ABSTRACT
The study investigated influence of personal variables on knowledge and practice of family planning methods among married women of reproductive ages in Benin metropolis. Specifically, the study was undertaken to determine knowledge of married women on family planning methods and the various family planning methods they practice. The study examined the influence of personal variables (age and educational qualifications) on their knowledge and practice of family planning methods. The descriptive survey research design was adopted for the study. The population of the study covered all the married women of reproductive age in Benin metropolis, Edo State comprising of 16,000 women as obtained from the provisional figure of the National Population Commission (NPC), Benin City (2014). A sample of 800 married women comprising market women, civil servants, teachers, female local farmers, women in religious worship among others. However, seven hundred and seventy two (772) copies of the questionnaires were recovered and used for the analysis. The instrument used a self-developed questionnaire with a reliability coefficient (α) of 0.73. Data collected from the survey were analysed with percentages (%), mean (
CHAPTER ONE
INTRODUCTIONBackground to the Study
Rapid population growth is a burden on the resources of many developingcountries. Unregulated fertility, which contributes to such situation, contributed tothe poor economic developmentand political instability of these countries. Therefore, many countries consider limiting population growth as an important component of their overall developmental goal to improve living standardand the quality of life of the people. This strategy is now enhanced by the availability of effective modern contraceptives methods. Since 1960s,many international institutionsand organizations such as: the World Health Organization (WHO),World Bank (WB), United Nation Population Fund Activities (UNPFA) and United Nations Children Education Fund (UNICEF), have strongly advocatedfor family planning as a means of spacing children,having limited family size and should be one of the essential primary health care services provided (Rosenfield& Schwartz, 2005).
The International Conference on Population and Development (ICPD) Cairo, 1994expanded marital healthto a broader scope of reproductivehealth and endorsed a range of major goals for countries to achieve. Two of the goals are: a) 75 percent reduction in the maternalmortalityratio by 2015 and b) all couples and individuals should have the full opportunity to exercise their right to have children by choice (Rosenfield& Schwartz, 2005).Also, the Millennium Development Goals (MDGs), adopted by United Nations in 2000 require member countries to achieve a set of 5 goalsamong which is to improve maternal health by reducing three quarters ofthe ratio of women dying in childbirth by 2015.In all these programmes, contraception and family planning play a central role in the strategies to achieve the set goals.
Encyclopedia (2013) defined family planning as birth control and other techniques to implement such plans which include sexuality education, prevention and management of sexually transmitted infections, pre-conception counselling and management of infertility. It further conceptualizes that family planning is educational, comprehensive medical or social activities which enable individuals to determine freely the number and spacing of their children and to select the means by which this may be achieved. Hence, it implies the ability of individuals and couples to anticipate and attain their desired number of children by spacing and timing their births (Umbeli, Mukhtar&Abusalab, 2005). Usually, family planningpractices are of two categories: the traditional methods and the modern (orthodox) methods. The traditional methods include prolonged breast feeding, isolation of women from husband, abstinence from sex,withdrawal method during sex, use of iron ring, use of local concussions and leather belt stuffed with charm among others.
The modern methods include: the use of condom, pills, coils, intra-uterine device (UIDs), and use of injectable hormones, sterilization, vasectomy and douching among others. There are manyreasons for family planning which among others include: to prevent pregnancy, to postpone pregnancies, to space children, for those who have all the children they want, to prevent future pregnanciesand for health and economic reasons. These reasons are often related to the stage of every woman’s reproductive life whether:single, new marriage, before birth, after first childand before last child. During each stage, contraceptive choices and need vary within this context. Hence, professional counsellorscan play a vital role in helping women or couples to choose an appropriate method that matches her or their needs during her or their current stage of reproductive life.
Globally, family planning is promoted as a mechanism to address the reproductive health needs of men and women, as well as the crucial challenge of rapid population increase. Family planning is a practice by which a couple space the number of years between each child they want to give birth to, through the use of contraceptive methods. More than 200 million women in developing countries would like to delay their next pregnancy or even stop bearing children altogether, but many of them still rely on traditional and less effective methods of contraception or use no method at all (UNPFA, 2001). Those who do not use any contraceptive method may lack access or face barriers in using contraceptives. These barriers among others include: lack of awareness, lack of access, cultural factors, religion, opposition to use by partners or family members, and fear of health risks and side effects of contraceptives.
However, despite the campaign on the usefulness of family planning inhaving smaller and healthier family, United Nation Population Fund Activities (UNPFA) (2001) indicated that contraceptive use is still low in many developing countries, including Nigeria where 23.7% of currently married women had never used one. One may ask if majority of Nigerian women are aware of family planning practices, and also whether very many of them use it for birth control. Observations have shown that some women in the cities, townsand villages are aware of the family planning campaign but many are reluctant to using them. Different factors such as culture, age, education, poverty and poor access among other numerous factors have been identified by scholars to militate against the use of family planning methods (UNPFA, 2001; Rosenfield& Schwartz, 2005).
Traditionally, most Nigerian cultures are highly patriarchal, having value for high fertility and male child preference. Hence, this perhaps could have a negative impact on the utilization of family planning services. A study by Rosenfield& Schwartz (2005) on reproductive motivation and family size preferences among Nigerian men, revealed that the characteristic male dominance, patrilineal traditions support for large family sizes and men’s reproductive motivation to a large extent, affect the reproductive behaviour of their wives. These cultural values undermine the utilization of family planning in many communities in Nigeria like the traditional core areas of Benin, where families still support large family sizes of more than four children per woman, and where polygamy is commonly practiced.
The use of modern contraceptive methods translates into the prevention of unwanted pregnancy and subsequent abortions. If contraceptive usage increases among Nigerian men and women who are sexually active, then, there will be a significant reduction in unwanted pregnancies and abortions leading to reduced maternal mortality.The importance of considering the well-being of women in development planning is well supported by the United Nations and many of its agencies; some of which areUnited Nation Population Fund Activities (UNPFA), United Nations International Children Educational Fund (UNICEF), and World Health Organization (WHO) among others. These agencies contribute to the increasing campaign for women right in family issues mostly as it pertains to their health and that of their child(ren) (born and yet unborn). Women are both beneficiaries and potential contributors to the development process and active efforts to meet their needs, should be considered a national priority, most especially their reproductive health issues. Despite all this, in most cases especially in rural areas, women do not have a say when it comes to family planning issues and reproductive health care. Many married women also, have been threatened, abused, beaten and sometimes overpowered when it comes to sexual play and matters that concerns family planning. Some married women either due to illiteracy or self-beliefs do not adhere or practice family planning. Many see the use of contraceptives as a portrayal of waywardness
The acceptance of family planning is known to be influenced by social and cultural factors, among others. Some of these factors comprise of family income, age, educational status, and occupation of married couples among others (Shareen, 2011; Ozumba, 2011). Such cultural indolence is often sustained by religious values even when there are no specific prescriptions against birth control. The Old Testament injunction to “be fruitful and multiply” has its counterpart in the teachings of several religions predominantly throughout Sub-Saharan African Countries, Nigeria inclusive. Although, family planning is widely promoted in Nigeria, it is not without ethical issues.Unfortunately in many religions, there is an opposition to human intervention in the reproductive process. This is as a result of the beliefs that procreation is sacred and any interference with it would bring down the wrath of God.
Desire by most individuals and couples for a large family size is as a result of the positive value which the Nigeria society attached to marriage, family life and procreation.Unexpected or unplanned pregnancies possess a major public health challenge in women of reproductive age, especially in developing countries. It has been estimated that of the 210 million pregnancies that occur annually worldwide, about 80 million (38%) are unplanned, and 46 million (22%) end in abortion. More than 200 million women in developing countries would like to delay their next pregnancy or even stop bearing children altogether, but many of them still rely on traditional and less effective methods of contraception or use no method at all (WHO, 2013). Those who do not use any contraceptive method may lack access or face barriers to using contraception. These barriers may include lack of awareness, lack of access, cultural factors, religion, opposition to use by partners or family members and fear of health risks and side effects of contraceptives.
In some areas of Nigeria, one in five women report having experienced an unwanted conception, of these 58% had an abortion and an additional 9% attempted unsuccessfully to end the pregnancy. It is estimated that about 25% of women who have abortion in Nigeria experience serious complications (Ozumba, 2011).Following the health problems inherent in women as a result of early pregnancies, unwanted pregnancies, complications and other health related problems, adopting family planning measures may help reduce unwanted pregnancies and abortions to its barest minimum.
The role of women in child rearing, family care, and the family formation process as a whole, cannot be overemphasized. Unfortunately, women in most cases do not have a say when it comes to family planning issues and reproductive health care. It has been observed that married ones among them, have been threatened, abused, beaten and sometimes overpowered when it comes to sexual play and matters that concerns family planning by their partners. Some married women either due to illiteracy or self-beliefs do not adhere or practice family planning. Many see the use of contraceptives as a portrayal of waywardness. Consequently, many of them get unintended pregnancy that they never planned for.
Birth resulting from unintended pregnancies can have negative consequences including birth defects and low birth weight. Such children are more likely to experience poor mental physical health during childhood, and have lower educational attainment and more behavioural issues in their teen years (UNPFA, 2001). In many male dominated societies Nigeria inclusive, women are not empowered to take decisions for family planning for reasons such as their personal beliefs, tradition, their social attitudes and literacy level. Consequently, many married women bear the burden of child-bearing and rearing with the attendant rigorous house chores and probable break down in health.
Governments have failed to provide basic infrastructure to run family planning programs in rural areas. In Benin metropolis, an average Benin man (irrespective of his age or social status) will want his wife to keep on conceiving until a son is born even if he has more than four female children. Consequently, many married women face the consequence of raising many children without proper child spacing. Many of them even ignore using contraceptives because their husbands do not support the use. Also, elders are often against family planning due to old age tradition and superstitions. Hence, youngsters who want to go in for family planning risk the wrath of elders. This situation poses a question or two on: what is the awareness level of married women on family planning methods and the methods they use to control child birth in Benin metropolis? What personal factors influence the knowledge and practice of family planning methods among married women of reproductive ages in the metropolis?
Furthermore, several studies have been undertaken on attitude towards contraceptives among married people with respect to their ages and religion respectively (Nyawade, 2008;Ugoji, 2008); family planning methods among married couples in Zululand, South Africa and Delta State, Nigeria respectively (Makhaza&Ige, 2014; Uwe&Okon, 2011); Knowledge, attitude and practices on contraceptive usage among undergraduates in Ekpoma-Edo State (Idonije, Oluba&Otamere, 2011) and Enugu (Ikeme, Ezegwui&Uzodimma, 2005). However, a knowledge gap exists on knowledge and practice of family planning methods among married women with respect to their reproductive ages and educational status in Edo State. Consequently, this study is undertaken to determine the influence of age and educational status on knowledge and practice of family planning methods among married women in Benin metropolis.
This study examines influence of personal variables on knowledge and practice of family planning methods among married women of reproductive ages in Benin metropolis. Specifically, the study sought to:
1. determine whether married women in Benin metropolis have knowledge of family planning methods
2. examine the family planning methods practiced among married women in Benin metropolis
3. find out the influence of age on knowledge of family planning methods among married women in Benin metropolis
4 find out the influence of age on practice of family planning methods among married women in Benin metropolis
5 determine the influence of educational status on knowledge of family planning among married women in Benin metropolis
6 determine the influence of educational status on practice of family planning methods among married women in Benin metropolis
This study was guided by the following research questions:
1. Do married women in Benin metropolis have knowledge of family planning methods?
2. What are the family planning methods practiced among married women in Benin metropolis?
3. What is the influence of age on knowledge of family planning methods among married women in Benin metropolis?
4. What is the influence of age on practice of family planning methods among married women in Benin metropolis?
5. What is the influence of educational status on knowledge of family planning among married women in Benin metropolis?
6. What is the influence of educational status on practice of family planning methods among married women in Benin metropolis?
The following research hypotheses were tested in the study:
1. There is no significant difference between old and young married women on knowledge of family planning methods.
2. There is no significant difference between old and young married women on practice of family planning methods.
3. There is no significant difference between well-educated and less-educated married women on knowledge of family planning methods.
4. There is no significant difference between well-educated and less-educated married women on practice of family planning methods.
The findings of this study will be of immense benefit to married men and women, guidance counsellors, public health administrators, the government and prospective researchers. The findings would be of benefit to them in the following ways:
To married men and women, findings from the study would show them the various family planning methods used by married women in Benin metropolis. Hence, this could help to show them the various family planning options available as well as the one they could adopt for their sex life with their life partner.
Guidance counsellors and public health Administrators would also benefit from this study in that findings would avail them with information on the level of awareness and methods of family planning adopted by married women of reproductive age. Hence, the outcome of the study could bring about increasing sensitization or awarenesscampaign on the use of safe family planning methods in the Benin metropolis and beyond.
Findings from this study would help the government to ascertain the influence of age and educational status on family planning methods practiced by married women in the metropolis. Hence, this could afford them the opportunity of determining the age status or class of married educated women to provide detailed information on birth control methods or family planning.
Lastly, findings from the study will contribute to knowledge, provoke further researches on this area and consequently lead to the production of more empirical data that would be of benefit to prospective researchers in the future.
The study will cover all married women of reproductive age in Benin metropolis including market women, civil servants, teachers, female local farmers, women in religious worship centres, health workers at the family planning unit, post-natal, and ante-natal unit of the Central Hospital Benin City, St. Philomena Hospital Benin City, Faith Medical Centre, University of Benin Teaching Hospital (UBTH), Benin City, Our Medical Centre, Benin City, Military Hospital, Benin City and RohobotMedical Centre,Benin City. The study will examine the influence of age and educational status on the knowledge and practice of family planning methods among married women of reproductive ages in Benin metropolis
Essentially, this study focused on the influence of age and educational qualification on knowledge and practice of family planning methods married women of reproductive ages in Benin metropolis. The population of the study covered market women, civil servants, teachers, female local farmers, women in religious worship centres, health workers at the family planning unit, post-natal, and ante-natal unit of selected hospitals in the metropolis. Hence, exclusion of other category of women reproductive ages such as academics, bankers, and public office servants (who usually possess high educational qualification), shows that generalizations from the study is only based on facts collected from women who are seemingly of low socio-economic background. Thus, generalizations from this study may be limited. Furthermore, the study relied only on questionnaire for collecting data. Recently, there have been clamour for both qualitative and quantitative methods for data collection. Hence, the involvement of interview schedule and focused group discussions (FGDs) with women of various ages and educational status would have further helped to determine the family planning methods practiced among married women in the study area.
The following terms are operationally defined for the study:
Family planning: This refers to birth spacingor birth control methods used by married women inpreventing a pregnancy.
Knowledge:This refers to awareness of married women in Benin metropolis on the various family planning methods or contraceptive practices.
Family planning methods:These are devices or practices usedor employed by married women to prevent pregnancy. Some of the devices include among others: contraceptive pills, condoms,and hormonal injection,while the practices include withdrawal methods, calendar estimationand abstinence from sex among others.
Married women of reproductive age: This refers to women still living with their spouse within the marriageable and child bearing age of 18-55years.
Ages: This refers to the oldness or youngness of women of married women of reproductive age.
Old women:This are married women that are above the age of 30years.
Young women:This are married women that are below the age of 30years
Well-educated women:Thisare married women that are degree holders. They cover married women with degrees and post-graduate degrees such as bachelor degrees, masters and doctorate among others from tertiary institutions.
Less-educated women:Thisare married women that do not hold a bachelor degree as their highest educational qualification but have lesser qualifications such as: diploma(s) (ND, OND, HND), secondary education, or primary school certificate.
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