Accessibility, Use, Misuse And Effects Of Combined Oral Contraceptives Among Women Of Child Bearing Age

Medical and Health Science Project and Seminar Material

Accessibility, Use, Misuse And Effects Of Combined Oral Contraceptives Among Women Of Child Bearing Age


Abstract


Unwanted pregnancy followed by unsafe abortion can be avoided by using different contraceptive methods. The purpose of this study was to investigate the accessibility, use, misuse and effects of combined oral contraceptives among women of child bearing age. To effectively investigate this, the health belief model was adopted. A total of 250 respondents were used out of the 300 sampled population for the study.

The knowledge of the side effects of contraceptives use and the management of contraceptives side effects among women in Aluu local government area, Rivers State was examined using the structured close ended questionnaire. the structured close ended questionnaire was used to obtain information on statement on level of knowledge and management measure on contraceptive side effect. The questionnaire was administered was then administered to 250 respondents in In Aluu LGA, Rivers State using purposive sampling procedure. The result of the findings from the respondents was presented using frequency and percentage.

Conclusively, the pattern of response from the respondent is similry in most questions implying a uniformity of level of opinion concerning their knowledge and management of the side effect of contraceptive use.Conclusively, the pattern of response from the respondent is similry in most questions implying a uniformity of level of opinion concerning their knowledge and management of the side effect of contraceptive use.


Chapter One


Introduction

Over the world, family planning and contraception is among the pertinent issues been discussed. In the early days, human societies had creation of as many children as possible, a central value. Today however, relatively few societies can afford this perspective, resulting in increased attempts to limit and manage the birth rate of their families of which Nigeria is no exception. The negative effect of high fertility rate on women and their children, and the benefits of fertility control are well known (Dona et. al., 2008).

The situation in Africa is as low as 25 percent, the lowest among developing regions in the world (RAND, 1998; UNFPA, 2001). In West Africa, about 36 percent of women are using contraceptives and this rate varies from a low percentage of 22 percent in Mali, 26 percent in Togo, 32 percent in Burkina Faso, and 33 percent in Nigeria (Dona et. al., 2008, UNDP, 2008). In Nigeria, a country with multiple ethnic sets and religious groupings, efforts made by the Ministry of Health (MOH) and other agencies on the use of contraceptives have resulted in a general increase over the last two decades (Ann et al 2002, UNDP, 2008). There has also been a drop in fertility rate from 6.4 percent in the 1970s to 4.4 percent in 2005 (UNDP, 2008).

Currently, a national contraceptive use of 33 per cent has been estimated even though 43 percent of married women in the country desire to space their children and an additional 24 percent need to limit births. The disparity of use of family planning methods among the urban and rural, and rich and poor puts many women in most deprived settings at a disadvantage (GSS, 2003). The use of contraceptives since 1960 have helped women worldwide to prevent about 400 million pregnancies, as a result, women lives have been saved from high risk of pregnancies. Again, contraceptives methods do excellent double duty as prophylactics (disease preventer), latex rubber and polyethylene condoms provide a barrier against STIs and HIV/AIDS infection whose spread is alarming in the country (Harvey, 2000).

The major concern here is about the accessibility, use, misuse and effect of combined contraceptives among women of child bearing age. Even though contraceptives have emerged in the prevention of unwanted pregnancies and sometimes STI, it has not been fully accepted by most communities for women of child bearing age to use them.

Concepts

Knowledge on contraceptives

This sub-section is intended to review information on the knowledge and awareness level of contraceptive. Knowing about contraceptives is presumed to be a first step in stimulating the desire for its use. In the year (2000) Takyi declared that knowledge assessment of contraceptives therefore does not only determine the extent of awareness and sensitization but further provides the background for which use of the service is further evaluated. Evaluation in this sense relates with the background characteristics, principally social, of users that influence these awareness and sensitization levels.

In 1998 the popular form of contraception for sexually active Canadian women surveyed was oral contraceptives (OCs) (Fisher et al, 1998). Seventy-three percent users at the time of the survey expressed a high degree of satisfaction with the pill, although misperceptions were prevalent. Few women knew it was safe for nonsmokers to take the pill after age 35, and that the pill reduces certain cancers. When asked whether taking the pill presented fewer health risks than pregnancy, just 4% strongly agreed.

Published literature on the efficacy of contraceptive counseling and education seems to reflect a significant gap between what providers think they offer and what consumers appear to receive. In 1999, Rajasekar et al., made mention that family planning audit users in Scotland has revealed a 30% discrepancy between the number of women whom clinicians thought they had appropriately counseled and the number of patients who actually understood the teaching. Oakley et al in the year 1994 estimated that up to one third of women require more individualized counseling to use oral contraceptives effectively. Getting the good news out about the many benefits of Oral Contraceptons will enable more women to take advantage of their positive health effects and may help increase compliance (Jenseen et al 2000, Shulman et al, 2000.) It was discovered that the knowledge of Canadian women on the pill regarding risks, benefits and side effects of the pill remains deficient in several key areas, but was increased by counseling.

According to the recent Nigeria Demographic Health Survey, 2003, knowledge of family planning was defined operationally as having heard of a method. The survey, which used an interviewer prompt method, showed that knowledge of contraceptive was known by 98 percent of women and 99 percent of men (GSS, 2003) considering that these proportions represented Nigerians who knew at least one method of contraception. Knowledge about modern and traditional contraceptive has changed over a decade and half ago. Whereas the latter was popular among Nigerians, the former is now popular even though users of contraceptives use the traditional methods (Clemen et al 2004, Hoque, 2007).

In a cross-sectional survey in Kinshasa, Democratic Republic of Congo, condom was the most widely known modern contraceptive method since it was cited by 43% of women; the Pill was by only 28%, Injectables 16.2%, IUD 8%, spermicidal foam 2%, and the diaphragm by less than 2%. Teenagers and young adults (15–24 years) were less knowledgeable of modern methods (Kayembe et al, 2003). The use of condoms, diaphram, the pill, implant, foam tablet and lactational amenorrhoea were among the methods commonly identified with a 100 percent knowledge on it usage among unmarried women.

In an assessment of gender issues relating to contraceptive use in Ebo State, Nigeria, Osaemwenkha observed that educated and sexually active youth had wide spread knowledge of contraceptives and this background correlates with the number of methods known (Osaemwenkha, 2004). Obviously, such wide knowledge does not necessarily mean that such persons have adequate exposure to the use of contraceptives because other decision-making influences could determine its use or otherwise. Even though Osaewenkha, perceived that his respondents, 800 university female students, may have had enough knowledge, he discovered that even among the enlightened, decision making on contraceptive use has the male involvement factor essential.

Socio-economic Characteristics on decision to use Contraceptives

This subsection reveals the influence of socio-economic characteristics on decision to contraceptive usage. There is a difficult decision on the use of modern contraceptives among prospective users in the country. These difficulties arise from the strength of the interplay of influences from close family relations. In the year 2005 the author Benefo made an assertion that, the economic dependency level of the woman on her close relations affects the decision process for the uptake of contraceptives. The type of work and the amount of income earned by the woman in particular have a strong relation to use of contraceptives (Baiden, F., 2003; Sign, et al, 2003).

Many researchers have observed that, this concept is a borrowed one from the west and its adaptation in the African setting. Considering the complexity of influences on close and external relations on their lives, in addition to their socio-economic standing (White, 2002), needs extensive examination (RAND, 1998; White et al, 2002; Awusabo-Asare, 2004; Solo et, al 2005). Level of education and socio-economic status of women have been identified to affect fertility decision directly (White, 2002).

In several studies on modernity and fertility, education is found to be the prime influencing factor. Education may have a direct influence on fertility, since education affects the attitudinal and behavioral patterns of the individuals. Lactational amenorrhoea, which lasts for two to three years in some societies, gives scope for longer birth intervals, thus affecting the fertility among such women (McNeilly, 1979). The economic value ascribed to children enhances fertility among those who are economically poor. During the past few decades studies have established a close and significant relation between contraceptive use and fertility preferences. Das and Deka (1982) have considered the cultural factors in fertility as there is evidence that the fertility behavior changes with different cultural settings. Narayan Dast in the year 1983 also studied the socio-cultural determinants of fertility.

As Anand, (1968) & Chandrasekhar, (1972) put it, the family welfare programmes, their reception, impact and utility have affected fertility in every society in this era of rapid population growth. Because of the government’s policy on birth control, exhaustive efforts are made by the government to popularize the different family welfare methods. Results achieved so far in this direction can be attributed to the programme inputs. However, besides several cultural factors, non-availability and/or lack of knowledge, attitude towards desired family size, traditional beliefs and practices play an important role in family planning.

A number of KAP studies have been taken up covering different population groups. Gautama and Seth (2001) in their study among rural Rajputs and Scheduled Caste (SCs) found out that raise in education besides providing knowledge on the contraceptive methods helps in improving acceptance of family control devices. There are other studies also in similar lines taken up among tribal and rural populations (Meerambika Mahapatro et al, 1999; Sushmita and Bhasin, 1998 and Varma et al, 2002). However, the national programme should have group specific and area specific interventions with regard to family planning. In this background, an attempt was made in that paper to study ‘knowledge and practice of contraception’ among Racha Koyas, a tribal population from Andhra Pradesh.

In this connection, it is pertinent to note that in the ‘National Health Policy’, the tribal groups need special attention as they are considered ‘a special group’. These among others account for the emphasis on the concept that contraceptive is a human rights issue. This concept does not only empower women to take control of their reproductive life but also develop themselves to be independent of others, so as to ensure their total well-being and that of their children.

In addressing the distribution of financial resources in relation to AIDS and family planning methods use in Offinso, Nigeria, Duodo and others implied that the inequitable distribution of resources to the detriment of rural communities affects contraceptive use (Duodo et al, 1998). In a study on empowering women in Navrongo and its environs, Nigeria, Solo and others observed that health decision making including the use of contraceptive is influenced by traditional beliefs, men animist rights and poverty (Solo and others., 2005).

Despite these others have observed contrary relations of use of contraceptive with socio-economic variables. In his study on factors affecting contraceptive use in Nigeria, Tawiah, using a regression analysis modeling identified that, respondent’s age, type of place of residence, religion, ethnicity, desire for more children, marital duration, availability of electricity in the household, husband’s approval of contraception, husband’s education and occupation, have no significant effects on current use of contraceptives (Tawiah, 1997).


1.2 Statement of the Problem

Oral contraceptives side effects in Nigeria in the contemporary time have become an issue that casts a gloomy shadow to the entire society especially among women. The case is not different among women in rivers state. During community posting experience in Alu health center, the researcher witness cases of high blood pressure, urinary tract infection, blood clotting, migraines, gall bladder disease, delay in pregnancy and infertility in women which were associated with contraceptives use. Today, Nigeria has one of the highest maternal mortality rates in the world and this has largely been attributed to lack of knowledge of contraceptives use to prevent the potential risks (Stover& Rose 2009). . However, only the women comprehensive knowledge onontraceptive use, risk will be able to take appropriate measures to prevent and manage side effect and associated risk. Acquiring knowledge about contraceptives is the best way to prevent potential risk and manage side effects. Women therefore need knowledge to prevent this risks and manage side effects, and make suitable contraceptive choices based on their health status. of contraceptive uses and be able to consider their health status in order to choose an appropriate and suitable Oral contraceptive (Bruce &Rymer, 2009). Deborah, Ikhena, & Julia (2012), observed that the necessity for women to be exposed to contraceptives options as early as 18.

Majority of women in Rivers State are facing some health challenges due to some types of contraceptives or after using it especially if women lack knowledge of choosing the right method that is suitable for their body. Some contraceptives increase the risk of developing blood clots, which can result into stroke. If a woman has high blood pressure, she needs to take this into consideration before using contraceptives. Other serious potential risks that accompany contraceptives are increased risk of cervical and breast cancer, increased risk of heart attack and stroke, migraines, high blood pressure, gall bladder disease, benign liver tumors, decreased bone density, yeast overgrowth and infection, increased risk of blood clotting and infertility. The dangers for use of oral contraceptives in women above age of 35 includes Smoking, Hypertension, History of thromboembolism, or Stroke (Rebecca, Charles &Norris 2012). Inadequate knowledge and lack of relevant information and education on preventive measure is a major barrier to women of reproductive age. Women often are not fully aware of their contraceptive choices.

According to Guttmacher (2008), women may not use contraception consistently because of problem they are facing such as lack of knowledge of their chosen method, infrequent sexual activity, and ambivalence about pregnancy, misperceptions about pregnancy risk, wrong information from friends and family members and lastly, self medication. Addressing these and other barriers to the use of effective contraception through health talks is key to helping women prevent contraceptives risks (Lee, Parisi, Akers, Borrero, & Schwarz, 2011). Currently, there are several entities that want to include health talks on knowledge and prevention of contraceptive risk, despite that contraceptives are used for child spacing, they also have their own side effects, such as increase in cardiovascular event especially in older women and smokers, increase in human papillomavirus (HPV) infection , breast cancer and an increase in cervical cancer, which is the second most common cancer worldwide (Harper, Brown, Foster-Rosales & Raine, 2010). Therefore, oral contraceptives fail the most important test of preventive medicine: they increase the risk of disease instead of decreasing it. Based on the above discoveries, the researcher is motivated to conduct a research among others to assess the awareness of contraceptive side effect and coping strategies used in its management among women in Aluu local government area, Rivers State.


1.3 Objectives of the Study

The purposes of this study are to:- topic

  1. To identify the types of Oral contraceptive methods practices among women in Aluu local government area, Rivers state.
  2. To examine the knowledge on side effects of Oral contraceptives use among women in Aluu local government area, Rivers State;
  3. To investigate the management strategies of Oral contraceptives side effects used by women in Aluu local government area, Rivers State;

1.4 Research Questions

  1. What are the types of Oral contraceptives methods practices among women in Aluu local government area, Rivers state?
  2. What is the knowledge on the side effect of Oral contraceptives among women in Aluu local government area, Rivers State?
  3. What are the management strategies of Oral contraceptives methods practices of among women in Aluu local government area, Rivers State?

1.5 Significance of the Study

The finding of the study will be significant in the following ways:

  1. Women in Rivers State will have knowledge on the risks of contraceptives due to regular health talks during antenatal and postnatal clinics.
  2. It will help women in Rivers State to understand ways of preventing contraceptives side effects after it has been discussed by heath care providers.
  3. It will benefit women of different age groups in Rivers State when
    Non governmental organizations address the side effects involved in contraceptives uses.
  4. It will motivate women of different age groups in Rivers State to take preventive measure while using contraceptives after attending health talks by health care providers and nongovernmental organizations.
  5. It will allow women of different marital status in Rivers State to gain more knowledge on contraceptives side effects through Medias such as radio and televisions.
  6. It will encourage women of different marital status in Rivers State to take preventive measure and choose the natural method of contraceptives to prevent all health hazards associated with other artificial contraceptives.

1.6 Scope of the Study

The study will aim at examining the knowledge of the Oral contraceptives side effect and it management strategies in reducing it side effects. The study will focus on women of reproductive age between 15-50 years that were present as at the time the survey was conducted. The study will focus on only the side effect of Oral contraceptives, women who have not used Oral contraceptives will be excluded from the study.


1.7 Operational Definition of Terms

Knowledge of Oral contraceptives side effects; This include the level of awareness or knowledge at which the study population possess on the harmful or side effect of using Oral contraceptives i.e knowing the side effect of the after use of Oral contraceptives.

Management strategies of side effect; It is the coping strategy adopt by women of reproductive age to reduce the side effect of Oral contraceptives.

Women of Reproductive Age; A woman of reproductive age is usually between the ages of 15- and 44-years old. These ages are a guideline and women can have babies earlier and later than the years indicated. A woman of reproductive age is typically considered fertile.


Chapter Five


Summary, Conclusion and Recommendations

5.0 Introduction

This chapter presents summary, conclusion, recommendations and suggestion for further studies


5.1 Summary

The purpose of this study was to investigate the accessibility, use, misuse and effects of combined oral contraceptives among women of child bearing age. To effectively investigate this, the health belief model was adopted. This model suggests that people’s beliefs about health problems, perceived benefits of action and barriers to action, and self-efficacy explain engagement (or lack of engagement) in health-promoting behavior. From the theory, the researcher realize that for a change of behavior to take place, individual must feel the reality of been vulnerable to contraceptive risk, the motivation to prevent an unwanted pregnancy would predict contraceptive compliance just as the motivation to prevent contraceptive side effect would predict interest of contraceptive knowledge and see that taking action is definitely going to prevent contraceptive side effect.

The knowledge of the side effects of contraceptives use and the management of contraceptives side effects among women in Aluu local government area, Rivers State was examined using the structured close ended questionnaire. the structured close ended questionnaire was used to obtain information on statement on level of knowledge and management measure on contraceptive side effect. The questionnaire was administered was then administered to 250 respondents in In Aluu LGA, Rivers State using purposive sampling procedure. The result of the findings from the respondents was presented using frequency and percentage.

The types of contraceptives mostly used as highlighted in the study are the oral contraceptive, the combined oral contraceptive pill is also known as colloquially and progestogen only pill (POP). The side effect of these pills ranges from the possibility having cervical cancer, arterial disease, high blood pressure, urinary tract infection to decreased risk of ovarian and endometrial (uterine) cancer, and decreased incidence of menstrual disorders, benign breast disease, uterine fibroids and ovarian cysts.

From the analysis of response from respondents on the knowledge on the side effect of Oral contraceptives among women in Aluu local government area, Rivers State, it was also discovered that Most are of the respondent aware that cervical cancer is one the risks of contraceptive use of using Oral contraceptives for long especially for women with human papillomavirus infection Also a sufficient percentage of the respondent are aware of urinary tract infection as a side effect of Contraceptive use. There are also those who believe that spermicide may cause reaction or infection in users with latex allergy.

In addressing the management strategies of Management strategies of Oral contraceptives methods practices of among women in Aluu local government area, Rivers State, it was discovered that value parental education and consulting a physician as common means of reducing adverse effect of Oral contraceptive in the area. respondent are also in support of management of Breakthrough bleeding with three-or four day hormone-free interval, Combination of mifeprex and ethinyl estradiol for reducing the duration of a single bleeding episode in women and combined oral contraceptive for the first six weeks postpartum. The result also showed that Combination of oral contraceptive with another is not a risk management strategy comfortable with the respondents.

Conclusively, the pattern of response from the respondent is similry in most questions implying a uniformity of level of opinion concerning their knowledge and management of the side effect of contraceptive use.


5.2 Conclusions

Based on the results of the findings in this study, the following conclusions were made:

  1. Women are knowledgeable about the side effect of contraceptives
  2. There is existence of preventive measure of contraceptives side effect on the knowledge possessed by women on contraceptives use in Aluu LGA, Rivers State.
  3. The kind of information clients receive on the methods chosen. Incorrect information leads to unsatisfactory usage and unable to prevent the risks, which can ultimately result to problem as a result of contraceptive uses

5.3 Recommendations

As a result of this analysis of the data in this study, the under mentioned are the recommendations

  1. Regular health talks about knowledge of contraceptives side effect should be discussed by health care providers with women attending antenatal and post natal clinics and be freely discussed within couples in Aluu LGA, Rivers State.
  2. Regular health talks about preventive measure on contraceptives side effect should also be discussed by health care providers with women attending antenatal and post natal clinics in Aluu LGA, Rivers State to avoid further complications.
  3. The awareness level on knowledge of contraceptives among women of different age group is very low; it is therefore recommended that nongovernmental organizations be used to address theseissues.
  4. Preventive measures of contraceptives use among women of different age group are very low; it is therefore recommended that health care providers and nongovernmental organizations be used to address these issues.
  5. The media especially the electronic media such as radio and television should carry more news on knowledge of contraceptives side effect among women of different marital status.
  6. There should be legislation on the use of contraceptives to prevent the potential side effect among women of different marital status so that the use is not shrouded in secrecy and the natural method of avoidance on contraceptive is still very popular among women and should be encouraged as this has the singular effort at preventing all the health hazards associated with other artificial contraceptives.

5.4 Limitation of the study

The main limitation of this study was fear of letting out information that are considered to be personal by the respondents, but the researcher assured them that their information are safe and gave them courage to cooperate with the researcher in filling the questionnaire accordingly.


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