ASSESSMENT OF THE KNOWLEDGE AND ATTITUDE OF WOMEN TOWARDS UTILIZATION OF MODERN CONTRACEPTIVES IN EKITI STATE UNIVERSITY TEACHING HOSPITAL ADO-EKITI
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DECEMBER,2018
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Background: Population growth remains high in Nigeria as a developing country, still has high fertility rate (4.6 children per woman) and fast population growth rate. Despite the enormous benefits of using modern contraceptive methods, the utilization of contraceptives remains low in Nigeria. Many women in the postpartum period do not start to use contraception until the return of menstruation.
Objective: To assess knowledge and attitude of contraceptive use among postpartum women in Ekiti State University Teaching Hospital Ado-Ekiti.
Methods: Facility based cross-sectional was conducted among postpartum women who admitted to postnatal ward of Ekiti State University Teaching Hospital Ado-Ekiti during the study period. The Study was conducted by using Systematic random sampling technique. Data was collected through face to face interview. Data collection tool was developed by reviewing related literatures. Data was coded and analyzed using manual compilation of the questionnaires. Descriptive statistics was used to describe the variables and the study result was presented in tables, chart and statements.
Result: Only 98 (92.5%) of the respondents had heard about family planning. About 65.7% of respondents have good knowledge, 34.3% have poor knowledge. Out of 106 respondents 74 (69.8%) have positive attitude towards contractive and the remaining 32 (30.2%) had negative attitude. Out of 106 respondents 62 (58.5%) of respondents had a safe practice and the remaining 44 (41.5%) were unsafe practice towards contraceptive use.
Conclusion: Nearly two third of respondents were knowledgeable. More than two third of respondents were positive attitude towards contractive. More than four fifth were interest to know about family planning. About more than half of respondents had a safe practice and about four fifth of respondents were used contraceptive to prevent unwanted pregnancy.
Keywords: Knowledge, Attitude, Contraceptive use, Ekiti State University Teaching Hospital Ado-Ekiti.
Abbreviation
FP: Family Planning;
HIV/AIDS: Human Immune virus/Acquired Immune Deficiency Syndrome;
IUCD: Intra Uterine Contraceptive Device;
MT Pill: Medical Termination of Pregnancy Pill;
OCP: Oral Contraceptive Pill;
PPFP: Postpartum Family Planning;
TFR: Total Fertility Rate;
WHO: World Health Organization
TABLE OF CONTENTS
TITLE PAGE
APPROVAL PAGE
DEDICATION
ACKNOWLEDGEMENT
ABSTRACT
TABLE OF CONTENT
CHAPTER ONE
- INTRODUCTION
- BACKGROUND OF THE STUDY
- PROBLEM STATEMENT
- AIM AND OBJECTIVES OF THE STUDY
- RESEARCH QUESTIONS
- SIGNIFICANCE OF THE STUDY
- LIMITATION OF THE STUDY
- DEFINITION OF TERMS
- STRUCTURE OF THE STUDY
CHAPTER TWO
2.0 LITERATURE REVIEW
2.1 OVERVIEW OF THE STUDY
2.2 CONCEPTUAL REVIEW
2.3 THEORETICAL REVIEW OF THE STUDY
2.4 CONTRACEPTIVE USE AND CHOICES
2.5 PURPOSES OF FAMILY PLANNING
2.6 EMPIRICAL REVIEW OF THE STUDY
2.7 ECONOMIC BENEFIT OF FAMILY PLANNING
2.8 REVIEW OF MODERN METHODS OF FAMILY PLANNING
2.9 PROVIDERS OF FAMILY PLANNING
2.10 BENEFITS OF USING FAMILY PLANNING
CHAPTER THREE
3.0 MATERIALS AND METHOD
3.1 STUDY AREA
3.2 STUDY DESIGN
3.3 SOURCE OF POPULATION
3.4 STUDY POPULATION
3.5 INCLUSION AND EXCLUSION CRITERIA
3.6 SAMPLE SIZE DETERMINATION
3.7 SAMPLING PROCEDURES
3.8 STUDY VARIABLES
3.9 DATA COLLECTION TECHNIQUE AND TOOLS
3.10 DATA PROCESSING AND ANALYSIS
CHAPTER FOUR
4.0 RESULT AND DISCUSSION
4.1 RESULT
4.2 DISCUSSION
CHAPTER FIVE
5.0 CONCLUSIONS AND RECOMMENDATION
- CONCLUSIONS
5.2 REFERENCES
CHAPTER ONE
1.0 INTRODUCTION
1.1 BACKGROUND OF THE STUDY
In 2015, world's population reached 7.3 billion. Population growth remains high in the group of 48 countries designated by the United Nations as the least developed countries (LDCs), of which 27 are in Africa (United Nations, 2015). Using modern Contraceptive method is widely approved as an important intervention towards achieving national and international goals, as it has proven to reduce maternal and child mortality and morbidity [Ayele et al., 2013].
Maternal health problems remain a major global concern since pregnancy and childbirth are the leading causes of morbidity and mortality among reproductive age women [Kassebaum et al., 2014]. Evidences have shown that encouraging early antenatal care visits, institutional deliveries, postnatal care, and contraceptive adoption are the key elements in improving safe motherhood. As the first pillar of safe motherhood and an essential component of primary health care, contraceptive plays a key role in reducing maternal and newborn morbidity and mortality by preventing unintended pregnancy and close birth intervals [Conde-Agudelo,2010].
A closed birth interval would endanger the lives of the mother, the newborn, and the (previously delivered child). When a mother becomes pregnant shortly after childbirth, she is more likely to develop complications including spontaneous abortion, postpartum bleeding, and anemia. Secondly, the newborn could be born low birth weight and/or preterm. Thirdly, the index child (previously delivered child) might receive inadequate care and support which, thereafter, could lead to vulnerabilities to disease and malnutrition [Conde-Agudelo, 2010].
The majority of women resume sexual activity within several weeks of the delivery. The amount of time following delivery that a woman is infertile is highly variable and dependent on multiple factors, including breastfeeding status. Ovulation can occur even if the mother has not resumed menstruation and could happen as early as 25 days postpartum. The probability of ovulation occurring before resumption of menstruation increases over time. Postpartum family planning (PPFP) focuses on the prevention of unintended and closely spaced pregnancies through the first 12 months following childbirth. Unmet needs could lead to unplanned and unintentional pregnancies which will increase the risk of adverse maternal and neonatal health outcomes [WHO, 2013].
In order to reduce the risk of adverse maternal, prenatal and infant outcomes, WHO, recommended that the interval between a live birth and an attempt to the next pregnancy should be 24 months [WHO, 2013]. Short birth intervals (< 24 months) also have a potential effect on the Contraceptives are used by the majority of married or in-union women in almost all regions of the world. Within these major areas there are large differences by region. Prevalence in 2015 was several times as high in Nigeria. Contraceptive use has been increasing recently in Nigeria and now stands at 40 per cent [United Nations, 2015]. Nowadays, 41% of currently married women are using any modern contraceptive methods [MacPhail, 2010].
Knowledge of family planning is considered the first stage toward the adoption of a contraceptive method. Lack of adequate knowledge and awareness has been found to be associated with lack of contraceptive use among young women. Its use has been found to be associated with having previously been pregnant, meaning it is only after a pregnancy that young women are educated about and subsequently offered contraceptives services. Lack of awareness and poor knowledge of contraceptives methods has been found to be common among young women seeking for abortion. Many who report familiarity with contraceptive were found to be having misinformation and very few knew the correct timing of use. Lack of detail and accurate information on contraceptive was found to have resulted in reluctance to adopt family planning method as some will want to know its side effect and contra indications (Tamire, 2007).
The study conducted in Ekiti State University Teaching Hospital Ado-Ekiti shows that Among the 230 women enrolled only 69% had heard about various methods of contraception. Only 65.95% women after one delivery or abortion had heard about contraception compared to 71.3% after two or more deliveries (Nath, 2016).
Study done aimed to determine the knowledge and attitude of contraception among the postpartum women attending Ekiti State University Teaching Hospital Ado-Ekiti majority of the participants 363 (90.8%) were aware of contraceptive usage (Nath, 2016).
Study done undertaken to explore the knowledge level, attitude and the factors influencing the potential use of spacing contraception among recently delivered women Ekiti State University Teaching Hospital Ado-Ekiti. The level of awareness about contraception was 70% though only 30% knew the correct use (Nath, 2016). Study undertaken to evaluate the knowledge and attitude about contraception in postpartum women in a Ekiti State University Teaching Hospital Ado-Ekiti. Among Five hundred (500) postpartum and post-abortal women were randomly selected in their study observed that only 72% of the ladies had heard about various methods of contraception (Nath, 2016).
Study was conducted to assess postpartum modern contraceptive use and associated factors among women in the extended postpartum period in Ekiti State University Teaching Hospital Ado-Ekiti. Nearly half (48.0%) of the women reported using modern contraceptive methods during the extended postpartum period (Nath, 2016).
According to the Health Survey 2021 shows that Overall, 41% of currently married women are using modern contraceptive methods, and 1% are using traditional methods. The most used popular contraceptive methods are also increased as follows injectable (23% to 27%), followed by implants (8% to 9%), and regarding to the pill and the IUD there is no increment it's the same as previous which is (2% in each). This shows the modern contraceptive methods usage increased dramatically from 35% to 41%. This can be translated to an average of 2% increase per annum [Abraham, 2016].
A study conducted in Ekiti State University Teaching Hospital Ado-Ekiti shows that the overall knowledge 63.6% and 36.4% participants have good and poor knowledge about contraceptive, respectively. Accordingly more than half of (56.4%) of the respondents have positive attitude and support use of contraceptives and 43.6% of them ad negative attitude for contraceptive use [Abraham, 2016].
Therefore the aims of this study is to assess knowledge and attitude of modern contraceptive use among postpartum women in Ekiti State University Teaching Hospital Ado-Ekiti.
1.2 PROBLEM STATEMENT
Globally, utilization of modern contraceptive like condom and IUD have increased in the recent past years – from 54% in 1990 to 57% in 2012 (WHO, 2012). However, the estimates in Africa remain persistently low at 23% and 24%, respectively. Of the 210 million pregnancies that occur each year, almost 80 million are unplanned. Each year, approximately 42 million pregnant women seek termination of their unplanned pregnancy whereby 20 million undergo unsafe abortions 67,000 die annually. Almost all of these deaths (99%) occur in under developed countries e.g DR Congo (Kangale, et. al., 2014).
A study carried out in Nigeria (Okech, et al, 2011) found out that only 51% of the respondents were using family planning services. Besides, Nigeria has one of the highest total fertility rates (6.7) worldwide (Hladik, et al., 2009). The same study revealed that, the most commonly used contraceptives methods were condoms (35%), pills (33%), injection (19%), and IUD (4%). Nigerias’ contraceptive prevalence rate is lower than that of other developing African countries such Kenya (46%), Tanzania (34%) and Rwanda (52%) (ICF International, 2012). It is for this reason that the researcher is prompted to assess the factors contributing to low utilization of modern contraceptives among women of reproductive age, as the recommendations of the findings can be documented to increase utilization of family planning services among women especially of reproductive age.
1.3 AIM AND OBJECTIVES OF THE STUDY
The main of this study is to assess knowledge and attitude of modern contraceptive use among postpartum women in Ekiti State University Teaching Hospital Ado-Ekiti.
Objectives
- To determine knowledge of contraceptive use among postpartum women in Ekiti State University Teaching Hospital Ado-Ekiti.
- To assess attitude of contraceptive use among postpartum women Ekiti State University Teaching Hospital Ado-Ekiti.
- To assess socio-cultural factors contributing to low utilisation of modern contraceptives among women of child bearing age in Ekiti State University Teaching Hospital Ado-Ekiti.
- To identify health facility related factors contributing to low utilisation of modern contraceptives among women of child bearing age in Ekiti State University Teaching Hospital Ado-Ekiti.
- What are the socio-economic factors contributing to low utilization of modern oral contraceptives among women of child bearing age in Ekiti State University Teaching Hospital Ado-Ekiti.?
- What are the socio cultural factors contributing to low utilization of modern contraception among women of child bearing age in Ekiti State University Teaching Hospital Ado-Ekiti.?
- What health facility related factors contribute to low utilization of modern contraceptives among women of child bearing age in Ekiti State University Teaching Hospital Ado-Ekiti.?
The findings contribute to formulation of guidelines and policies to improve on utilization of modern contraception services among women of reproductive age in the district and the country at large.
The findings of the study will be documented into a report and submitted to Institution research review committee as well as guide future researchers.
1.7 LIMITATION OF THE STUDY
This study is limited to the child bearing age in Ekiti State University Teaching Hospital Ado-Ekiti.. It does not intend to judge the efficiency of acceptance and usage of modern contraceptive - family planning, but to find out what influences the acceptance and usage of women towards modern contraceptive. It does not cover treatment of side effects or failures of the methods.
1.8 DEFINITION OF TERMS
Family Planning: This implies the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their birth.
Contraception: Method and practice of preventing conception is the fertilization of an ovum.
Menstruation: The monthly elimination of the blood filled lining of the uterus (womb), which takes about four to five days, depending on individual physiology.
Ovulation: The release of ripe egg cells from the ovary about once a month.
Vasectomy: Cutting of the vascle ferens through which the sperms reach the penis, so that they are not ejaculated.
Tubalization: Cutting of the female fallopian tube so that egg cells cannot enter the uterus.
Knowledge: Knowledge was defined as being aware of and mentioning at least two contraceptive methods.
Good Knowledge: According to this study the mother who responds correctly for at least three or more postpartum contraceptive method question is considered having good Knowledge.
Poor knowledge: According to this study the mother who responds correctly for one or less postpartum contraceptive method question is considered having poor knowledge.
Favorable (positive) attitude: Those who are able to answer ≥ 70% of the attitude questions correctly will be regarded as having favorable attitude.
Unfavorable (negative) attitude: Those who are able to answer < 70% of attitude questions will be regarded as having unfavorable attitude.
Safe practice: If the client answers greater than or equal to 70% postpartum contraceptive method practice questions correctly she would be considered having good practices.
Unsafe practice: If the client answers less than 70% about postpartum contraceptive method practice questions she would be considered as having poor practice.
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