An Assessment On The Use Of Natural Emergency Contraception Among Women

Project and Seminar Material for Nursing (Science)

Abstract

Unplanned pregnancies complicate maternal health and child health through many ways. On the other hand, unplanned pregnancy is one of the major reasons, which exposes women for unsafe abortion. Family planning is a means of promoting the health of women and families and part of strategies to reduce the high maternal, infant and child mortality. It has been used in different countries of the world and the number of users is increasing rapidly from time to time. The access is spreading among the young generation than long years ago. Knowing the prevalence and associated factors of Family planning was help to design and deliver different intervention.

This study based the use of natural contraception using: knowledge, attitude and practise of the said type of contraceptive. Quantitative community based cross sectional study was employed. The data was collected by face-to-face interview using structured questionnaires. The sample size for this study was 75 selected from the study population.

A total of 75 women of reproductive age group (15-49) were participated in the study accounting for a response rate of 97.33%. Majority 27 (36%) of the respondents were in the age range of 20-24 years and 36(48%) of the respondents were Catholics by religion. In case of ethnicity igbo covers 39(53.33%) of the respondents. As to monthly income, occupation, and educational status of the respondents, about 25(33.34%) got 301-400 birr, by income, 26(34.67%) were house wife by occupation and most 21(28%) of the respondent can read and write. In case of marital status 21(54.66%) of the respondents were married.

According to this study most 18(26.69%) of the respondent having knowledge about natural contraceptive method, mentioned calendar rhythm and 15(22.05%), 9(13.24%), of them mentioned symptothermal and lactational infertility respectively. This finding is same what similar with a survey of knowledge, attitude and practise conducted among lower, middle and upper class women in Gondar women 1999, in which 44% of the study subjects mentioned Calendar rhythm, followed by ginger roots.

Chapter One

Introduction

1.1 Background of the Study

Family planning is a means of promoting the health of women and families and part of strategies to reduce the high maternal, infant and child mortality. It is also an important means of strategies to lower maternal death by spacing or preventing pregnancy especially on high-risk mothers (Bohmor L., 1995, P-10).

Almost everywhere in the world, there is interrelation between population rate and socio- economic condition of the country. Poverty and illness that causes unhappiness is the most important consequences of rapid population growth, which will interfere inadequacy of public services. (Friedman, Herbert, L. 1993, pp. 22-23)

The major concern of family planning today is the reproductive health problem of the adolescent age group. One third of the population is between 10 and 24 years of age and four out of five of these young people live in developing countries. This period is the line when dynamic change, emotional, social development and adjustment take place. Any interference other than the expected normal will have an implicit effect on the normal physiological development of individual with potential hazards of leading to social maladjustment. (Friedman, Herbert, L. 1993, pp. 22-23)

Reducing the number of unplanned pregnancy promotes reproductive health mainly by reducing; the number of time women is exposed to the risk of pregnancy and child bearing in adverse circumstances. Unplanned pregnancies complicate maternal health and child health through many ways, because most of these categories, less than 18 or very old greater than 35, short pregnancy intervals which are highly associated with risk for infant mortality.(4Ethiop. J. Health Dev. 2009;23(2))

Alike other developing countries, Nigeria is facing a population crisis. This is more evident when we look at the estimation on the annual population growth rate of 3.6% in 2011, similarly, the total fertility rate for each womanare on average 6.6, moreover, it was also estimated that 48.5% of the total population. (Tekaba Ayalew and btal:. Nigerian medical journal of health 1995 vol. 14 no pp. 41-46)

1.2 Statement of the Problem

Globally, 38% of all pregnancies were unplanned and 22% of those are abortion (5). World fertility survey conducted in Egypt and Morocco respectively from 1950 and 1979 to 1995. The result show that from the late 1970 to the mid 1990 fertility declined to 44% in Morocco and 28% in Egypt reflecting a drop in both the level and space of child bearing. The cumulative proportion of women progressing to each successive parity fall by at least 25% at a third and fourth birth in Egypt, the pattern is more mixed in Morocco, with declines fluctuating between 11% and 27% starting at the transition between a second and a third birth. Moreover, the median length of time between births increased over a period, especially in the interval between births at parties 1-3 in Egypt (increases from 3.0-3.6 month). Among the factor, contributing to these fertility declines was a rise over the period in the simulated mean age at marriage (by five years in morocco and by one year in Egypt.

(Tekaba Ayalew and btal:Nigerian medical journal of health 1995 vol. 14 no pp. 41-46.). On the other hand, unplanned pregnancy is of the major reason, which exposes women for unsafe abortion in most of developing countries. For example, worldwide estimate of 40-60 million women resort abortion to end unwanted pregnancies. These abortions are unsafe; the procedure carries a high risk of injury and death accounting 125,000 to 2,000,000 female deaths annually (Yohannes Tolosa: 2004.).

Studies in a number of countries have shown that wherever fertility is high maternal, infant and child mortality rates are high. Fetal deaths, low weight at birth and related problems are also associated with unregulated fertility. More specifically, high maternal, infant and child mortality rates are associated with such reproductive practices as short birth intervals, pregnancies in women under the age of 20 and above the age of 35 and so on. (Samuel G.Shiferaw, Mandeferew Gebrehiwot.T 1996. Pp.25)

In developing countries outside of sub-Saharan Africa from 1/10th to 1/3th of all recent birth reported are unplanned and similar figure were reported to be mistrusted. (Abdella. A 1996.East African medical journal 73(10): p-64-66).

Unwanted pregnancies and child birth are still leading cause of death. Disease and disability is common among women in reproductive age in developing countries. Over 300 million women in developing countries suffer from short term and long-term illness brought by pregnancy and child birth (Samuel G.Shiferaw, Mandeferew Gebrehiwot.T 1996. Pp.27.).

The percentage of unwanted pregnancies among African women were 65% in Swaziland 56% in Comoros ,53% in South Africa ,45% in Kenya, 35% in Ethiopia and lowest in Nigeria which is 10%. (A qualitative elicitation study Psychology, Health& Medicine November 2010.)

This indicates that in Nigeria also there is high rate of unwanted pregnancy which can affect directly or indirectly the life of individual as well as community.

In sub-Saharan Africa, each year 265,000 mothers die in childbirth and 4.5 million children die before age of five from preventable causes. Nigeria is one the country in which large number of children dies due to different factors like malnutrition, diarrheal diseases, and other infection. (Yohannes Tolosa: 2004, p-32)

In Nigeria, social and cultural norms dictate that women bear children only within the context of marriage. The recent national fertility and family survey and subsequent studies have indicated that social economic factors and values have an impact on fertility. (Tekaba Ayalew, Nigerian medical journal of health 1995 vol. 14 no pp. 41-46)
As the problem identified, failure of family planning clinic to motivate the forget groups and recommended high prevalence of unplanned pregnancies while using contraceptive methods indicates to improve the women knowledge about how to use the methods.

In Nigeria, the situation is not different than developing countries; women suffer from problem of related pregnancies and child bearing. Maternal mortality rate from pregnancy and pregnancy related condition was still as high as or more than 10/1000 pregnancies (Yohannes Tolosa: 2008, p-34).

As it is the main part of Nigeria with large population, Abia State is the top contributing State of the related maternal problems.

A study conducted on unmet need and demand for family planning in Abuja, showed unmet need for contraceptives was 21.6%. Annual population growth rate is high whereas family planning prevalence rate is as low as 9.1% (A qualitative elicitation study Psychology, Health& Medicine November 2010).

High maternal, infant and child mortality rates are associated with such reproductive practices as short birth intervals, pregnancies in women under the age of 20 and above the age of 35 and so on. (Nigeria. J. Health Dev. 2009;23(2)).

Therefore, this is the main reason that made to assessthe use of natural emergency contraception among women.

1.3 Objective of the Study

General objective

To assess the use of natural emergency contraception among women

Specific objectives

To assess knowledge of contraceptive utilization of women at reproductive age group in a study area.
To assess attitude towards contraceptive utilization of women at reproductive age group in a study area.
To assess practice of contraceptive utilization of women at reproductive age group in a study area.
To assess the association of socio-demographic characteristics with Knowledge Attitude and Practise of women of reproductive age group in this study area.

1.4 Research Questions

The research questions for this study will be:

Are women in the study area at reproductive age groups known the benefits and types of natural contraceptive?
Are women in the study area at reproductive age groups believed in importance of natural contraceptive?
Are women in the study are at reproductive age groups use natural contraceptives?
Is there a relationship between knowledge, attitude and practice of family planning method and religious groups?

1.5 Significance of the Study

Nigerian women suffer from the effect of early pregnancy, too frequent and too many pregnancies. Contraceptive prevalence rate of Nigeria is about 10-15% compared to 71% of developed countries. Annual population growth rate is high were as family planning prevalence rate is as low as 9.1%. Nigeria is one of the developing countries in which total fertility rate and maternal mortality rate is high. Unplanned pregnancy is one the cause for such increased total fertility rate and maternal mortality rate, so this study may enable to address the extent of knowledge, attitude and practice toward family planning utilization, natural contraceptives and to determine the effectiveness of health activities in the study area. Additionally, it provides information that can be used as source of information for the next researchers and for all concerned bodies like Umuahia Health Bureau and Rural Health Extension Workers.

1.6 Limitation of the Study

The factors expected to hinder the modern family planning usage may not be exhaustive. There could be other influencing factors which this study did not reveal.
Generalization is limited by the fact that the study was conducted in a small locality.
Husbands may interfere the decision making power of the women. This can limit the family planning method usage of women.

1.7 Operational Definition of Terms

Knowledge is determined by considering the first knowledge question as a base.

Knowledgeable- if they attain or know about contraceptive (yes answer for question number one which is base for the second and third questions.) otherwise not knowledgeable.
Positive attitude-women’s having greater than or equal to 16 scores for an attitude question.
Negative attitude –women’s having less than 16 score for an attitude question.
Good practice – women’s answering ‘yes’ for questions number one and three of the practice questions.
Poor practice – women’s answering ‘no’ for questions number one and three of the practice question.

1.8 Organization of the Study

The first chapter contains the study’s introductory section, which includes the study background, the statement of the research problem, the study of the objective, and the scope of the study. The second chapter is a critical review of other literatures relevant to the study and its objectives, as well as the study’s theoretical framework. The third chapter discusses the methods of data collection, sampling, and data analysis used in the study. The fourth chapter focuses on the research findings, including an examination of how they relate to previous findings. The fifth chapter contains a summary of the findings, a conclusion, and recommendations based on the study objectives.

Chapter Five

Summary Conclusion and Recommendation

5.1 Summary and Conclusion

Family planning is a means of promoting the health of women and families and part of strategies to reduce the high maternal, infant and child mortality and yet, there is very little information on what influences its utilization in Nigeria.

From this study out of 75 study subjects interviewed as if they have knowledge about natural contraceptive, only 68(90.67%) of them were found to be knowledgeable, and this finding is different from a cross sectional survey conducted in Addis Ababa, February. 1-5, 2010 in which, a total of 361 study subject were interviewed making the coverage of study 265 (73.54%) had good knowledge about natural contraceptive and A survey of knowledge, attitude and practise toward contraceptive utilization conducted among lower, middle and upper class women in Gondar women 1996 which showed 65% of the respondent knew about natural contraceptive method. The likely exception for this dissimilarity might be due to difference in study period, level of education of the study subjects involved and Operationalization of utilization.

According to this study most 18(26.69%) of the respondent having knowledge about natural contraceptive method, mentioned Calendar rhythm and 15(22.05%), 9(13.24%), of them mentioned symptothermal and Lactational infertility respectively. This finding is same what similar with a survey of knowledge, attitude and practise conducted among lower, middle and upper class women in Gondar women 1999, in which 44% of the study subjects mentioned Calendar rhythm, followed by tuba ligation.

Out of 68 respondents knowing natural contraceptive method 27(40.69%) of them strongly agreed that child spacing is important, and 29(42.64%), 10(14.70%), and 2(2.94%) of them agreed, disagreed and undecided respectively with an importance of child spacing; and for limiting the number of children, 32(47.05%), 25 (36.76%), 7 (10.29%), and 4 (5.88%) of them strongly agreed, agreed, disagreed and undecided respectively.

Of the 68 respondents 13(38.35%), 12(36.41%), of them strongly agree respectively with the use of natural contraceptive method is to prevent pregnancy question. From the total score of attitude, the positive and negative attitude level was classified on the seated criteria, accordingly 12(36.644%) had a positive attitude and the rest 21(63.35%) had a negative attitude. This finding was similar with a cross-sectional survey conducted in Addis Ababa February. 1-5, 2005, in which 279(77.3) had favourable attitude towards natural contraception. (13)
From the ofsample thenatural contraceptive users 44(34.37%) of them used Calendar rhythm whereas symptothermal, Ginger root, Lactational infertility, and Stoneseed root were used by 51(39.84%), 17(13.28%), 12(9.37%), and 4(3.13%) respectively. This study finding was same what similar with a study done on family planning among mothers of Mexico which shows the use of family planning among women of reproductive age group, was high, overall 47% of women use family planning method. Among current users’ majority relay on Lactational infertility, Calendar rhythm and symptothermal are most widely used 8% and 6% respectively. (4)
Generally, as to the knowledge, attitude and practice of respondents, the main factors as challenges to its poor utilization were: religion and culture and fear of side effect. This finding was not much different from what has been observed from the finding in Nigeria which showed that knowledge of mothers of reproductive age group on natural contraceptive was high, 22% of women ever use family planning and 13% of them were not using, 44% did not know any family planning method and 22% were afraid of side effects and did not know where to obtain.

Furthermore, this study further revealed as there is no significant association between socio-demographic characteristics and knowledge, attitude and practise toward natural contraceptive utilization.

5.2 Conclusion

Based on the finding of the study the principal investigator has made the following conclusions: –

Most 68 (90.67%) of the study subject had knowledge about natural contraceptive method and most of them mentioned Calendar rhythm as a natural contraceptive method and benefit of natural contraceptive method were known as to space birth by majority of the respondents.
From the total score of attitude, the positive and negative attitude level was classified on the seated criteria; accordingly, majority of respondents had a positive attitude while the rest of respondents had a negative attitude.
There was no significant association between socio-demographic characteristics and knowledge, attitude and practise toward natural contraceptive utilization found.

5.2 Suggestions and Recommendation

Based on study finding and conclusion the following recommendations are made to the responsible bodies

Health education is better to be given to mothers of reproductive age group regarding the benefit of using preferred type of family planning method, the uniqueness of each type of methods and their side effects by nearby health centre and health extension workers of the Ohiocha town.
Efforts should be made to change the community attitude on contraceptive utilization through provision of adequate information and training by Umuahia health bureau and other concerned body.