Variables |
Frequency |
Percentage |
|
Maternal age (years) |
|||
15-19 |
88 |
22.9 |
|
20-49 |
296 |
77.1 |
|
Maternal education |
|||
None formal |
20 |
5.2 |
|
Primary |
83 |
21.6 |
|
Secondary |
179 |
46.6 |
|
Tertiary |
102 |
26.6 |
|
Employment status |
|||
Working |
86 |
22.4 |
|
Not working |
298 |
72.4 |
|
Marital status |
|||
Married |
200 |
52.1 |
|
Living together |
78 |
20.3 |
|
Widowed |
10 |
2.6 |
|
Separated |
04 |
1.04 |
|
Divorced |
08 |
2.1 |
|
Single |
84 |
22.0 |
|
Religion |
|||
Catholic |
92 |
23.9 |
|
Other Christians Other religion |
19 |
4.9 |
|
Monthly income (?) |
|||
<10,000 |
265 |
69.0 |
|
10,000-14,999 |
41 |
10.7 |
|
15,000-19,999 |
34 |
8.9 |
|
?20,000 |
44 |
11.5 |
|
Cost of transportation to nearest PHCs (?) |
|||
<200 |
334 |
81.2 |
|
200-499 |
29 |
7.6 |
|
500-799 |
08 |
2.1 |
|
?800 |
12 |
3.1 |
|
Husband Education |
|||
Non-formal |
10 |
3.6 |
|
Primary |
34 |
12.2 |
|
Secondary |
124 |
44.6 |
|
Tertiary |
110 |
39.6 |
|
Spousal attitude to contraception |
|||
Support |
299 |
77.9 |
|
Non-support |
85 |
22.1 |
|
Availability of health Centre in communities |
|||
Yes |
350 |
91.2 |
|
No |
34 |
8.9 |
|
Travel time health Centers (mins) |
|||
<30 |
289 |
75.3 |
|
30-59 |
70 |
18.2 |
|
?60 |
25 |
6.5 |
|
Number of health talks ever attended |
|||
1 |
81 |
21.2 |
|
2 |
192 |
50.1 |
|
3 |
62 |
16.2 |
|
4 |
28 |
7.3 |
|
?5 |
20 |
5.2 |
|
Mass media exposure |
|||
Yes |
68 |
17.7 |
|
No |
316 |
82.3 |
Source: Author’s compilation (2020).
Patterns of contraceptive use among respondents
In Table 2, we examined the various contraceptive used by the study participants. About 19.3% of the respondents were currently using contraceptive while 31.8% reported they once used contraceptive, but they stopped. Examination of various types of contraceptive use revealed that in order of frequency, the most commonly used method of contraceptives were injectable (26.2%), oral pills (24.6%), and implant (14.8%). Also, withdrawal method accounted for 9.8%, safe period for 8.2% and breast feeding for 3.3%.
Table 2: Patterns of contraceptive use among study participants
Variables |
Frequency |
Percentage |
Current use of modern contraceptive/Family planning (FP) |
||
Yes |
74 |
19.3 |
No |
310 |
80.7 |
Once used contraceptive/ FP but stopped |
||
Yes |
122 |
31.8 |
No |
262 |
68.2 |
Method of contraceptive/FP |
||
Male condom |
10 |
8.2 |
Female condom |
02 |
1.6 |
Oral pills |
30 |
24.6 |
IUCD |
0 |
0 |
Implant |
18 |
14.8 |
Injectable |
32 |
26.2 |
BTL |
04 |
3.3 |
Breast feeding |
04 |
3.3 |
Safe period |
10 |
8.2 |
Withdrawal |
12 |
9.8 |
Female sterilization |
0 |
0 |
Vasectomy |
0 |
0 |
Source: Author’s compilation (2020)
Bivariate analysis
In Table 3, the proportion of respondents that use modern contraceptive against those who did not use across the various socio-demographic factors is presented. The use of modern contraceptive is more pronounced among participants within the age group (15-19) years (34.1%), those who reported tertiary educational qualification (44.1%), Catholic Christians (52.6%), those who were divorced (62.5%) and participants who belonged to the income bracket, ? (20,000-99,999) (40.9%). Furthermore, the use of modern contraceptive is higher among respondents who reported transport cost to the nearest facility as ? (500-799) (62.5%), whose partners had primary school educational qualification (41.2%), those whose partners were in support that they should use contraceptive (32.1%) and those who lived within 30 minutes’ walk to the nearest health centre (33.2%). In comparison with respondents living in communities without health centres, those in communities with health centres were more likely to use modern contraceptive (32.6%). Women who reported they attended health talks twice were more likely to use modern contraceptive (33.9%). Finally, higher proportion of women who recorded media exposure utilized modern contraceptives (33.8%).
Table 3: Bivariate analysis of use and non-use of modern contraceptive among study participants
Socio-demographic factors |
Non-use (%) |
Use (%) |
Maternal age (years) |
||
15-19 |
65.9 |
34.1 |
20-49 |
68.6 |
31.4 |
Maternal education |
||
None formal |
80.0 |
20.0 |
Primary |
78.3 |
21.7 |
Secondary |
68.7 |
31.3 |
Tertiary |
55.9 |
44.1 |
Religion |
||
Catholic |
47.4 |
52.6 |
Other Christian |
69.9 |
30.1 |
Other Religion |
66.3 |
33.7 |
Marital status |
||
Married |
68.8 |
31.2 |
Widowed |
60.0 |
40.0 |
Separated |
66.7 |
33.3 |
Divorced |
37.5 |
62.5 |
Single |
69.0 |
31.0 |
Monthly income (?) |
||
< 10,000 |
68.9 |
31.1 |
10,000-14,999 |
73.2 |
26.8 |
15,000-19,999 |
67.6 |
32.4 |
?20,000 |
59.1 |
40.9 |
Cost of transportation to nearest PHCs (?) |
||
<200 |
69.1 |
32.9 |
200-499 |
86.2 |
13.8 |
500-799 |
37.5 |
62.5 |
?800 |
75.0 |
25.0 |
Husband's education |
||
No husband |
70.8 |
29.2 |
None formal |
60.0 |
40.0 |
Primary |
58.8 |
41.2 |
Secondary |
65.9 |
34.1 |
Tertiary |
71.8 |
28.2 |
Spousal attitude to contraception |
||
Support |
67.9 |
32.1 |
Non-support |
68.2 |
31.8 |
Travel time health Centers (mins) |
||
<30 |
66.8 |
33.2 |
30-59 |
74.3 |
25.7 |
?60 |
64.0 |
36.0 |
Availability of health Centre in communities |
||
Yes |
67.4 |
32.6 |
No |
92.7 |
7.3 |
Number of health talks ever attended |
||
1 |
67.9 |
32.1 |
2 |
66.1 |
33.9 |
3 |
69.4 |
30.6 |
4 |
71.4 |
28.6 |
?5 |
75.0 |
25.0 |
Mass media exposure |
||
Yes |
68.4 |
31.6 |
No |
66.2 |
33.8 |
Source: Author’s compilation (2020).
Reasons for use of modern contraceptive
The data showed that 27.9% of the women used modern contraceptive for child spacing. In addition, 18.0% mentioned that they already had enough children and their usage of modern contraceptive was to avoid unwanted pregnancy and possible unsafe abortion (9.8%). Only a relatively small number of them were using modern contraceptive because their husbands desired it or approved of it (4.9%) (Table 4).
Table 4: Reasons for use of modern contraceptive
Reason for use |
Number of women |
% of women |
To space children |
34 |
27.9 |
I have enough children |
22 |
18 |
To avoid unsafe abortion |
12 |
9.8 |
My husband demanded for it |
06 |
4.9 |
Source: Author’s compilation (2020).
Reasons for non-use of modern contraceptive
A higher proportion of the respondents (39.6%) reported side effects as reason for their non-use of modern contraceptive, while 33.3% reported other barriers as the reasons why they were not using modern contraceptive. Furthermore, 16.7% reported their desire for more babies as their reasons for discontinuing the use of modern contraceptive. Also, 6.3% reported that their husband desired they stop. Finally, only 4.2% of them reported high costs of modern contraceptive as their major hindrance (Table 5).
Table 5: Reasons for non- use of modern contraceptive
Reason for use |
Number of women |
% of women |
Reasons for non-use |
||
Side effects |
19 |
39.6 |
Too expensive |
02 |
4.2 |
I wanted another baby |
08 |
16.7 |
My husband forced me to stop it |
03 |
6.3 |
Others |
16 |
33.3 |
Source: Author’s computation (2020).
Predictor of modern contraceptive use
In Table 6, univariate analysis and results of multivariate analysis using binary logistic regression showing predictors of modern contraceptive use is presented. In reference to respondents who had no formal educational qualification, those with secondary educational qualifications {aOR: 1.46, 95% CI: 0.45-4.71} and tertiary education qualifications {aOR: 3.09, 95% CI: 0.93-10.24} were significantly more likely to use modern contraceptive.
Table 6: Factors Associated with the use of Modern Contraceptive
Variable |
Unadjusted Odds Ratio (95% CI) |
Adjusted Odds Ratio (95% CI) |
Maternal age (years) |
||
15-19 (ref) |
1 |
1 |
20-49 |
0.886 (0.54 – 1.47) |
0 |
Maternal education |
||
Non-formal(ref) |
1 |
1 |
Primary |
1.108 (0.33 – 3.73) |
0.831 (0.24 – 2.91) |
Secondary |
1.821 (0.58 – 5.70) |
1.456 (0.45 – 4.71)* |
Tertiary |
3.158 (0.99 – 10.11) *** |
3.091 (0.93 – 10.24)* |
Employment status |
||
Working (ref) |
1 |
1 |
Not working |
1.262 (0.76 – 2.09) |
0 |
Marital status |
||
Married(ref) |
1 |
1 |
Living together |
1.401 (0.40 – 5.35) |
1.379 (0.35 – 5.42) |
Single |
1.103 (0.10 – 12.33) *** |
2.341 (0.19 – 29.68) |
Separated |
1.678 (0.86 – 15.74) |
3.586 (0.77 – 16.78) |
Widowed |
0.989 (0.58 – 1.68) |
1.100 (0.63 – 1.92) |
Religion |
||
Other Christians (ref) |
1 |
1 |
Catholic Christian |
0.386 (0.15 – 0.99) *** |
0.328 (0.12 – 0.94) |
Other Religion |
0.457 (0.17 – 1.24) |
0.400 (0.13 – 1.21) |
Monthly income (?) |
||
<10,000 (ref) |
1 |
1 |
10,000 14,999 |
0.804 (0.38 – 1.68) |
0 |
15,000-19,999 |
1.048 (0.49 – 2.25) |
0 |
20,000-99,999 |
1.518 (0.79 – 2.92) |
0 |
Spousal support for contraceptive |
||
Support (ref) |
1 |
1 |
No support |
0.984 (0.58 – 1.65) |
1 |
Travel time health Centers (mins) |
||
<30 (ref) |
1 |
1 |
30-59 |
0.696 (0.39 – 1.25) |
0 |
?60 |
1.131 (0.48 – 2.65) |
0 |
Number of health talks ever attended |
||
1(ref) |
1 |
1 |
2 |
1.083 (0.62 – 1.88) |
0 |
3 |
0.935 (0.46-1.91) |
0 |
4 |
0.846 (0.33 – 2.17) |
0 |
?5 |
0.705 (0.23 – 2.15) |
0 |
Mass media exposure |
||
Yes (ref) |
1 |
1 |
No |
1.104 (0.63 – 1.92) |
0 |
Partner's education |
||
No partner (ref) |
1.612 (0.43 – 6.12) |
0 |
Non-formal |
1.694 (0.76 – 3.77) |
0 |
Primary |
1.254 (0.72 – 2.20) |
0 |
? Secondary education |
0.949 (0.53 – 1.71) |
0 |
Availability of health Centre |
||
Yes (ref) |
1 |
1 |
No |
0.745 (0.34 – 1.65) |
0 |
Cost of transportation to PHC (?) |
||
<200 (ref) |
1 |
1 |
(200-499) |
0.326 (0.11 – 0.96) *** |
0.295 (0.10 – 0.90) |
(500-799) |
3.394 (0.77 – 14.46) *** |
4.141 (0.93 – 18.43) |
?800 |
0.679 (0.18 – 2.56) |
0.665 (0.17 – 2.68) |
Source: Author’s computation (2020).
0 Variable not included in the model; *Signi?cant at 1% signi?cance level; ** Signi?cant at 5% signi?cance level; + represent unemployed women.
Discussion
The study examined the use of modern contraceptive among reproductive age women in eight randomly selected rural communities in Delta State, Southern Nigeria. Also, the determinants of modern contraceptive and reasons for use and discontinuation of use were explored. The result of the study showed that 19.3% of the women reported they were currently using modern contraceptive. Although, the contraceptive prevalent rate reported in this study is higher than the 17% reported by the most recent National Demographic and Health Survey (30), it is still far below the global average of 63% (31). Several recent Nigerian studies have reported low contraceptive prevalent rate (2, 30, 32, 33, 34, and 35). In 2011, the Nigerian government launched the free family planning commodity policy, by committing itself to providing family planning commodities free of charge to all women attending public health facilities. Again, following the 2012 London family planning summit, family planning 2020, Nigerian government set a target of achieving a 36% modern contraceptive prevalent rate by 2018 (2). Annually, the target was to increase the modern contraceptive prevalent rate by 1.5% (35). Also, the prevalence reported in this study is far below the 66.1% reported by a recent Nigerian study conducted in South-western geopolitical zones of Nigeria (22). The low contraceptive prevalent rate in the study area shows that a lot of the women who did not desire babies in the next few years were still not using contraceptive, making it impossible for them to avoid unwanted pregnancies and it attendant undesirable consequences (10). Low Nigerian contraceptive rate has been associated with high fertility rate and rapid population explosion (6, 36). Evidence has linked both high under-five mortality rate (120 per 1,000 live births) and high maternal mortality rate (565 per 100,000 live births) in Nigeria to the high fertility rate (10). These indicators are the themes that featured in both the MDGs and SDGs. Hence, to achieve the SDGs, efforts must be made to redress the RPG by encouraging the use of contraceptive among rural Nigerian women.
Approximately 40% of the respondents reported side effects as the major reason why they discontinued the use of modern contraceptive. This is far higher than 7.2% reported by the most recent National Demographic and Health Survey (30). Decisions to use modern contraceptives was influenced by the side effects of the methods, dislike of existing methods, inconveniencies associated with the usage and the desire to have more children. Though some respondents were practising family planning the fear of side effects discouraged them. It is the most cited reasons for discontinuation of, or reluctance to use modern contraceptive in this study. Ajayi, Adeniyi and Akpan (22), remarked that the fear of side effects with respect to modern contraceptive may push some women to rely on less effective traditional methods (withdrawal and rhythm methods). Other recent Nigerian studies reported fear of side effect as deterrent to use of modern contraceptive (32,33) Erroneous perception of the side effects of modern contraceptive and possibly infertility associated with it is common among women who do not have adequate reproductive health information. The women in the study area should be educated on the usefulness of modern contraceptive and that the method is safe without any side effect. Reproductive health information can be broadcasted through radio, television and other media platforms. Intervention programs that involve the use of health workers to educate women can be implemented in the study areas. Family planning and reproductive health should be integrated in the study area.
Furthermore, the desire to space children and avoid unplanned pregnancy were the two major reasons advanced why some women were using contraceptive. These set of practitioners are aware of the relationships between the use of contraceptive, their own health and their children’s health and the overall quality of life (37). It can be deduced from the findings of the study that women are likely to use contraceptive to avoid unwanted pregnancies and its undesirable consequences.
The logistic regression result showed that maternal education significantly influenced the use of contraceptive. This finding corroborates that of several other studies both for Nigeria and elsewhere (2,10, 16, 38-40).The positive effects of education on contraceptive use is due to the fact that education improves women’s socioeconomic status and empowerment, and as a result impacts positively on contraceptive use. In the literature, education is associated with knowledge, attitude and utilization of modern maternal care services (34). Maternal education enhances their capability and also their reproductive rights to decide freely and responsibly the number, spacing and timing of their children and to have other necessary information regarding reproductive rights. Though the women in the study area are significantly educated as shown by the summary statistics, however, for the few who are not educated, opportunities should be expanded for them to acquire formal education. For both primary and secondary school, enrolment should be made compulsory for women. At the tertiary level, a preferential cut-off should be used to encourage female enrolment rate. Free tuition fee should be implemented for female children in order to encourage female educational enrolment rate.
Limitation of the study
The study has three limitations that should be noted. First, the data analysed was gotten through verbal reporting, hence was not subjected to any form of validation such as the use of health facility card. Second, the study was cross-sectional and so the interporal relationship between the socio-demographic factors and the use of contraceptive was not established. Third, the findings of the study cannot be generalized to urban population.
Conclusion
The study concludes that a significant proportion of the respondents were not using contraceptive despite the fact that they were not planning to have children in the next two to three years. Thus, the coverage of contraceptive is both poor and unimpressive. Fear of side effects of contraception and women wanting more children are significant reasons for poor practice. Socio-demographic factor like education and monthly income was found to influence the use of contraceptive among respondents. In addition, whether women practise family planning depends on many factors and the most common factors are avoiding unwanted pregnancy or spacing out the number of children, the side effects of the methods and other reasons advanced by respondents. Side effects were the biggest concern for non-users. Rumours about possible side effects deterred some women from using modern contraceptive; especially the pill and injectable contraceptive. The various stakeholders involved in the implementation of family planning programmes should, therefore, intensify awareness campaigns on specific methods of contraception and management of possible side effects and improve public, private and outreach family planning services provision to improve uptake and reproductive health outcomes in the study area.
Abbreviation
MDGs: Millennium Development Goals; SDGs: Sustainable Development Goals; ICPD: International Conference on Population and Development; POA: Plan of Action; USAID: United States Agency for International Development; UN: United Nations; FGN: Federal Government of Nigeria; NPPD: National Policy on Population and Development; RPG: rapid population growth; NPPSD: National Policy on Population and Sustainable Development; NPopC: National Population Commission and LGA: Local Government Area; FP: Family Planning.
Funding
This research has no funding to report.
Availability of Data and Materials
The dataset used and analyzed during the current study is available from the corresponding author on a reasonable request.
Acknowledgement
We are grateful to Chioma Grace Igbojekwe and Aigbokhan Believe who were Research Assistants that assisted in Data collection. We are most thankful to lead contact persons particularly Peter Umudo, Reverend Erico, Felani and Issah.
Authors’ Contribution
RRA conceived the study, undertook the analysis while CIN undertook the write up of part of the manuscript and estimated the models. All two authors read and approved the final manuscript. It was the responsibility of RRA to upload and send to the journal.
Conflict of Interest
The authors declared they have no conflicts of interest.
Footnotes:
1.According to the 2013 NDHS, modern contraceptives method are pills, intra-uterine device, injectable, implants, female condoms, male condoms, diaphragm, foam/jelly, female sterilization, male sterilization and lactational amenorrhea (NDHS, 2014). Methods outside of these are non-modern methods, which could be either traditional methods or the folklore methods.
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