researcher also observed a similar trend in the Family
planning pattern of women in NsitIbom
LGA which was recorded to be 5 based on the findings from the research
study. Women’s non involvement in their Family planning decisions affects their
health and could lead to high frequency of childbirth among women which could
result in serious health risk like; maternal, neonatal and child mortality and
morbidity; over population, social ills, poverty, lack of community development
hence the family is the building block of the community, economic stagnation,
marital burden and inability of families
to educate most of their children resulting in high illiteracy rate in the
rural communities of the State . Consequently the question that comes to mind
are: Is the large family size the choice of the woman or women have no role in
decision making with regards to controlling their fertility ? If family planning
is women’s rights do these rights apply in family decisions? To what extent do
women exercise reproductive right by participating in issues that directly
affect their well beings ? Do women have any control over decision - making
issues that relate their child bearing ? To answer these questions and many
others the study seeks to assess the child bearing decision of nursing mother
attending post natal care at Alex Ekwueme Federal University Teaching Hospital
Abakaliki, Ebonyi state. Hence the need for this study cannot be
overemphasized, especially in an environment with high fertility and low
contraceptive use.
PURPOSE OF THE STUDY
The
purpose of this study was to assess the child bearing decisions made by nursing
mother attending post natal care at Alex Ekwueme Federal University Teaching
Hospital Abakaliki of Ebonyi state.
The specific objectives
of the study include;
The
objectives of the study were to:
1. Identify the pattern of family planning amongnursing mother attending post natal care at
Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi state.
2.
Identify the extent of women’s participation in family planninguse among
nursing mother attending post-natal care at Alex Ekwueme Federal University
Teaching Hospital Abakaliki, Ebonyi State
3. Determine the factors that influence
women’s family planning use among nursing mother attending post-natal care at
Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi state.
RESEARCH QUESTIONS
The research was guided by the following
questions as:
1.
What is the pattern of child-bearing among nursing mother attending post natal
care at Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi
state?
2. To what extent do women in Attending post
natal care at Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi
state participate in child-bearing decision making?
3. What are the factors that influenced
decisions made by women during Family planning in Alex Ekwueme Federal
University Teaching Hospital Abakaliki, Ebonyi state?
SIGNIFICANCE OF THE
STUDY
The study is to help in finding the reasons
for women’s participation or not in family planning decisions of their families that, to some
extent, inform the pattern of childbirth which results in fertility
differentials at Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State. This will help address the issues
related to women’s empowerment and their reproductive autonomy at Alex Ekwueme
Federal University Teaching Hospital Abakaliki, Ebonyi State. Findings from this study will add to
the existing literature on pattern of Family planning and how decisions about
Family planning are taken in Nsit Ibom local government, Ebonyi state Nigeria. The result of the study will also
assist planners and administrators of the town to adopt strategic plans that
will help raise the level of consciousness of the women in the town with regard
to their child bearing. The study will also serve as the source of information to
students and the basis of further research into women’s reproductive decisions.
SCOPE OF THE STUDY
The
study was delimited to the birth patterns and Family planning decisions of nursing
mother attending post natal care at Alex Ekwueme Federal University Teaching
Hospital Abakaliki, Ebonyi State, the
factors that influence women’s Family planning
decisions and the extent to which they have the autonomy to participate
in the Family planning decisions of their families. This study is delimited to
all women within the age of 15 and 49 years who will be present in the area
during the period of the study and will be willing to participate in the study.
DEFINITION OF TERMS
FAMILY PLANNING; the practice of controlling the number of
children one has and the intervals between their births, particularly by means
of contraception or voluntary sterilization
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