Awareness, Acceptability And Barriers To The Utilization .
ORIGINAL ARTICLEAwareness, Acceptability and Barriers to the Utilization of Modern Methodsof Family Planning Among Women Attending Antenatal Clinic in BayeroUniversity, KanoAuwal Umar Gajida1, Idris Usman Takai2, Emmanuel Ajuluchukwu Ugwa3, Murtala Yusuf2ABSTRACTBackground: Contraceptive prevalence rate (CPR) is generally very low in Nigeria, butparticularly lowest in northern Nigeria. Barriers to access and utilization have been variouslystudied, but there is need to consider specific contexts. Objective: The aim of this study is todetermine the level of awareness, acceptability, and barriers to the utilization of modernmethods of family planning in Bayero University, Kano, North-west, Nigeria. Methodology:This was a cross-sectional study conducted at the antenatal section of BUK staff clinic, among152 pregnant women between May and October 2013. Ethical approval and informed consentwere obtained. Descriptive statistics was used to report categorical variables. Results:Awareness of modern methods of contraception was high (86.18%) and the majority (86.19%)knew at least one method of family planning. The commonest methods known by therespondents were: Oral contraceptive pills (39.47%), injectables (22.37%) and condom (14.47%).Out of the152 respondents, 77(50.66%) accepted the use of modern methods of family planningand 39(25.65%) out of these number had ever used at least one method, while 38(25.00%) didnot. Fear of side effects (42.11%), desire for more children (15.79%), and lack of awareness(13.82%), religious prohibition (10.53%) and opposition by male partners (7.89%) constituted themajor barriers to the utilization of modern methods of family planning. Conclusion: The levelof awareness was found to be high but acceptability and utilization were low, this is due to theexisting barriers to utilization of modern methods of family planning. Effort should be made toallay the fear of side effects and to educate women on the implication of frequent childbirth.Keywords: CPR, modern methods, awareness, acceptability, barriers.Departments of 1Community Medicine and 2Obstetricsand Gynaecology, Bayero University/Aminu KanoTeaching Hospital, Kano3Federal Medical Centre, Birnin Kudu, Jigawa StateCorresponding Author:Idris Usman TakaiDepartment of Obstetrics and Gynaecology, B.U.KE-mail: takaiidris@yahoo.co.ukAccess this article onlineQuick Response Codewebsite: www.bornomedicaljournal.comDOI: 10.31173/bomj.bomj 137 16Borno Medical Journal January-June 2019Vol. 16IntroductionFamily planning is one of the importantdeterminants of the quality of life of women,their family, the community and the nation atlarge.1 It is also an important component ofreproductive health.2 Effective familyplanning strategies enable women to pursuegood education, to contribute to thedevelopment of their country and beeconomicallyempowered.1Availablestatistics from National Demographic HealthSurvey of 2013 show that, about 576 womenper 100, 000 live births die from pregnancyrelated complications and deliveries.3Issue 1This work is licensed under a Creative Commons Attribution 4.0 International LicensePage1
Gajida AU et alUnfortunately some of these p regnancies areunwanted and unplanned. Unprotectedintercourse has been found to be theprimary cause of unwanted pregnancies.4Hence, unwanted pregnancies pose a majorhealth challenge among women ofreproductive age. Unsafe abortions contributeto 11% of maternal mortality worldwide and20-40%4 of about 60,000 maternal deaths thatoccur in Nigeria annually. Unfortunately,80% of the cases of unsafe abortions happenamong adolescents and young adults.4 Thehigh maternal mortality ratio and morbidityrates can be related to low contraceptiveprevalence rate which was 5-15% 6 for any kindof contraceptives and 10% for modern methodsof contraception.6 With a rapidly increasingpopulation of over 167 million, the countryremains in dire need of increasedcontraceptive coverage and access toreproductive healthcare to meet the need ofthe rising population.7 There have beenincreases in contraceptive coverage over theprevious years. Nevertheless, effectivecontraceptive coverage which is one of thereproductive health indicators is still verypoor.4, 7 Family planning programming has notbeen very effective as shown by the pooracceleration of family planning access and useespecially in northern Nigeria.3 Such programshave not been able to explore the socio-culturalfactors that may affect utilization of familyplanning commodities and extrapolating resultsfrom other sociocultural context will not improveprogress. This study was undertaken to explorecontext specific factors that affect utilization offamily planning in an urban setting of Kano state.Similar study will need to be conducted in the ruralsetting to be able to generate data that will berepresentative of the state.Materials and MethodThis was cross-sectional study conducted atthe antenatal section of BUK staff clinic.Borno Medical Journal January-June 2019Vol. 16Ethical approval was from AKTH ethicscommittee and informed consent was obtainedfrom the participants. The study groupcomprised of female students, female staff,staff’s wives and other women fromneighbouring communities attending antenatalClinic in Bayero University Kano (BUK) healthclinic. Bayero University Kano has twohealthcare services one on each site of thecampuses. Each offers 24hrs primaryhealthcare services, antenatal and familyplanning services to the staff, their familiesand students, and antenatal, family planningand emergency services to the neighbouringcommunities (Bakan lamba and Danbarecommunities in new site clinic, Kabuga, KofarFamfo and Dorayi in old site clinic). The healthservices have16-bed capacity manned by eightmedical officers and 32 nurses and midwives.The sample size was estimated using theFishers’ formula: n z2pq / d2. To allow forattrition and non-response 10% ofminimum sample size is added to givean approximate sample size of 152.Simple random sampling was used. Therespondents completed pretested structuredquestionnaires. Data was entered, cleaned andanalysed with Microsoft Excel and Minitabstatistical software version 12. Categoricalvariables were summarized with absolutenumbers and simple percentages. Measures ofcentral tendency (mean and median) andmeasures of dispersion (range and standarddeviation as appropriate) were used tosummarize qualitative data. Significantassociation was determined where p value 0.05 was considered significant.ResultsThe age range of the respondents wasbetween 15 and 48years with a mean age of25.41 5.80. Majority of the women weremultiparas (35.53%). They were also mostlyIssue 1This work is licensed under a Creative Commons Attribution 4.0 International LicensePage2
married (98.03%), Muslims (96.71%) andeducated, majority had tertiary education(42.10 %).Awarenessofmodernmethodsofcontraception was high (86.18%) and themajority knew at least one method of familyplanning (Table 2). The commonest methodsknown by the respondents were: Oralcontraceptive pills (39.47%), injectables(22.37%) and condom (14.47%). The mainsource of their information (Table 3) about themodern methods of contraception was viaBorno Medical Journal January-June 2019Vol. 16medical personnel (47.37%), Radio/TV(12.50%) and workshops/seminars (5.92%).Out of the152 respondents, 77 (50.66%)accepted the use of modern methods offamily planning and 39 (25.65%) out of thesenumber have used at least one method, while38 (25%) did not. Fear of side effects (42.11%),desire for more children (15.79%), lack ofawareness (13.82%), religious prohibition(10.53%) and opposition by male partners(7.89%) constituted the major barriers (Table6) to the utilization of modern methods offamily planning.Issue 1This work is licensed under a Creative Commons Attribution 4.0 International LicensePage3
Gajida AU et alTable 1: Socio-Demographic and Obstetric 7.249019732459.2112.504.6121.052.63Age Group (years)15 –1920 – 2425 – 2930 – 3435 – 3940 – 4445 – 49Marital MultiparaGrandmultiparaeEducational oOthersOccupationUnemployedCivil ServantsTradersStudentsOthersBorno Medical Journal January-June 2019Vol. 16Issue 1This work is licensed under a Creative Commons Attribution 4.0 International LicensePage4
Table 2: Modern Methods of Family Planning known to the respondentsMethodsFrequency (n 152)PercentageOral 26Implant31.97foaming Tablet21.32BTL21.322113.82NoneTable 3: Sources of information about modern methods of familySourcesFrequency (n 152)PercentageMedical Personnel7247.37Radios/TV1912.5095.92School hop/SeminarsNot awareTable 4: Number of family planning methods known by respondentsNumberFrequency (n 152)PercentageNone2113.81One10065.78Two2013.15More than two117.23Borno Medical Journal January-June 2019Vol. 16Issue 1This work is licensed under a Creative Commons Attribution 4.0 International LicensePage5
Gajida AU et alTable 5: Acceptability of modern contraceptives methodsAcceptabilityFrequency (n le 6: Barriers to the utilization of modern methods of family planningBarriersFrequency (n 152)PercentageFear of side effects6442.11Opposition by male partners127.8921.32Religious Prohibitions1610.53Cultural Prohibitions21.32Poor Access to providers21.32Lack of awareness2113.82Desire for more children2415.79Cost53.29None42.63Opposition by Family membersDiscussionThis study was conducted in a Universitycommunity in North West Nigeria that ispredominantly inhabited by Hausa/Fulaniwho are predominantly Muslim, in acommunity where early female marriage ispracticed. Hence, majority of the womenwere married (98.03), Hausa/Fulani (88.81%)and Muslims (97.30%) with tertiary education(42.00%). Being a University community,most of (42.00%) the study population hadBorno Medical Journal January-June 2019Vol. 16either completed a tertiary education or arepursuing it at the time of the study. This wasalso the findings of similar studies done inour community.8 Those with non-formaleducation (4.00%) and those with informaleducation, could have come from theneighbouringruralcommunities(Bakanlamba and Danbare). Majority (50.3%)of the study population were unemployed,despite the study being conducted in anIssue 1This work is licensed under a Creative Commons Attribution 4.0 International LicensePage6
enlightened community, which have beencited by a similar study done in a teachinghospital in Kano,9 and has been attributed tothe fact that most of the women were full timehousewives, which is in line with Hausa/Fulani culture and Islamic religion thatconstituted the majority of the population inthis study. Also, a significant number(21.05%) of the respondents were studentswho were not in gainful employment at thetime of the study.Awareness of modern contraceptives washigh (86.16%) among the respondents bututilization was low (25.65%), this is inagreement with similar studies done in ourcommunity and other parts of Nigeria.3,4,10The high level of awareness of moderncontraceptives among the respondents,majority of whom were parous, has beenattributed to the inculcation of familyplanning counselling into the antenatal clinichealth talk and the fact that they could havebeen exposed to information in their previousantenatal clinic attendance as well as theirlevel of education may have played someroles. This is however lower than 92% level ofawareness of methods of family planningreported by Ashimi et al11 in Jigawa Northwest, 94% reported by Obisesan et al. inIbadan South‑West12, 96% reported byIgwegbe et al. in Nnewi South‑East Nigeria13and 88% reported by Utoo et al. from Jos,North central.14Oral pills (39.1%) was the commonestmethod known by the respondents, followedby the injectables (23%)and condoms (14.7%)which was also in line with the findings of asimilar study done in our environment8 butcontrary to the findings of Monjek et al.4 Thismay probably be because oral pills arecommonly used by the young couples andstudents, and it is recommended below theage of 40yrs. Studies4,10 have actually shownBorno Medical Journal January-June 2019Vol. 16that, most young couples prefer oral pills,more so, oral pills are easily available over thecounter in pharmacies and patent medicinestores. Injectables are preferred by olderwomen of higher parity since most of themultiparous women are of higher age andothers use injectable so that their husbandswho will not give consent may not be awareof what is going on. It also saves them thetrouble of daily ingestion of pills and that ofexposure for IUCD insertion. Condoms arealso readily available and are a method ofchoice for most couples and students alikeand the fact that condom has been advocatedin the prevention of HIV/AIDs and STIswould have increased its awareness andutilization. Utilization of I.U.C.D (5.3%) andfoaming tablets (1.3%) are low probablybecause they both involve exposure whichmost of the women would not like. The lowfrequency of use of bilateral tubal ligation(B.T.L) may be because most of the women dohave desire for more children so they do notlike permanent contraceptives, this has beencited by other studies done in Nigeria 4 butcontrary to what is obtainable worldwide.15Majority (47.3%) got their information frommedical personnel, probably becausemajority of the women were married andcould have gotten information duringantenatal clinic. This was shown by similarresearch in other parts of Nigeria.4, 10Similarly, other sources of informationidentified by our study, is in agreement withthe literature.4, 10 Fear of side effectsconstituted the major (42%) barrier to theutilization of family planning. The existingmyth and misconception like, O.C.P can causepermanent sterility, and I.U.C.D can perforatethe uterus 4 could have accounted for this.This finding is in agreement with studiesdone in Sudan17 and in Pakistan.8 Similarstudy in a sub-urban setting however notedIssue 1This work is licensed under a Creative Commons Attribution 4.0 International LicensePage7
Gajida AU et althat husband’s refusal was a major barrier toutilization of family planning.11 Being anenlightened community, their husbands orfamily members are not likely to interferewith their personal affairs hence this does notconstitute a significant barrier.Other barriers are, religious prohibitions(since it is a predominantly Muslimcommunity), and desire for more childrenbecause of their interest for large family size.Lack of awareness constituted a significantbarrier among the respondents. This isprobably because some of the respondentscame from rural areas and this agrees with aprevious study.15Although family planning awareness is veryhigh, its acceptability is low, and fear of sideeffect was a major barrier to utilization. It iscrucial to advocate to religious leaders to allayfear of religious prohibition in order toimprove on acceptability of family planningmethods among couples.The limitation of this study is that individualopinion was used as assessed, but it wouldhave been better to also review some servicestatistics related to family planning. Alsobeing a facility-based survey, it is notrepresentative of the whole of Kano State notto talk of north-west. There will be need in thefuture to conduct a community-based study.References1. Utoo, BT, Swende TZ, Utoo FM, Ifenne DI.Barriers to utilization of modern methods offamily planning among women in acommunity south-south of Nigeria. Trop JObstetric Gynaecol 2012; 29(1):66 – 672. Repositioning family planning in reproductivehealth services: framework for acceleratedaction 2005-2014. AF/RC54/IIRevl.l-8Borno Medical Journal January-June 2019Vol. 163. Federal Republic of Nigeria Gazette. TheProvisional Results of 2006 Census. 2007;94:182-183.4. Monjok E, Smesny A, Ekabua JE, Essien EJ.Contraceptive practices in Nigeria: literaturereview and recommendations for future policydecisions. Open Access J of Contraceptive 15. Anthony Ol, Joseph OU, Emmanuesl NMI.Prevalence and determinant of unmet need forfamily planning in Nnewi, south-east Nigeria.Int J of Med and Med Sci 2009; 1(8):325 – 329.6. Boniface A, Oye-Adeniran, Isaac FA, AugustineVu, Adesina. O, Abidoye G et al. Communitybased study of contraceptives Behaviors inNigeria. Afri J Reprod Health 2006; 10(2):90 –104.7. Farouk MJ. Pathfinder International: Nigeria, AGlobal Leader in Sexual and ReproductiveHealth, An overview of Nigeria 20128. Syed K A, Ghulam M, Wegas H,Muhammad A, Afhb A, Mohsina B, Barrierand perception regarding differentcontraceptive and family planning practiceamong men and women of reproductiveage in Pakistan: A qualitative studies. Pak JPublic Health 2012; 2(1):1 – 8.9. Kragelund NK, Nielsen SM, Butler R,Lazarus JV. Key barriers to the use ofmodern contraceptives among women inAlbania: A qualitative study. US NationalLibrary of Medicine National Institutes ofHealth Reprod Health Matters. 2012;20(40):158 – 65.10. Oluyemi A, Truter EJ. A review of managementof infertility in Nigeria: Framing the ethics of anational health policy. Int. J Women's Health2011; 3:265 – 275.11. Ashimi AO, Amole TG, Ugwa EA, Ohonsi AO.Awareness, practice, and predictors of familyplanning by pregnant women attending atertiary hospital in a semi-rural community ofIssue 1This work is licensed under a Creative Commons Attribution 4.0 International LicensePage8
North-West Nigeria. J Basic Clin Reprod Sci 15. United Nations, Department of Economic and2016; 5:6 – 11.Social Affairs, Population Division. World12. Obisesan KA, Adeyemo AA, Fakokunde BO.contraceptives use 2009:1. Available @Awareness and use of family planning methodswww.unpopulation.orgamong married women in Ibadan, Nigeria. East 16. Onwuzurike BK, Uzochukwu BS. Knowledge,Afr Med J 1998; 75:135 – 8.attitude and practice of family planning13. Igwegbe AO, Ugboaja JO, Monago EN.amongst women in a high-density low incomeKnowledge and practice of family planningurban of Enugu, Nigeria. Afr J Reprod Healthamong antenatal care attendees at Nnewi,2001; 5:83 – 9.South East Nigeria. Niger Postgrad Med J 2010; 17. Susan M, Abdallah O, Muhammad A.17:287 – 90.Barriers to contraceptive use. Geneva14. Utoo BT, Mutihir TJ, Utoo PM. Knowledge,foundation for medical education andattitude and practice of family planningresearch, GFMER foundation Sudan, 2012methods among women attending antenatalForum no 3 (Fear of site effect)clinic in Jos, North‑central Nigeria. Niger J Med2010; 19:214 ‑ 8.Cite this Article as: Auwal Umar Gajida, Idris Usman Takai, Emmanuel Ajuluchukwu Ugwa,Murtala Yusuf. Awareness, Acceptability and Barriers to the Utilization of Modern Methodsof Family Planning Among Women Attending Antenatal Clinic in Bayero University, Kano.Bo Med J 2019;16(1): Source of Support: Nil, Conflict of Interest: None declareBorno Medical Journal January-June 2019Vol. 16Issue 1This work is licensed under a Creative Commons Attribution 4.0 International LicensePage9
Awareness, Acceptability and Barriers to the Utilization of Modern Methods of Family Planning Among Women Attending Antenatal Clinic in Bayero University, Kano Auwal Umar Gajida1, Idris Usman Takai2, Emmanuel Ajuluchukwu Ugwa3, Murtala Yusuf2 ABSTRACT Background: Contraceptive prevalence rate (CPR) is generally very low in Nigeria, but
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