INTRODUCTION
1.1 Background of the Study
The knowledge and practice of family planning hasattracted much attention in recent times. This is in part due to the increase in unwanted or unplanned pregnancies, induced or criminal abortions, maternal mortality, sexually transmitted infections and the list goes on.
Family planning is the means by which individuals or couples space the process of conception, pregnancy and childbirth at intervals mutually determined by both husband and wife in order to have the desired number of children that they can conveniently maintain. Family planning also assists couples who have difficulty in having children (Malthus,2012). People everywhere have developed various means of family planning methods in fertility regulation for reasons such as ensuring better maternal / infant health, paternal care for children, reducing the burden of poverty, improving standard of living, education for wards, maternal adjustment between couples and welfare for the community and the nation at large (Delano, 2010).
According to Schenker and Rabenou, (2013), population growth before the industrial revolution worldwide was checked by fatal diseases, often epidemics, promoted by lack of proper sanitation, poor nutrition, natural disasters such as floods, earthquakes and others; death rates were high. Conversely, following the industrial revolution, modern preventive medicines such as immunizations and new drugs, (antibiotics) improved education, sanitation, better income and improvement in general living standard had a positive effect on population growth. In developing countries like Nigeria, birthrate remains high and declining more slowly than death rate (Schenker and Rabenou, 2013). Records show the current worldwide annual population growth rate is 1.7%, which, means an additional 90 million people each year, or an increase in the world’s population of 170 persons per minute (Schenker and Rabenou, 2013).The rates of population growth worldwide have caused political leaders to encourage national and regional fertility regulation projects as vital. Supports for regulation of individual fertility have been evident in all cultures and at all times even in those societies in which social and religious rules have favoured the abundant production of children (Billing, 2012). The need for fertility regulation methods to be applied by national and regional authorities was discussed by the United Nations population Committee in 1947. In 1968, the United Nations General Assembly and other international bodies affirmed family planning as a basic human right (FilstieandGuileband, 2009).
However, there were problems associated with the introduction of the modern technological methods of family planning ranging from religious, moral and cultural prohibition. There is also the individual aspect to family planning as shown in the records of the world fertility survey in 1970.It was discovered that though people have strong desire for fertility regulation in nearly all societies, achieved family size is greater than desired family size. Presently, about half of the women in the world who currently have three or more children do not wish to have more but there still exist gaps between stated desire to control fertility and actual practice (Goldzierher, 2011). From experience, this may be because many women have neither sufficient motivation, nor adequate access to the services they would need to meet this goal. It may also be due to lack of knowledge in the application of other alternatives available, such as the natural family planning methods.
The various methods of family planning can be categorized as; the traditional methods, which involves the use of native objects such as charms, amulets, rings, keys,fluid from dead bodies and other things for birth control purposes, while the modern methods involve the introduction and uses of contraceptives such as pills, injectable, intrauterine devices, implants and others for family planning purposes (Delano, 2010). This is the commonest and mainly advertised form of family planning. However, some research results show that most Nigerian couples are non-contraceptive users (Suleiman, 2010). Some of the reasons for the low rate of contraceptive practice according to (Ikechebelu, Ikechebelu, and Obiajulu,(2015), range from factors such as “the fear of side effects, husband’s objection, religious and cultural prohibitions”. The Nigerian population as at 2010, was estimated to be about 158 million by the population reference Bureau Washington USA, with fertility rate of 5.7 and 42 birth per 1000. Nigeria is ranked the 8th largest in population in the world behind China, India, United State, Indonesia, Brazil, Pakistan and Bangladesh followed by India and Japan. It is also on record that whenever a Nigerian woman gets pregnant, she has a 1 in 13 chance of dying, mainly due to the poor utilization of modern family planning methods (Umar, 2010).
The Nigerian government in 2004 revised the national policy on population alongside emerging issues to improve the state of the economy and make progress towards long–term sustainable development. The policy emphasized among other priorities the reproductive rights of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children, and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. Taking into consideration the social, economic and emotional needs of their living/ future children and their responsibilities towards the community.In spite of these efforts and more, it has been shown that there still exists the problem of motivation in the practice of family planning among couples and problems in the delivery of family planning services.Alot of research has gone into the role of men in the use of family planning methods with the women folk relegated to the background. It is for this reason that this study seeks to investigate the knowledge and practice of family planning among women in primary health care centre,Ujoelen Ekpoma
1.2 Statement of Problem
Family planning methods are considered a first line of defense against unwanted pregnancy, sexually transmitted infections (STIs) and human immune- deficiency virus (HIV). The consistent and correct use of modern family planning methods reduce greatly unwanted pregnancies, STIs and HIV among women of reproductive age in any nation thus enhancing their health. However, it appears that attitude and practice of modern family planning among women of reproductive age in Nigeria is low and it varies by demographic and socio-economic characteristics. This calls for a study to verify what obtains in Ekpoma using the primary health care centre in Ujoelen as reference point. The use of family planning methods among women of reproductive age will reduce unwanted pregnancy, mortality and morbidity associated with abortion. HIV and STIs incidence among women of reproductive age will also be minimized, thus, enhancing their health. Studies have been conducted on attitude to and practice of modern family planning methods among women of reproductive age in many parts of the World including Nigeria. However, none of such studies, to the best of my knowledge as the researcher, has been conducted in primary health care centers in Ekpoma. Following this, the need arose to study the knowledge and practice of family planning methods among women of reproductive age in the primary health care centre in Ekpoma using Ujoelen as reference point.The desired family size among the Nigerian women was estimated at 4 on the average from the national demographic health survey 2008 studies, which means there is every tendency for most of the women to have more than 4 children in their life time considering the problem that it is easier said than done. This is because achieved family size is greater than desired family size, a gap remains between stated desire to control fertility and actual practice. Particularly among poorly educated and low income women, living in rural areas and urban slums (Goldzierher, 2011).
Also, most maternal death has been associated with unwanted pregnancies resulting from unsafe abortions, high rate of infant and childhood mortality, miscarriages or foetal wastages are problems associated with short birth interval (Suleiman, 2010). This study result can help alleviate these problems.Furthermore, certain studies showed that although most couples have knowledge about family planning but they lack adequate skill to practice it effectively in fertility regulation (Audu, Yahaya and Bassi, 2016). Also, the present economic situation in the country does not favour the production of large families. It can lead to unemployment, food shortage, inadequate housing, overused of health and educational facilities, increase in crime rates due to unemployment to mention a few. The introduction and use of modern methods of family planning though very useful in some cases at fertility regulation, its uses are not accepted by some couples for many reasons such as the report of side effects on users of some of the hormonal drugs. Some do not like using these hormonal drugs on religious and cultural prohibition. At times couples do not agree also on usage. In the search of method that can be culturally acceptable, tolerated by couples without complains of side effects, family planning and couples involvement in its knowledge and practice becomes necessary.
1.3 Research Questions
The study seeks to provide answers to the following questions:
1.4 Aim and Objectives of the Study
The aim of the study is to determine the knowledge and practice of family planning among women in primary health center in Ujoelen, Ekpoma. This will be achieved by the following specific objectives:
1.4.1 Justification of the Study
Studies such as the 2008 NDHS have revealed that contraceptive use prevalence is very low in Nigeria which includes Ekpoma, hence it becomes important to study the knowledge and practice of family planning among women in the primaryhealth care center independently so as to provide useful knowledge directed at controlling high birthrate and to avoid the problems associated with over population. Most researchers and policy makers before now have focused mainly on men in their studies of family planning issues with little or no reference to their female partners thereby, underestimating the role of women in family planning, after all it takes two to tangle and without women there would have been no need to talk about family planning. Men decide when, where and how family planning programs should be conducted, however the women have to accept family planning methods if the venture is to be successful, so it becomes important to focus on women in such researches rather than onmen alone for an effective change in attitude and motivating couples towards the practice of family planning. Also, there seems to be very few studies done so far on the knowledge and practice of women in Nigeria when it comes to family planning. Also, there is evidence that family planning methods such as use of pills can be useful in checking fertility rate and it has actually been in use by couples in developed countries like the USA (Goldscheider and Mosher, 2008). Couples around these areas too will benefit from such knowledge in their practice of natural family planning by providing them with evidence based information on the right skills to be applied in the practice of natural family planning for effective fertility regulation. Although, there are religious dimensions for its usage. Other studies such as Sherry, Choi and Wiebe, (2010) also have shown that most physicians underestimate the effectiveness of family planning and only few of them provide information about family planning contraceptive counseling. Physician need better understanding of modern methods of natural family planning to provide evidence based contraceptive counseling to selected highly motivated patients who prefer natural family planning as a contraceptive (Sherry, Choi and Wiebe, 2010). It is hoped that the study results will come up with useful information that will help physician in these areas of providing contraceptive counseling to patients. The study results will also help policy makers and program planners determine what issues need to be stressed in the design of future family planning awareness.
1.5 Significance of Study
The study will be used to determine the extent at which health education which includes family planning is effective at the grassroots. It is hoped that this study will have both theoretical and practical significance, since it is geared towards addressing an issue that is fundamental to the society at large, Nigeria in particular. Practically, the findings from the study will be used by future researchers to explore other ways of reducing maternal mortality/ morbidity, unwanted pregnancy/complications and sexually transmitted infections. The knowledge acquired from the study will be used to create the study awareness on the modern family planning methods. To individual, families and communities, a study of this nature will help the policy on the importance of child spacing to the public as it will help in the economic development of the nation. It will equally help in the management of populations control and human resources development.
1.6 Scope of the Study
The study revolves around issues such as the knowledge and practice of family planning among women in primary health care in Ujoelen, Ekpoma. The research is focused on Women within Ekpoma comprising Esan west local government Area. The study seeks to address such issues as the Women level of knowledge of family planning methods, their attitudes towards the practice of family planning and how they practice it as well as the challenges they experience while practicing it. Based on the findings of the study, recommendations can be made to encourage the practice of family planning among women and couples at large
1.7 Definition of Terms
Knowledge: Knowledge within the context of this study refers to what the research subjects know about family planning, it comprises how they first come to be aware about family planning and the various methods of family planning.
Practice: The application of roles and knowledge that leads to action. It also refers to how the couples apply their knowledge about family planning methods into use for the purpose of fertility regulation.
Family Planning: It implies the ability of individuals and couples to anticipate and attain their desired number of children by spacing and timing their birth. Is the means by which individuals or couples space the process of conception, pregnancy and childbirth at intervals mutually determined by both husband and wife in order to have the desired number of children that they can conveniently cater for.
Contraception: A means of avoiding pregnancy despite sexual activity. There is no ideal contraceptive, and the choice of method depends on balancing considerations of safety, effectiveness and acceptability. The best choice for any couple will depend on their ages and personal circumstances and may well vary with time. Contraceptive techniques can be classified in various ways, but one of the most useful is into ‘barrier’ and ‘non-barrier’ methods.