|Year : 2015 | Volume
| Issue : 4 | Page : 154-159
Uptake of family planning services among women of reproductive age in Edo North senatorial District, Edo State, Nigeria
Innocent Osi Alenoghena1, Essy Clementina Isah1, Alphonsus Rukewe Isara1, Soter Sunday Ameh2, Vincent Yakubu Adam1
1 Department of Community Health, University of Benin Teaching Hospital, P. M. B. 1111, Benin City, Nigeria
2 Department of Community Medicine, College of Medical Sciences, University of Calabar, Cross River State, Nigeria
|Date of Submission||13-Jun-2015|
|Date of Acceptance||21-Sep-2015|
|Date of Web Publication||22-Dec-2015|
Innocent Osi Alenoghena
Department of Community Health, University of Benin Teaching Hospital, P. M. B. 1111, Benin City
Introduction: Inadequate provision of family planning and contraceptive services contributes immensely to the worldwide burden of maternal and child morbidity and mortality. Objectives: To assess the uptake of family planning services and its determinants among women of reproductive age group in Edo North Senatorial District, Edo State. Methodology: A descriptive cross-sectional study was carried out. Respondents were selected using multi-stage sampling technique. Questionnaires and observational checklists were used for data collection. Data were analyzed using SPSS version 17. Results: A total of 340 respondents and 15 primary health care facilities were assessed in this study. Sixty percent of the respondents had at least secondary education. The choices of contraceptives were as oral contraceptive pills (OCP) (77.0%), condoms (75.8%), and injectables (56.2%). The predictors of uptake of contraceptives were as marital status (odds ratio [OR] =0.283, 95% confidence interval [CI]: 0.108, 0.746), monthly income (OR = 0.628, 95% CI: 0.491, 0.802), and respondents residence (OR = 0.504, 95% CI: 0.296, 0.859). Conclusion: Uptake of family planning services was higher than both the national and Edo State average values. The determinants of uptake of these services were, marital status, monthly income, and respondents' residence. The state and local government should increase the availability of family planning services in all the communities and create awareness among the single and unmarried women for improved uptake.
Keywords: Edo State, family planning, uptake, women of reproductive age group
|How to cite this article:|
Alenoghena IO, Isah EC, Isara AR, Ameh SS, Adam VY. Uptake of family planning services among women of reproductive age in Edo North senatorial District, Edo State, Nigeria. Sub-Saharan Afr J Med 2015;2:154-9
|How to cite this URL:|
Alenoghena IO, Isah EC, Isara AR, Ameh SS, Adam VY. Uptake of family planning services among women of reproductive age in Edo North senatorial District, Edo State, Nigeria. Sub-Saharan Afr J Med [serial online] 2015 [cited 2019 May 24];2:154-9. Available from: http://www.ssajm.org/text.asp?2015/2/4/154/172433
| Introduction|| |
Family planning refers to the conscious effort by a couple to limit or space the number of children they have through the use of contraceptive methods. It is also described as a practice that help couples to avoid unwanted births, bring about wanted births, and ultimately determine the number of children in the family. ,, The United Nations Conference on Human Rights at Teheran in 1968 recognized it as a basic human right and as a concept beyond just birth control.  Family planning has been added to the fifth Millennium Development Goal (MDG) as an indicator for tracking progress in improving maternal health.
Modern contraceptive methods include male condoms, female condoms, female/male sterilization, the pill, the intra-uterine device (IUD), injectables, implants, the diaphragm, foam/jelly, lactational amenorrhea (LAM), and emergency contraception. The traditional methods include rhythm (periodic abstinence) and withdrawal methods.  Modern contraceptives with short-term and reversible features (e.g., pill, injectable, and male condoms) are more commonly found in Africa and Europe than elsewhere in the world and the longer-term methods (e.g., IUD or sterilization) are more common in Asia and North America.  The most common contraceptives in Nigeria include injectables, male condoms, and the pill; other modern methods used by <1% of women include IUD, implants, diaphragm, and emergency contraceptives. 
Family planning could reduce maternal mortality by 20% or more and infants are twice more likely to survive if the previous birth interval is at least 2 years.  Access to family planning services can bring about a drop in unintended pregnancies by about 77%;  which can lead to a corresponding reduction in the number of women requiring medical care from complications of unsafe abortions. , By this, it confers important health benefits to individuals, families, and the nation at large. It contributes toward the control of population growth and the achievement of the MDGs. 
Globally, it has been estimated that about 17% of married women have an unmet need for family planning, and this greatly contributes toward a large proportion of unintended pregnancies and a resultant high maternal morbidity and mortality, especially in the developing countries. , In Nigeria, about 15% of married women use modern family planning services, which is lower than the current Sub-Saharan Africa average of 17%.  Globally, Nigeria has the second highest maternal mortality (after India) and this has been attributed to illegal abortions and high rate of transmission of sexually transmitted infections, which are directly or indirectly related to low uptake of family planning services.  Some of the barriers associated with low uptake of contraceptives in the developing countries include poor physical access to the provider and time constraints, type of community (remoteness of communities), poverty, illiteracy, poor co-ordination of family planning programs, and negative cultural and religious beliefs. ,, Most of these factors vary from one zone to another, between and within developing countries.
The consequences of low uptake of family planning services, which are primarily related to maternal morbidity and mortality, are a persistently high total fertility rate of 5.5 per woman and an unmet need for family planning of 16% among married women in Nigeria.  This study was conducted to assess the available family planning services and their uptake, by women of reproductive age in public primary health care (PHC) facilities in Edo State, Nigeria.
| Methodology|| |
This descriptive cross-sectional study was carried out in Edo North Senatorial District of Edo, Nigeria between March and December 2012. Edo North is made up of six local government areas (LGAs). It has 16 public secondary health care facilities and 136 public PHC facilities, with about 450 PHC health workers attached to these facilities. 
The study population included women of reproductive age (15-49 years) who resided in the study area for at least 6 months prior to the study. The public PHC facilities in the selected communities were assessed for availability of family planning services. The minimum sample size was calculated, using the formula for determining the proportion of a factor in a descriptive study, n = Z 2 pq/d 2 .  With 31% as prevalence of uptake of family planning services in Edo State, planning services in Edo State, a maximum error of 5% and a degree of freedom of 95%, a minimum sample size of 323 was calculated. A sample size of 356 was, however, used, considering a nonresponse of 10%.
A multi-stage sampling technique was used to recruit respondents for this study. First, a simple random sampling method was used to select three LGAs from the six LGAs that make up the Senatorial District. Thus, Owan West, Owan East, and Etsako East LGAs were selected. Second, in each of the selected LGAs, the local government headquarters was purposively included in the study (because of the presence of comprehensive health centers in the LGA headquarters and their sub-urban nature) and thereafter, four communities each were selected using simple random sampling methods. Thus, five communities each from the selected LGAs were included in the study. These included: Ozalla, Uhonmora, Sabongidda Ora, Eme-Ora, and Oke Old in Owan West LGA; Agenebode, Ivbiukwe, Ivioghe, Ivari, and Ageire in Etsako East LGA; and Afuze, Oluma, Igwe Saleh, Uokha, and Amuya in Owan East LGA. Third, respondents were selected from households in the communities. This was however preceded by the identification of a central point in the communities (as for this study, the market places were found to be at the center of most of the communities). From the central point, a direction was randomly chosen. Household was selected along this direction up to the edge of the community and respondents were then interviewed in these households.
All the PHC facilities in the selected communities were included in the study.
Data were collected using both questionnaire and observational checklist. The questionnaire contained questions on respondents' sociodemographic data, previous usage and the preferred choices of contraceptives. Respondents were categorized as using contraceptives if they or their spouses used any form of modern contraceptive. The observational checklist was used to assess the availability of family planning services at the PHC facilities. Data analysis was carried out with the use of SPSS version 17 statistical software (SPSS Inc. Chicago, Illinois, USA). Chi-square statistical test of significance was used to test for associations between sociodemographic variables and factors influencing the uptake of family planning services. Variables that showed statistically significant associations were further entered into a binary logistic regression model to identify predictors of uptake of family planning services. As for the binary logistic regression test, the uptake of family planning services was set as the dependent variable and other factors: Geographical location of respondents, marital status, educational status, etc., as the independent variables. Statistical significance was set at P < 0.05.
For availability of family planning services at PHC facilities, a score of 2 was given for the presence of services (these include the availability of common contraceptive commodities) with records, a score of 1 was allocated for the presence of services without records and a score of 0 was awarded for the complete absence of family planning services. Scores were allocated contextually by authors.
Ethical approval for the study was obtained from the Ethics and Research Committee of University of Benin Teaching Hospital. Permission was also obtained from the Local Government Service Commission of Edo State and consent obtained from respondents before participating in the study.
| Results|| |
A total of 340 questionnaires were analyzed (response rate of 95.5%) and 15 PHC facilities were assessed in this study. Three of the PHC facilities were in the sub-urban areas, and 12 were from the rural communities.
[Table 1] shows the sociodemographic characteristics of the respondents. Most of the respondents were within the ages of 25 and 34 years (with a standard deviation of 7.4 years) and almost (90.4%) all the respondents were married. Christianity was their main religion (94.4%) and 49.1% and 11.1% of them had secondary and tertiary level of education respectively. The majority (55.0%) of the respondents were Owans while a higher proportion of them (38.6%) were traders. The average monthly income was N15, 727:13.
[Table 2] shows the availability of family planning services in the PHC facilities. These services (which included the provision of common contraceptive commodities e.g., injectables, male condoms, the pill etc., by staff in the PHC facility) were most readily available in Uhonmora (100%) and Afuze (100%). In terms of the LGAs, the highest uptake of family planning service was in Owan West LGA (60%). This was closely followed by Owan East LGA (50%).
[Figure 1] shows the most preferred family planning methods by the respondents. This was OCP (77.0%), closely followed by male condoms (75.8%), and injectables (56.2%). The least preferred choice of contraceptives was male sterilization (0.2%).
|Table 2: Availability of family planning services at the PHC facilities in the LGAs* |
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|Figure 1: Most preferred methods of family planning services obtained by respondents from primary health care facilities|
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[Table 3] reveals the association between some sociodemographic variables and the uptake of family planning services. There was higher utilization of contraceptives in the sub-urban compared to the rural communities. There was also an increase in the number of those who obtained family planning services based on a history of previous contact with a PHC facility. Marriage appeared to increase the chances of using contraceptives. There was a statistically significant association between family planning services and the geographical location (or residence) of the respondents (P = 0.018), history of previous contact with a PHC facilities (P = 0.035), monthly income (P = 0.0001), and the marital status of the respondents (P = 0.044).
|Table 3: Association between some sociodemographic variables and the uptake of family planning services |
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[Table 4] shows the logistic regression model for utilization of family planning services. The significant predictors of the uptake of family planning services at the PHC facilities were marital status (odds ratio [OR] =0.283, 95% confidence interval [CI]: 0.108, 0.746), average monthly income (OR = 0.628, 95% CI: 0.491, 0.802), and place of residence of the respondents (OR = 0.504, 95% CI: 0.296, 0.859).
|Table 4: Logistic regression model for factors influencing the utilization of family planning services by respondents |
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| Discussion|| |
Family planning services uptake from this study was higher than the average national value (15%) for married women in Nigeria.  The common determinants of this uptake were marital status, monthly income, and geographical location (or residence) of the respondents. Family planning services were available in varying proportions in most of the PHC facilities assessed.
Almost (90.6%) all the respondents interviewed in this study were married and about two-third of them had at least secondary school education. This was higher than the national average literacy level for females (53%) in Nigeria.  Family planning service (which included provision of common contraceptive commodities, e.g., injectables, male condoms, and pills) was available in over three-quarter of all the PHC facilities assessed. The facilities without family planning services at all were the health post that are usually constrained by the limited training of the personnel manning the facilities. This finding is in keeping with the recommended minimum standard of services from various types of facilities, as outlined in the ward minimum health care package in Nigeria.  It was also consistent with the reports of previous studies by the Federal Ministry of Health and World Bank about the types of services obtainable from various types of PHC facilities in Nigeria. , Owan West LGA had the highest uptake of this service. This was probably due to its proximity to the state capital and for the numerous support received from partner agencies such a Unite Nations Population Fund (UNFPA) and United Nations Children's Fund (UNICEF).  The other LGAs by their geographical locations were relatively further away from state capital and that may make supervision more difficult for the reproductive health supervisors from the State Ministry of Health.
Family planning services uptake by the married respondents in this study was 39.1%. This was slightly higher than the current value for Edo State and much higher than the national average of 15% for married women in Nigeria.  It was also higher than the average uptake of 20% for Africa.  Again, the finding from this study was much higher than that from a previous study done in the Northern part of Nigeria, where 1.8% of the respondents utilized family planning services.  The result was, however, consistent with the report of a Zambian study, in which the uptake varied between 16.6% and 41.2% for rural and urban settings respectively.  An explanation for the uptake of family planning services in this study may be the fairly high literacy level of the respondents. This is in keeping with previous studies, ,, on the effect of education on the utilization of maternal services. The current uptake of family planning services may also be related to the provision of support from nongovernmental agencies such as UNFPA in Edo State in the provision of free family planning commodities for all the PHC facilities in most parts of the study area. The most commonly used contraceptives by respondents were OCP, male condoms, and injectables. This trend is related to the sources of contraception in our environment.  OCP and condoms are readily available in patent medicine shops, pharmacy shops, and health institutions. They are also available in various forms, and this contributes to their high uptake. Furthermore, the high uptake of OCP may be related to the fact that its usage does not require the cooperation of the clients' partner and this is often the preferred form of contraception for females in cultural settings that favor male dominance in sex-related issues. This result is consistent with data from previous studies. , However, contrasting data have been reported on projected contraceptive trends in developing countries, in which barrier methods were shown to be the most commonly used methods in middle and western Africa. 
The determinants of family planning services uptake included marital status, average monthly income, and geographical location (or the type of community) of the respondents. The significance of marital status on the utilization of family planning services may be related to common cultural values among most communities in Africa concerning who should use family planning services. There is a high premium on virginity from these cultural systems, especially among females before marriage and so most adolescents (and the unmarried) avoid going to PHC facilities to get help on family planning. The effect of monthly income on the uptake of contraceptives may not be unrelated to the concept that income, wealth, and socioeconomic status are closely related and tend to correlate positively. , Those with higher monthly income (especially the educated females) are often more conscious of the significance of child spacing and, therefore, tend to utilize family planning and other maternal services more frequently.  Similar findings have also been documented in earlier reports. ,
There was a statistically significant difference between utilization of family planning services in the sub-urban and rural communities. This may not be unrelated to the differences in the socioeconomic and educational status of the respondents in the various geographical locations. In terms of the attained educational status of the respondents, a greater percentage of respondents from the sub-urban settings had higher education compared to those from the rural areas. This finding was consistent with previous studies. , Another possible explanation for a higher utilization of family planning services in the sub-urban communities compared to the rural is the greater availability of health providers in the sub-urban communities compared to the rural communities.
| Conclusion|| |
Family planning services uptake in this study was slightly higher than the current value for Edo State and much higher than the national average for married women in Nigeria. The services were available in over three-quarter of all the PHC facilities assessed. Common determinants of the uptake of family planning services were marital status, average monthly income of the respondents, and the geographical location (type of community of residence) of the respondents. The use of OCP, condoms, and injectables by the respondents was consistent with documented trends of contraceptives choices among Nigerians.
The state and local government should increase the availability of family planning services in all the communities and create awareness among the single and unmarried women for improved uptake.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]