Department of Health Education

FACTORS AFFECTING FAMILY PLANNING SERVICES AMONG WOMEN IN RURAL AREA (A CASE STUDY OF ESAN WEST LOCAL GOVERNMENT EDO STATE)

Chapter One

Introduction

Background to the Study

Family planning is widely acknowledged as an important intervention towards achieving Sustainable Development Goals (SDGs) three (3) as it has proven to reduce maternal and child mortality. Family planning can prevent unwanted pregnancies and unsafe abortions. Some family planning methods such as condom usage can protect individuals from Sexually Transmitted Infections (STIs) including HIV/AIDS. Family planning has also been found to promote gender equality as well as promote educational and economic empowerment for women. Despite the enormous benefits of family planning services, the uptake of the service still remains low in Sub-Saharan Africa including Nigeria (Eliason, 2013).

Furthermore, Eliason said that although most people are aware of the benefits of family planning services, they complained that it was difficult to access family planning services as such services were provided by health facilities that were far from their homes. In addition, religious inclination has been noted to be a major constrain to the uptake of family planning services in Africa. Also, some individuals perceived that family planning services were meant for only married couples whilst others fear that they will become sexually promiscuous if they go for family planning services once they cannot become pregnant. It has been observed that a large number of women have an unmet need for family planning as the acceptor rate for family planning services remains low. It is on this note that scholars like Haffner, (2010) argue that the lives of mothers and children will be improved and maternal mortality reduced if family planning acceptor rate is improved.

However, according to World Health Organization, (2016) family planning is the practice that allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility. A woman’s ability to space and limit her pregnancies has a direct impact on her health and well-being as well as on the outcome of each pregnancy (WHO, 2016). Therefore, family planning services are defined as educational, comprehensive medical or social activities which enable individuals, including minors, to determine freely the number and spacing of their children and to select the means by which this may be achieved (Burke, 2010).

Family planning is a wide-reaching occurrence. The promotion of development and improvement of quality of life require co-ordination of action in all major socio-economic fields including that of population, which happens to be the inexhaustible source of creativity and a determining factor of progress. At the international level a number of strategies and programmes whose explicit aim is to affect variables in fields other than population have already been formulated. In many developing countries, attempts to improve the socio-economic conditions of the population are seriously hindered by the rate of population growth. This is true of both urban and rural areas where population growth is simply above the ordinary (WHO, 2015).

However, making the rural issues concerning family planning more understanding, Etukudo, (2014) opined that in rural areas of Edo State where there is a high desire for large family size by couples and lack of communication activities and behavior inventions to increase knowledge and use of family planning, lack of access to family planning services can be a barrier to women’s use of family planning services. Besides that, Etukudo further said that, large number of Nigerian women including some of those in Esan West Local Government Area of Edo State do not see the need of family planning. And that a good number of them see family planning as a taboo which is against their culture and many refer to religion to support their argument and disapproval of family planning (Etukudo, 2014). Similarly in addition said that, a critical look at the issue reveals that ignorant peasant women living in Esan West Local Government and other communities in Nigeria want to have large families. Hence, there is evidence that women are prepared to have fewer children and adopt family planning if they are provided with adequate information, service and supplies. Etukudo, (2014) concluded that urban women are more than twice as likely as rural women to use a method of contraception (20 percent versus 9 percent). Majority of the women hardly gave birth in hospitals and depended on their husbands to decide what ever method will be used to space or limit the number of children they will have. This notwithstanding, there still exist a great challenge of unmet needs regarding family planning especially in the rural part of Edo State like Esan West Local Government as the desired attitudinal and behavioral changes towards family planning is yet to be achieved (Etukudo, 2014).

Family planning has proven to be of immeasurable value world over, especially in Sub-Saharan Africa which has one of the highest fertility rates in the world. It helps to reduce maternal morbidity and mortality among other benefits. It has also been shown to be cost-effective to families, reducing poverty, and enhancing socioeconomic development of the developing world. It improves economic security for families, households, and communities by enhancing greater wealth accumulation and higher levels of education. In fact, it is estimated that for every one United States dollar spent on family planning, at least $4 that could have been spent on complications of unintended pregnancies is saved and government saves up to $31 in health care, water, education, housing, etc. Furthermore, there is evidence showing that if couples can space their pregnancies by at least 2 years using family planning methods, about 35% of maternal deaths and 13% of child mortalities can be averted.

But despite these huge gains of family planning and the enormous amount of resources spent on it by both the donor agencies from the developed world and the indigenous governments of developing countries, acceptance and utilization of family planning services and commodities remain abysmally low in our sub-region, country, and immediate practice environment. For instance, contraceptive prevalence defined as the percentage of currently married women in an entity or place who are using a method of contraception which actually measures the actual contraceptive practices of a country or place at that time is usually low in developing countries. In Nigeria for instance, it is 15% according to the 2013 National Demographic and Health Survey, an increase of only 2% since the 2003 survey. Moreover, this is in spite of the huge amount of time, material, and human resources invested in family planning in the country. The situation in Edo State, Nigeria, where we practice is even worse because some of the indices used to judge successes in family planning are abysmally low and indeed below the national average.

There is therefore an urgent need to find out the reasons for the low uptake of family planning services and commodities being witnessed presently in the country and her component parts despite the huge and proven benefits of family planning. This will enable programs and the enormous resources spent on family planning to impact more on the target population. Reasons for low uptake for family planning commodities no doubt abound, but they are different in different parts of the world and even in different parts of the same country. There is, therefore, the urgent need to find out the contraceptive prevalence in our area of practice and the reasons for whatever the prevalence is in our practice environment which has worse success indices that are most times below the national average. This informed the need for this study. The obstacles for family planning acceptance if found and programs specifically designed to overcome them will assist our people and have tremendous impact on family planning acceptance.