|Year : 2019 | Volume
| Issue : 3 | Page : 182-188
Utilisation and preferences of family planning services among women in Ikosi-Isheri, Kosofe Local Government area, Lagos, Nigeria
Oluchi Joan Kanma-Okafor1, Eucharia Justin Asuquo1, Michael Orji Izuka2, Mobolanle Rasheedat Balogun1, Olayinka Olufunmi Ayankogbe1
1 Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
2 Federal Medical Centre, Umuahia, Abia, Nigeria
|Date of Web Publication||13-Aug-2019|
Dr. Oluchi Joan Kanma-Okafor
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos
Source of Support: None, Conflict of Interest: None
Background: Despite women's adequate knowledge and the obvious unmet need for family planning (FP), contraceptive prevalence in Nigeria is low. A greater understanding of the barriers to FP that informs service utilisation and preferences is needed to improve service delivery. Aim: This study was aimed at assessing the use and preferences of FP services among women. Subjects and Methods: A community-based, descriptive, cross-sectional survey was carried out among 367 women (15–49 years of age) residing in Ikosi-Isheri, Kosofe local government area, who were selected by multistage sampling method. Data were collected using a pre-tested, semi-structured, interviewer-administered questionnaire and were analysed using SPSS software version 20. Frequency distributions and cross tabulations were generated. The Chi-square and Fisher's exact tests were used to determine associations, and the level of significance was set at P ≤ 0.05. Results: Although 64.0% were aware of FP, only 26.4% had ever used FP services. The contraceptive prevalence was 17.9%. Traditional or religious restrictions were given as the reasons for not using FP (40.9%). The preferred FP services were those offered at primary healthcare centres (45.2%) and teaching hospitals (33.9%) because of proximity (38.7%), privacy (14.5%) and health workers being female (22.6%). Age, level of education and marital status were associated with the utilisation of FP services (P < 0.001, P = 0.020 and P < 0.001, respectively). Conclusion: Although awareness was high, uptake was low. Government health facilities were preferred. Primary healthcare should be strengthened, and FP services should be scaled up to make FP more accessible. Services should be closer to where people live while providing the privacy they desire.
Keywords: Family planning services, Ikosi-Isheri, Kosofe, Lagos, mothers, Nigeria, preferences, utilisation
|How to cite this article:|
Kanma-Okafor OJ, Asuquo EJ, Izuka MO, Balogun MR, Ayankogbe OO. Utilisation and preferences of family planning services among women in Ikosi-Isheri, Kosofe Local Government area, Lagos, Nigeria. Niger Postgrad Med J 2019;26:182-8
|How to cite this URL:|
Kanma-Okafor OJ, Asuquo EJ, Izuka MO, Balogun MR, Ayankogbe OO. Utilisation and preferences of family planning services among women in Ikosi-Isheri, Kosofe Local Government area, Lagos, Nigeria. Niger Postgrad Med J [serial online] 2019 [cited 2019 Aug 26];26:182-8. Available from: http://www.npmj.org/text.asp?2019/26/3/182/264387
| Introduction|| |
Family planning (FP) allows individuals and couples to achieve their desired number, spacing and timing of their births using contraceptive methods. Globally, 63% of married or in-union women of childbearing age were using some form of contraception in 2017. However, contraceptive use was above 70% in Europe, Latin America, the Caribbeans and Northern America; below 25% in Middle and Western Africa and specifically 16% in Nigeria. Globally, more than one in ten married or in-union women have an unmet need for FP. This is much higher in the least developed counties with an estimate of 22%, especially in sub-Saharan Africa where the highest unmet need for FP is estimated at 24% and in Nigeria, it is estimated at 16%. In many low- and middle-income countries, contraceptive prevalence remains low, while fertility, population growth and the unmet need for FP are high.
The provision of quality, affordable and adequate maternal healthcare services improves the FP experiences of women in low-resource countries. Despite women's increased awareness and knowledge, and the obvious unmet need for FP, there clearly exist economic, cultural, cognitive and administrative barriers to FP service utilisation. Demand-side barriers (e.g., geographical accessibility, availability, affordability and acceptability) and supply-side barriers (e.g., location, unqualified health workers, staff absenteeism, inadequate health services, costs and prices of services including informal payments and staff interpersonal communication skills) influence women's preference of FP services.
Utilisation of FP services can contribute to a substantial reduction in fertility, unwanted pregnancies and maternal deaths. In 2008, contraceptive utilisation averted over 250,000 maternal deaths worldwide by reducing unintended pregnancies, which is equivalent to 40% of the 355,000 maternal deaths. Asides the fear of the side effects of contraceptives, cultural barriers and associated treatment cost, many women do not get the services they would prefer to receive, and this can hamper the effective utilisation of FP services. With a knowledge of the preferences of women, the characteristics of the health service environment can be harnessed or changed to improve utilisation. This study extends previous FP research by examining the factors that influence service utilisation and preferences among women.
| Subjects And Methods|| |
A descriptive cross-sectional study was carried out from August to October 2018 in Ikosi-Isheri, Kosofe local government area (LGA) of Lagos, South Western Nigeria. Lagos State is the most economically important state of the country. Kosofe is made up of 29 administrative wards which are divided into two constituencies. Administrative wards are local authority areas, typically used for electoral purposes, whereas a constituency is a purely electoral classification which relates representativeness in parliament. Ikosi-Isheri is a ward in constituency 2 of Kosofe LGA. The study was conducted among women (15–49 years of age) residing in Ikosi-Isheri. The sample size was determined using the Cochrane formula as follows:
n = z2 P (1 − p)/d2
where n = minimum desired sample size, z = 1.96 (the standard normal deviate at 95% confidence level), p = the prevalence rate (i.e., proportion in population estimated to have the particular characteristics of interest based on a previous study i.e., the proportion of women who had used at least one FP method at some point in time) =0.683, q = the proportion of failure (1 − p) = (1 − 0.683) =0.317 and d = level of precision or margin of error = 5% =0.05.
To achieve the minimum sample size, 10% of the calculated sample size was added to compensate for an assumed potential non-response.
10% of 333=0.10 (333) =33.3 = 33
Minimum sample size = 366.
A multistage sampling method was used to select the respondents. In stage one, 25 out of 100 streets were selected by systematic sampling by selecting every fourth street, starting at the first street. Stage two involved the selection of houses by systematic sampling. Each street had an average of 48 houses; hence, every third house was selected from each of the 25 streets. Fifteen houses in all were selected from each street, except on the last street where only 7 houses were selected; on the last street, only 7 houses were selected. Each house was occupied by several households; thus, in stage three, 1 household in each house was selected by simple random sampling using balloting. In stage four, in each of the households, a woman was selected using simple random sampling through balloting. In all, 367 women participated in the study.
A pre-tested, semi-structured, interviewer administered questionnaire adapted from the Demographic and Health Surveys (DHS) Model Questionnaire (DHS7-Womans-QRE-EN-17Dec2018-DHSQ7) was used to collect data on the sociodemographic characteristics of the respondents (age, religion, marital status, occupation, education and number of children) and respondents' utilisation and preferences of FP services. The questionnaire was administered by three trained research assistants.
The Statistical Package for Social Sciences (SPSS) software (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0, Armonk, NY, USA) was used for analysis of data. Descriptive statistics were calculated for all variables. For continuous variables, the mean and standard deviations were calculated. Frequency distributions and cross tabulations were generated. The Chi-square test and Fisher's exact test were used to compare proportions, and the level of significance was set at P ≥ 0.05.
Ethical approval was obtained from the Health Research Ethics Committee (HREC) of our university teaching hospital on 14 August 2018 (Ethical approval number ADM/DCST/HREC/APP/240). Written informed consent was obtained from the respondents prior to the interview. Adequate information was given on the nature of the study, and anonymity was maintained. The respondents were assured that all findings from the interview would be treated with the utmost confidentiality and would be used for the purpose of this research only. They were also informed that participation in this study was purely voluntary and that they could withdraw their participation at any time during the study.
| Results|| |
The mean age of the respondents was 27.19 ± 9.4 years. Majority were aged between 15 and 20 years (31.9%) and between 21 and 30 years (37.6%). The largest proportion (35.2%) of the women had secondary school education. Less than half (45.5%) were married, A greater proportion (37.9%) of the respondents were traders, while 48.5% were of the Yoruba ethnic group. The majority (65.9%) were Christians [Table 1].
Over half (56.4%) of the respondents had ever been pregnant, and majority (61.3%) had been pregnant <6 times. The majority (57.9%) had 1–5 children. Those with 1–2 years spacing constituted the highest proportion of respondents. Only 13.1% of spacing between children was over 2 years. Regarding the decision to have a child, most frequently (37.7% of cases), the pregnancies were unplanned. Only in 25.1% of cases, pregnancies were decided upon by both partners. The decision to have another child was mostly (60.8%) not influenced by the gender of the couples' living children [Table 2]. About two-thirds (64.0%) were aware of FP, though only 26.4% had ever used any FP services. Majority (73.6%) had never used FP services before. Traditional or religious restrictions were given as the reason for not using FP services (40.9%). The proportion of respondents currently using at least one FP method (the contraceptive prevalence) was 17.9%. The majority (82.1%) were not currently using any FP methods. Less than half of the respondents (42.6%) had ever used a FP method. Lactational amenorrhoea method (16.1%), male condom (15.2%) and oral pills (15.2%) and were the most frequently everused methods of FP. The most common FP method in current use was the male condom (28.6%), followed by intrauterine contraceptive device (16.7%), implants (14.3%), injectables (11.9%) and lactational amenorrhea (11.9%) [Table 3].
Decisions regarding FP were mostly made by the respondents' husbands or partners (62.9%). The women themselves made the decision in 4.8% of cases. The preferred FP services were those offered at the primary healthcare centre (PHC) (45.2%) and then at the teaching hospital (33.9%). These preferences were informed mostly by the proximity to the respondents' homes (38.7%) and if the services are offered with privacy (14.5%). The factors that influenced the preference of FP services were the health talks the client received during visits (25.8%), the respectful attitudes of the health workers towards them, their opinions and their needs (58.1%). Female health workers were preferred by 22.6% of the women, whereas 77.4% had no preferences for the gender of the health worker. None of the respondents preferred to receive FP services from a male health worker. Only 25.8% of the respondents recently used FP services [Table 4].
The age, level of education and marital status of the respondents showed statistically significant associations with the utilisation of FP services (P < 0.001, P = 0.020 and P < 0.001, respectively). Women between 41 and 50 years of age constituted the highest proportion of users of FP services. The highest proportion of users of FP services were among those women who had tertiary education (34.4%). Women who were or had been in-union (married or divorced/separated) constituted the greatest proportion of ever using FP services [Table 5]. None of the sociodemographic factors were identified as significantly affecting respondents' preferences regarding FP services [Table 6].
|Table 5: Factors associated with the utilization of family planning services among those aware of family planning (n=235)|
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|Table 6: Factors associated with preferences regarding family planning services among users (n=62)|
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| Discussion|| |
According to the Nigerian DHS, 85% of all women in Nigeria are aware of at least one FP method, which is much higher than the proportion found in this study (64.0%). Although a large proportion were aware of FP, only 26.4% had ever used any FP services, giving reasons of traditional or religious restrictions for not using FP services (40.9%). Majority (73.6) had never used FP services even though they may have used a FP method. This implies that many of the mothers used FP methods that were obtainable outside the health facility. A study in Ghana similarly revealed that though 89% of the respondents were aware of FP services, only 18% of the respondents had used FP services in the past, with the major reasons for not accessing FP services being opposition from their husbands (90%) and misconceptions about FP (83%). This study found the most commonly ever used family planning methods to be lactational amenorrhoea, the male condom and oral pills and lactational amenorrhoea. This differed from another study in urban FP clinics in Kumasi and Accra, Ghana, where the three most commonly used FP methods were the implant (40.1%), injectables (32.4%) and the intrauterine device (13.4%). In this study, less than half of the respondents (42.6%) had ever used a FP method, and the contraceptive prevalence was low at 17.9%. This contrasts sharply with a similar study in India where 84% of the women had ever used any method of contraception, and the contraceptive prevalence was 58%. In another study in Uganda, 62% of the women reported current use of any FP method. In this study, majority of the FP decisions were made by the women's husbands or partners (62.9%); only 4.8% of the women decided on their own about FP. This underscores the importance of male involvement in FP activities. This finding is supported by a study in Bauchi State, Northern Nigeria, in which 84.4% of respondents' utilisation of FP services depended on their husband's acceptance of the FP method. The study also found that cultural acceptance, access to FP services, schedule of FP clinic, effectiveness of FP method and awareness (75%, 75%, 62.5%, 79.2% and 63.5%, respectively) all influence the utilisation of FP. The FP services' preferences were determined by the proximity to the respondents' homes (38.7%) and if the facility offered privacy (14.5%). Other influencing factors that affected the preference of FP services were the health talks the client received during visits and the attitudes of the health workers, if they showed respect towards them, their opinions and their needs. These are supported by a United states study that found that to clients, the most important aspects of services are receiving personalised attention, having staff who spend enough time explaining issues, being able to see the same provider at different visits, receiving care that is technically appropriate and receiving affordable care. In this study, although the majority of mothers had no gender preference and none showed preference for males, female health workers were preferred by 22.6% of women. This finding is similar to that obtained in Ethiopia where married young women's reported preferences for FP facilities and providers suggest that they are looking for convenient and affordable care from female providers of any age.
The age, level of education and marital status of the respondents were statistically significantly associated with the use of FP services (P < 0.001, P = 0.020 and P < 0.001, respectively). The older women (41 and 50 years) used FP services more, probably because they had already achieved their desired family size and were thus preventing pregnancy. Utilisation was higher with highly educated women (66.7%). Similarly, the study in Bauchi showed academic attainment and the mothers' level of knowledge of FP as significantly influencing FP use (P < 0.05) such that more women with higher academic attainment used FP services. Women who had ever been married were the ones who had ever used FP services meaning that they embraced FP because they knew and appreciated the role of FP in successful family life.
| Conclusion|| |
Although most women were aware of FP services, the uptake was low. There is thus the need for health education to be intensified on the benefits of FP, educating the women as well as their partners who mostly make the decisions about FP. Women would utilise maternal healthcare services in a facility if it is staffed with encouraging, respectful healthcare providers and if it provides good services such as health education. PHCs should be strengthened and FP services should be scaled up to make FP more accessible while proximity to where people live and providing privacy should be given priority in planning.
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], [Table 5], [Table 6]