ABSTRACT
In Ghana, fertility rates
continue to vary widely; ranging from 2.5 children per woman in the Greater Accra region to 6.8 children in the
Northern Region. Moreover, the use of any contraceptive method is highest among women in
the Volta Region (32%) and lowest among women
in the Northern Region (11%).Using a qualitative explorative descriptive
design, this study explores the factors affecting contraceptive utilization
among married women in the reproductive age group (15 – 49 years), through
in-depth interviews in the North Gonja District. The data collected was
analyzed by means of thematic analysis. This included construction of a
thematic framework, coding, editing and categorization of available data as
well as the creation of sub-themes. The study revealed that there is limited
knowledge and a general lack of understanding about contraceptives among the
married women who were interviewed. The result also suggested that male
domination and social stigma are some of the factors affecting the utilization
of contraceptives. In view of this, it is recommended that Ghana should develop
some educational and counselling techniques to educate the public to help
debunk the social stigma in the community. Besides, the study recommends an
effective development and implementation of male-involvement contraceptive
initiatives to address men's negative beliefs regarding contraceptive services.
CHAPTER ONE
INTRODUCTION
Background to the Study
Population explosion is the major contemporary issue in this
part of the world. The alarming increase in the world population poses certain
crucial economic, political and social problems in almost all spheres of life
and in all sectors of the human race. In addition to the depletion of
environmental resources and the impact of global climate change, most
developing countries realize the implication of rapid population growth on the
socio- economic status and welfare of the people (Yunus, 2006).
With the human population exceeding 7 billion and the food
and energy prices rising, the longstanding question of the adverse consequences
of expanding populations in the developing world and rising consumption
everywhere is commanding the attention of scientists and policymakers. In
addition to the depletion of environmental resources and the impact of global
climate change, other potential adverse effects of rapid population growth and
high fertility include poor health among women and children, slow economic
growth and widespread poverty, and political instability in countries with
large numbers of unemployed young people (John, 2012).
Family planning has been defined (WHO, 2015) as allowing
people to attain their desired number of children and determine the spacing of
pregnancies. It is achieved through the use of contraceptive methods and the (treatment
of infertility). Thus, researchers have discovered that the same pill used to
prevent pregnancy can actually help a woman conceive. The study found that a
two-week intervention treatment using a standard low-dose birth control pill can help time egg harvesting, making the in
Vitro Fertilization (IVF) process more convenient for both doctor and patient.
While the previous definition focuses on limiting the size of the family, the
2009 Collins English Dictionary (Collins,2009), specifies the use of
contraceptives when defining family planning as the control of the number of
children in a family and the intervals between them, especially by the use of
contraceptives. The Medical Dictionary (Marriam, 2007) on the other hand adds a
sense of intention and determination to the two previous definitions by stating
that family planning is intended to determine the number and spacing of one‘s
children through effective methods of birth control.
The World Health Organization (WHO, 2006), issued a
recommendation that, after a live birth, the interval before attempting the
next pregnancy should be at least 24 months, and at least six months after a
miscarriage or induced abortion, in order to reduce the risk of adverse
maternal, perinatal, and infant outcomes (Healthy Timing and spacing of
pregnancy) .
Contraceptive use in the United States is virtually universal
among women of reproductive age: virtually all women of reproductive age in
2006– 2010 who had ever had sexual intercourse have used at least one
contraceptive method at some point in their lifetime (99%, or 53 million women
aged 15– 44), including 88% who have used a highly effective, reversible method
such as birth control pills, an injectable method, a contraceptive patch, or an
intrauterine device (Daniels, Mosher, & Jones, 2013). In 2002, 90% had ever
had a partner who used the male condom, 82% had ever used the oral contraceptive pill, and 56% had ever had a partner who used
withdrawal (Michael, 2012).
Modern contraceptive methods constitute most contraceptive
use. Modern contraceptives method are contraceptives that are based on
scientific knowledge of the process of conception. Globally in 2015, 57% of
married or in-union women of reproductive age used a modern method of family
planning, constituting 90% of contraceptive users. Traditional contraceptive
methods are contraceptives which are prescribed or supplied by traditional
healers or methods used traditionally in specific cultures without any
prescription. When users of traditional methods are counted as having an unmet
need for family planning, 18% of married or in-union women worldwide are
estimated to have had an unmet need for modern methods in 2015 (United Nations,
2015).
The modern contraceptive prevalence rates (that is, the
proportion of women of reproductive age who are using a modern contraceptive
method, vary widely across the African region. Among women of reproductive age,
Contraceptive Prevalence Rate (CPRs) for modern methods ranges from 1.2% in
Somalia to 60.3% in South Africa. Countries in Southern Africa reported the
highest levels of contraceptive use, followed by countries in East Africa. With
a few exceptions, West and Central African countries report very low rates of
family planning use. Some of the lowest contraceptive prevalence rates in the
world exist in these two sub regions of Africa (United Nations, 2009).
Sub Saharan African countries by and large are characterized
by high fertility and correspondingly high rates of population growth for the foreseeable future. Most countries in the region will grow by
100-300% by 2050 and in total, the population of the region will double over
the next 45 years. The main driver of high fertility (5 children per woman) in
most countries is a persistent demand for large numbers of children, as
expressed by women responding to questions about desired child bearing.
Fertility would decline only if women had no undesired childbearing, that is,
if greater access to quality family planning services respond to unmet needs
(Levin, 2009).
Since the 1960s, alongside efforts to increase levels of
education and improve health conditions, the main policy response to rapid
population growth has been the implementation of voluntary family planning
programs that provide information about and access to contraception. This
policy has permitted women and men to control their reproductive lives and
avoid unwanted childbearing. The choice of voluntary family planning programs
as the principal policy to reduce fertility has been based largely on the
documentation of a substantial level of unwanted childbearing and an
unsatisfied demand for contraception (John, 2012).
Although there has been a marginal improvements in
infrastructure and consumable items needed for family planning services
delivery in many parts of Ghana, the Ghana Health Service Survey (GHSS) in 2012
also noted many barriers to the utilization of family planning. According to
the GHSS, (2012), these barriers include frequent periods of contraceptives
being out of stock at the facility level, limited provider skills, limited use
of educational tools, and limited number of methods. Low contraceptive use is
attributed to a number of barriers acting at policy, facility, district,
community and individual levels (Benefo, 2005). Within individual level, knowledge of family
planning services and methods is crucial (Bamikale &Casterline, 2010).
Whereas evidence from a number of researches around the world
reveal a near universal knowledge on family planning methods among the women of
the reproductive age, this has not translated into increased utilization of
these methods in the North Gonja District in the Northern Region of Ghana. Low
usage of family planning services and methods has been widely attributed to the
negative attitude towards the use of modern contraceptives (Addai.2009).
Specifically, approval/disapproval of the modern methods by self and partner,
fear of harmful effects on health and low levels of education (Benefo, 2005),
have been identified to influence the use of modern family planning methods in
Ghana, and for that matter the North Gonja District.
Religions vary widely in their views on the ethics of birth
control. Some religious sect accepts Natural Family Planning. Natural Family
Planning is the use of calendar or rhythm of a woman‘s menstrual cycle to time
sexual intercourse with the aim of preventing conception The Roman Catholic
Church accepts only Natural Family Planning and only for serious reasons, while
Protestants maintain a wide range of views from allowing none to very lenient.
In Islam, contraceptives are allowed if they do not threaten health, although
their use is discouraged by some. Hindus may use both natural and artificial
contraceptives; however they are against any other contraceptive method that
works after fertilization. A common Buddhist view of birth control is that
preventing conception is ethically acceptable, while intervening after
conception has occurred or may have occurred is not. A number of nations today are experiencing population decline. Growing
female participation in the work force and greater numbers of women going into
further education has led to many women delaying or deciding against having
children, or to not have as many. In Eastern Europe and Russia, natality fell
abruptly after the end of the Soviet Union. The World Bank issued a report
predicting that between 2007 and 2027 the populations of Georgia and Ukraine
will decrease by 17% and 24% respectively (Agyei, 2014).
People‘s control over their sexual lives and choices is in
turn shaped by gender-related values and norms defining masculinity and
femininity. These culturally-defined gender values and norms evolve through a
process of socialisation starting from an early stage of infancy (Agyei, 2014).
Studies have suggested that greater gender equality may encourage women‘s
autonomy and may facilitate the uptake of contraception because of increased
female participation in decision making (Hakim, Mumtaz & Salway, 2003).
However, it has not been set as a prerequisite for widespread adoption of
contraceptives (Amin & Ahmed, 1998).
Empirical review on the effect of decision-making patterns on
contraceptive use often does not distinguish between women participating in
decisions and controlling them and account for the effects of common
decision-making patterns within the community. This strong effect of normative
decision-making patterns within the community is net of individual education
and community education, both of which had strong and significant effects. Less
traditional gender roles as measured by normative decision-making patterns seem
to support more innovative fertility behavior. Community decision-making
patterns matter importantly for contraceptive use in this low contraceptive prevalence setting and the need to
be assessed elsewhere. Furthermore, women‘s influence is inadequately measured
where joint decision-making and wife-dominated decision- making are considered
together (Agyei, 2014).When a couple‘s most fundamental assumptions of a faith
are dissimilar to those of the health care provider, medical recommendations
may be made that are not consistent with the couple‘s religious or cultural
values. Health care providers in culturally diverse nations must understand the
possible influences of culture and religion on a couple‘s willingness to use
contraception, and they should be familiar with a range of contraceptive
options in order to address such situations in the most appropriate ways.
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