Factors Affecting Family Planning Services In Rural Areas Among Women (A Case Study Of Nsit Ibom)

Project and Seminar Material for Public Health

Factors Affecting Family Planning Services In Rural Areas Among Women (A Case Study Of Nsit Ibom)


Abstract


The empowerment and autonomy of women to enable them to take active part in their child-bearing decisions, decide as to when to marry and give birth and either to space or limit their births have been given much prominence at major international and national seminars and conferences on population, women and Development over the years. This study this assess the child bearing decisions made by women in Nsit Ibom Local Government Area of Akwa Ibom State. The study revealed that women of the study communities do not independently make decisions in their Family planning issues and most women are not educated hence education is a pre- requisite for effective reasoning and informed decision making. Therefore midwives have a role to play by health educating women on the need for their involvement in decision making with regards to their fertility and also the need for family planning as an effective way to reduce their family size, unsafe abortion, maternal mortal and achieve their MDG 4 $ 5 target.


Table Of Contents


Preliminary Page(s)

  • Title Page
  • Declaration
  • Approval
  • Dedication
  • Acknowledgement
  • Abstract
  • Table of Content

Chapter One

1.0 Introduction

  • 1.1 Background of the study
  • 1.2 Statement of the problem
  • 1.3 Objectives of the study
  • 1.4 Significance of the study
  • 1.5 Scope and Limitations of the study
  • 1.6 Assumptions of the study
  • 1.7 Formulation of Hypothesis
  • 1.8 Definition of Terms

Chapter Two

2.0 Review of Related Literature

  • 2.1 Conceptual review
  • 2.2 Theoretical review
  • 2.3 Empirical review

Chapter Three

3.0 Design and Methodology

  • 3.1 Primary Sources of Data
  • 3.1.1 Personal/Oral Interview
  • 3.1.2 Questionnaire Method
  • 3.2 Secondary Sources of Data
  • 3.3 Population and Sample Size Determination
  • 3.4 Methods of Data Collection
  • 3.5 Method of Validating the instrument
  • 3.6 Method of Data Analysis
  • 3.7 Problems of data collection

Chapter Four

4.0 Presentation of Analysis of Data

  • 4.1 Presentation of related data
  • 4.2 Analysis of Data
  • 4.3 Test of Hypothesis
  • 4.4 Interpretation of Result

Chapter Five

5.0 Summary / Discussion of Findings, Conclusion and Recommendation

  • 5.1 Discussion Of Findings
  • 5.2 Limitations of the study
  • 5.3 Conclusion
  • 5.4 Recommendations
  • References

Chapter One


Introduction

1.1 Background to the study

The ability of women to take decisions in family planning issues such as family size, when to have a baby, choice of spacing period and the use of family planning services may not only enhance their bargaining power in family matters but will also reduce their vulnerability to sexually transmitted infections (STIs) (Tavory & Swidler, 2009) Fertility and its decisions in the family is influenced by ideas and changes that occur in the life of the individual associated with such characteristics as education and income levels. Thus as women climb the educational ladder and men are faced with economic challenges of life, coupled with the pressure from the family to provide and satisfy their physiological needs, women are faced with the need to make choices with respect to the number of children they should give birth to and the size of their families (Weeks, 2010) and many others. In developed and industrialized societies, the trend towards smaller family sizes has emerged due to the spread of formal education, medical and health advancements and the enhanced status of women (Miller, 2010).

Education, for example, is a very powerful indicator of involvement in fertility decision making among women globally (United Nation, 2005). It has been widely recognized as a key concept in understanding fertility behaviour (Miller, 2010). This is in line with Weeks (2010), who asserted that women who delay marriage are more likely to stay in school and then upon attaining higher education, are also more likely to find suitable employments ,they are able to compete effectively with their male counterparts in family building and lower parities than their less educated female counterparts that give birth to larger number of children.

In as much as women have been empowered through education and economic employment to be assertive in family life decisions gender inequality, is a universal phenomenon which largely confronts women. The UN World Conference held in Mexico City, Copenhagen and Nairobi in 1975, 1980 and 1985 respectively for the advancement of women underscored the peculiar problems facing women (Pietila, 2007).Globally, women do not enjoy equality with men in terms of political, legal, social and economic rights. It has been observed that in every country, jobs that were predominantly done by women were the least well-paid and had the lowest status (Marger, 2008).The 1995 World Bank report acknowledged the same fact that gender inequality also manifests itself in family planning decision-making hence gender inequality in decision-making constitutes the major concern in this study. Family planning decision of women is a global concern because of the social and environmental impacts of population growth and maternal mortality (Ronsmans & Graham, 2006).

Furthermore, Marger, (2008) admitted the gender differences in family planning decision making and attributed to power relation and traditional gender roles. This view was surported by Vaessen, (2004) who argued that women lack control over decision-making in reproductive health especially with regards to their family planning. They commented that women are often pressured by husbands and relatives to have large families and maintained that society had not recognized and made use of women’s knowledge and capabilities. In most developing societies, most women have no option than to succumb to the dictates of their spouses, friends and kinsmen with no control allowed over their family planning decisions (May, 2014). Of great concern is the high value traditionally placed on children, which has sustained the high fertility rate in Nsit Ibom Local Government Area and made it resistant to the forces that brought about decline in fertility in the developed countries. The cultural and national traits of women of some geo- political regions of the world do influence their family planning decisions to the extent that the family planning preferences of these women even in the developed nations reflect what obtains in their home regions as revealed by Woollett, Matwala and Hadlow ( UN, 2009). Human reproductive behaviour which is the result of a complex interplay of economic, social, cultural, religious and biological factors influence the family planning decisions of women in the developing world (Caldwell, 2009).

Family planning decisions within the traditional family system are based on factors such as children as old age security for parents, prestige attached to large family size, labour force for agricultural practices, as security against high infant mortality and the social benefits of having children and grandchildren. Children are, therefore, cherished as sources of labour in the agrarian and traditional societies. This has led many women into having many children as a result of many child births which have effects on the mother, children in such families and the nation at large. The effects include: maternal, neonatal and child mortality and morbidity; over population, social ills, poverty and lack of community development hence the family is the building block of the community. The low status accorded to women made them desire for larger family sizes. They felt secure in the number of children they had, as a woman’s value and status were linked to her reproductive efficiency and this also give them support in the event of unexpected vicissitudes of life such as widowhood, divorce and physical incapacitation. How applicable are these global gender inequalities with respect to child bearing decision-making of women in the 21st century Nigeria especially in Nsit Ibom-North Local Government, Akwa Ibom state. This is what the researcher seeks to investigate.


1.2 Statement Of Problem

More than half a million women, nearly all of them in developing world die each year in pregnancy or childbirth, amounting to one death every minute (Ronsmans & Graham, 2006). Another million suffer serious, and sometimes permanent pregnancy – related injuries such as – vesico vaginal fistula etc. Much of this suffering and death could be prevented through appropriate maternal and child health services including ANC, labour and delivery services as well as family planning services. 4 In Nigeria traditional attitudes towards gender relations have affected the power of decision- making both within and outside the house hold. Buor, (2004) observed that women, especially in traditional families were subservient to the man in marital relationship, so the man assumes a key position in decision making which is evidenced in the area of Family planning. Some of the result of such subservient role in decision making include; a situation where a pregnant woman’s life is in danger on presenting to the hospital required immediate surgical intervention but will refuse to give her consent until the husband comes. This was observed severally by the researcher and most times when the husband comes, he might decide to take the woman out of the hospital putting the woman’s life in great danger and many others scenario that the researcher personally observed in Nsit Ibom – North LGA hence the women cannot solely make decision on their own even on issues that affect their health during Family planning which sometimes result to maternal death due to delay in decision making. It was suggested that traditional attitudes towards gender relations might reduce effective communication between couples and restrain a wife’s freedom to make chilbearing decisions (May, 2014).

The effect of the inferior role of women in decision- making is that they have traditionally been suppressed in taking decision even on matters that affect them such as childbirth. The National Population commission (2014) reported that Akwa Ibom State in Nigeria demographic and health demographic and survey (NHDS, 2013) recorded a total fertility rate of 5.7 and there existed fertility differentials between the rural and urban communities of the state of 7.0 and 4.7 respectively. The researcher also observed a similar trend in the Family planning pattern of women in Nsit Ibom LGA which was recorded to be 5 based on the findings from the research study. Women’s non involvement in their Family planning decisions affects their health and could lead to high frequency of childbirth among women which could result in serious health risk like; maternal, neonatal and child mortality and morbidity; over population, social ills, poverty, lack of community development hence the family is the building block of the community, economic stagnation, marital burden and inability of families to educate most of their children resulting in high illiteracy rate in the rural communities of the State.

Consequently the question that comes to mind are:

  1. Is the large family size the choice of the woman or women have no role in decision making with regards to controlling their fertility?
  2. If family planning is women’s rights do these rights apply in family decisions?
  3. To what extent do women exercise reproductive right by participating in issues that directly affect their well beings?
  4. Do women have any control over decision – making issues that relate their child bearing ?

To answer these questions and many others the study seeks to assess the child bearing decision of women in Nsit Ibom Local Government Area, Akwa Ibom State. Hence the need for this study cannot be overemphasized, especially in an environment with high fertility and low contraceptive use.


1.3 Purpose Of The Study

The purpose of this study was to assess the child bearing decisions made by women in Nsit Ibom Local Government Area of Akwa Ibom State.

The objectives of the study were to:

  1. Identify the pattern of family planning among women in Nsit Ibom Local Government Area, Akwa Ibom State.
  2. Identify the extent of women’s participation in family planning decisions in Nsit Ibom Local Government Area, Akwa Ibom State
  3. Determine the factors that influence women’s family planning decisions in Nist Ibom Local Government Area, Akwa Ibom State.

1.4 Research Questions

The research was guided by the following questions as:

  1. What is the pattern of child-bearing among women in Nsit Ibom Local Government Area, Akwa Ibom State?
  2. To what extent do women in Nsit Local Government Area, Akwa Ibom State participate in child-bearing decision making?
  3. What are the factors that influenced decisions made by women during Family planning in Nsit Ibom Local Government Area, Akwa Ibom State?

1.5 Significance Of The Study

The study is to help in finding the reasons for women’s participation or not in family planning decisions of their families that, to some extent, inform the pattern of childbirth which results in fertility differentials in Nsit Ibom Local Government Area, Akwa Ibom State. This will help address the issues related to women’s empowerment and their reproductive autonomy in Nsit Ibom Local Government Area, Akwa Ibom State. Findings from this study will add to the existing literature on pattern of Family planning and how decisions about Family planning are taken in Nsit Ibom local government, Akwa Ibom state Nigeria. The result of the study will also assist planners and administrators of the town to adopt strategic plans that will help raise the level of consciousness of the women in the town with regard to their child bearing. The study will also serve as the source of information to students and the basis of further research into women’s reproductive decisions.


1.6 Scope Of The Study

The study was delimited to the birth patterns and Family planning decisions of women in Nsit Ibom Local Government Area, Akwa Ibom State, the factors that influence women’s Family planning decisions and the extent to which they have the autonomy to participate in the Family planning decisions of their families. This study is delimited to all women within the age of 15 and 49 years who will be present in the area during the period of the study and will be willing to participate in the study.


1.7 Definition Of Terms

Family Planning;

The practice of controlling the number of children one has and the intervals between their births, particularly by means of contraception or voluntary sterilization


Chapter Five


5.0 Summary / Discussion of Findings, Conclusion and Recommendation

5.1 Discussion Of Findings

This chapter presented the discussion of major findings based on specific objectives, implication for nursing, limitations of the study, suggestion for further studies, summary, conclusion and recommendations.

Discussion of major findings
Respondent’s characteristics

It was revealed from the findings that majority of the respondents have low literacy level and are poorly empowered economically. This was shown by the findings that respondents 137(35.4%) had no formal education, 98(25.3%) had attained primary school education and 88(22.7%) had attained secondary school education. Only as few as 64(16.5%) had attained tertiary education qualifications and Majority of the women (236) were self employed farmer and petty trader and they account for 61% of the respondents. About 90(23.3%) were full time housewives. Education and enhanced economic power of women has been seen as a pre-requisite to effective decision making of all kinds including that pertaining to the Family planning decision among women. Hence this finding was not in conformity with the assertion made by Weeks, (2010) who saw fertility and its decisions in the family to be influenced by ideas and changes that occur in the life of the individual associated with such characteristics as education and income levels. Thus as women climb the educational ladder and men are faced with economic challenges of life, coupled with the pressure from the family to provide and satisfy their physiological needs, women are faced with the need to make choices with respect to the number of children they should give birth to and the size of their families (Weeks, 2010).

The findings was also contrary to the assertion made by Miller,(2010) who noted that; In the developed and industrialized societies, the trend towards smaller family sizes has emerged due to the spread of formal education for women and the enhanced economic status of women (Miller, 2010). Education, for example, is a very powerful indicator of involvement in fertility decision making among women globally (United Nation, 2005). It has been widely recognized as a key concept in understanding fertility behaviour (Miller, 2010). This shows that women who were not enlightened educationally as well as on their rights are not likely to be knowledgeable about their child-bearing decisions and will not show positive attitude to fertility regulation programmes. Generally, the occupation/economic activities conformed with the general employment trend where women are mostly found in the informal sector. The higher concentration of respondents in the informal sector is attributed to the few respondents with higher education which is a requirement for recruitment into the formal sector. This explanation is in line with Momsen, (2004) submission that female access to education would expose them to better-paid jobs. Here, Momsen has established the relationship between education and employment. Education and employment also influence Family planning decision. When women are exposed to opportunities of education and employment,’time’ becomes an important factor in household decision on number of children to bear (Monsen, 2004). With a higher percentage of women in employment, it is expected that they would be exposed to the stress of the double burden of childrearing and productive roles and their leisure would become valuable
(Momsen, 2004). The effect would be women’s preference for fewer children. It is contended that as the wealth of women increases through their engagement in economic activities with children no longer used as source of wealth, the opportunity cost of raising children becomes higher and the incentive to have children declines.

Objective1; To determine the pattern of family planning among women in Nsit Ibom LGA.

The mean value on the number of children that are alive per woman is 4.68 and what this means that pattern of family planning in the local government is almost 5 children per woman. It was also revealed that some women had more than 5 children as findings showed that an appreciable numbers of women had between 6-10 children. This is an indication of high fertility which exist in most rural areas of various communities of the L.G.A. This findings agree with the report released by the United Nations Population Division which revealed that between 1995 and 2000, 49 countries with a total population of 770 million, most of which could be located in the developing world, have fertility levels of 5 children or more per woman (UN, 2009). The World Population Data Sheet places the most regions within the 3.9 to 5.5 children per woman range with East and West/ Middle Africa falling within the fertility ranges of 5.1 to 7.0 and 5.1 to 7.5 children per woman respectively (Population Reference Bureau,2000).

This findings also confirms National Population commission (2014) report that Akwa Ibom State in Nigeria health demographic and survey (NHDS)-2013, recorded a fertility rate of 5.7 and there existed fertility differentials between the rural and urban community of the state of 7.0 and 4.7 respectively. The survey also revealed that higher frequency of birth among women result in serious health risk, economic stagnation and poverty, marital burden and inabilities of the families to educate most of their children, resulting in higher illiteracy rate in the rural communities of the state.

Secondly on the pattern of Family planning, age at first birth showed that an average women starts sexual debut at 16 years old hence the mean age is 16.18 and the age with highest frequency is 13-17 years. This could also determine the number of children a woman in Nsit Ibom would like to have or had already hence Weeks, (2010) asserted that age at marriage which also influences the time of first birth is another factor that influences the reproductive decisions and fertility levels of women and also determines the number of children they give birth to during their reproductive years. Thus, many women in the rural communities of the developing world who marry at an early age either consciously or unconsciously have many children (Weeks, 2010), because of lengthened period of fecundicity

Objective Two: Identify the extent of women’s participation in child-bearing decisions in Nsit Ibom Local Government Area, Akwa Ibom State

The importance of women’s control over their Family planning decision–making includes an affirmation of their reproductive health and the prevention from exposure to precarious health conditions due to undue pressure to have large family size. Other benefits include prevention of unwanted pregnancy and the opportunity to engage in other activities such as education and employment which would enhance their status in the society. The researcher, therefore, asked whether women are the sole decision makers their Family planning but findings from this objective showed that majority of the women take some part in making decision about their child bearing. Here the means values for these statements; When to become pregnant, Number of children, when to have sexual intercourse and child spacing period were 2.93, 2.93, 2.93 and 2.96 respectively. This shows that the women would at least take these decisions with their husbands. Women invariably lack total control over decision making in these aspects hence (Marger, 2008) admitted gender differences in Family planning decision making and attributed this to power relation and traditional gender roles. This view was surported by Vaessen, (2004) who argued that women lack total control over decision-making power in reproductive health especially with regards to their Family planning. They commented that women are often pressured by husbands to have large families and maintained that society had not recognized

and made use of women’s knowledge and capabilities. In most developing societies, most women have no option than to succumb to the dictates of their spouses, with no control over their Family planning decisions (May, 2014). The study therefore revealed that Family planning decision-making was jointly taken by the wife and the husband.

Majority of the women were more involved in making these decisions on where to receive antenatal

and where to deliver. Women’s control over their antenatal care and place of delivery decision-making was relevant for several reasons. The right of access to appropriate health care services to enable women to go through pregnancy safely and childbirth, and provide couples with the best chance of having healthy infant, has been emphasized by healthcare providers. The ability of women to exercise control and power in Family planning decision making, especially in antenatal care, is a necessity to guarantee their access to healthcare which, in turn, would ensure safe delivery and prevention of pregnancy related complications (Nkrumah, 2011).

The reasons underlying women’s greater participation in antenatal care decision-making may have been the notion shared by many that women were exclusively exposed to the health hazards associated with pregnancy and hence needed to influence antenatal care decision-making.

Apart from the health reasons which informed women’s participation, the role of the media, both print and electronic in information dissemination on reproductive health cannot be overemphasized. Women are increasingly becoming aware of their reproductive health needs, and taking advantage of the government policies and programmes on reproductive health (Nkrumah, 2011).

Majority of the women are not involved in decision of when and how to use family planning. Family planning is an asset for both the family and the society. It is the means of preventing unwanted pregnancies and thus making abortions unnecessary. It also has the socio-economic benefits of providing families with better options to plan for nourishment, care, housing and education of their children (Pietila, 2007). On the basis of the foregoing submissions, the researcher sought to explore the respondent’s role in decision-making on family planning. The data shown in table 3 in chapter 4 above showed Majority of the women are not involved in decision of when and how to use family planning. Brown, (1994), however, confirms this finding with the assertion that the traditional role of the male as a decision-maker is evident in the area of family planning hence a woman might not be able to take family planning decision alone. Most of the respondents don’t know about family planning while those that know said they don’t want to hear about it. Furthermore, the trend may be as a result of ineffective communication between couples and the women’s religious background as most of their churches condemn family planning together with abortion. As women remain dependent, and patriarchal dominance in marital relations increases, their bargaining power diminishes.

Objective Three: Determine the factors that influence women’s family planning decisions in Nsit Ibom Local Government Area, Akwa Ibom State.

3a) Socio-economic factors that influenced the decisions made by women on child bearing matters.

The result in this study shows that these socio economic factors (Level of education, Employment status, Space in your house, Husbands occupation ,Age ,Availability of social amenities) did not have any effect on the women’s family planning decision apart from the cost of raising children which has mean value that is approximately 2.5. This contradicts this view by (Gabriel & Villarreal in UN, 2009;Miller, 2010, Weeks, 2010 & May, 2014) that in the developing nations, socio-economic factors had been identified as the most dominant that influence women’s child-bearing decisions especially in the rural communities. Against this back drop however, education, especially women’s education has received considerable attention from researchers and scholars with respect to the concept of fertility in demographic literature. Writing on the situation in Bangladesh, (Miller, 2010) reiterated the role education plays in women’s child-bearing decisions as influencing their supply of children, their ages at marriage, family size, duration of lactation and post-partum care as well as education and welfare of their children, among others. In corroboration with Miller’s view , Weeks, (2010) postulated that the educated females are more conscious and courteous of their family size, quality of life and the functioning of their human bodies, placing a higher premium on their families’ living standard, their personal health and the health of their children. To Weeks, the educated women show a more positive attitude toward fertility regulation programmes than their illiterate counterparts.

Linked to these fertility decisions is the issue of residence, rural or urban which (UN, 2007) reveals that rural women in most cases have no role models, little or nothing to compete for and no struggle for the use of land, accommodation and other facilities as compared to their urban counterparts who have to compete for schools, health facilities, land, water, accommodation and other socio-economic facilities at higher cost (Weeks, 2010.). However, the cost of raising children is a factor that affects family planning decision. This conforms (Gabriel & Villarreal in UN, 2009) that in the developed world where scientific innovations, technology, good and quality healthcare and nutrition coupled with quality and higher education abound, the decisions of women to give birth, when to give birth and the number of children to give birth to depend to some extent, on the cost of child birth, care and the education of the children from their toddlerhood to adulthood when they become independent to cater for themselves. The economic costs of child birth and care are therefore felt by both men and women. Education has been identified as the main economic cost of child birth and care in the developed world (Caldwell, in UN 2009). Gabriel & Villarreal in UN, (2009) also posited that with poor socio-economic background, children from poor households have less chance of acquiring educational and nutritional profile that will secure them productive employment hence the women from the study environment recognized the cost of training the children as a socio-economic factor that they considered or needed to be considered.

Cultural factors that influenced the decisions made by women on family planning matters

The result shows that a good number of the cultural factors influence the family planning decisions of the women. The mean values showed that factors like to have children to care for them when they are old and to continue their husband lineage were the upper most in the factors that affected family planning decisions. This was followed by the statement that children are old age security.

This result was in conformity with (Avatim, 2009; Bleek in Stephenson, 2006 & Oppong & Abu, 2007) that within the traditional sphere, child-bearing ability of women was explained as the means by which the lineage ancestors were allowed to be reborn. Barrenness was therefore considered the greatest misfortune. It was confirmed that by this traditional view of procreation, about 60% of women in Nigeria’s rural communities preferred to have families of five (5) or more children (Avatim, 2009). Cultural beliefs in Nigeria detract women from their ability to negotiate sexual relations, determine the number of children they want to and should have and the method to apply in that regard, resulting in the high fertility levels in the rural corridors of the country (Avatim, 2009). Family planning decisions within the traditional family system are based on factors such as children as old age security for parents, prestige attached to large family sizes, labour force for agricultural practices , as security against high infant mortality and the social benefits of having children and grandchildren. Children are, therefore, cherished as source of labour in the agrarian and traditional societies .The low status accorded to women made them desire for larger family sizes. They felt secure in the number of children they had, as women’s value and status were linked to their reproductive efficiency and this also give them support in the event of unexpected vicissitudes of life such as widowhood, divorce and physical incapacitation (May, 2014). Children in the Nigerian cultural setting was seen as social insurance benefits of the aging parents, social prestige and source of labour in the agrarian societies where food and cash crop farming, fishing and animal rearing are the dominant economic activities. (Bleek in Stephenson, 2006) . Thus to (Oppong & Abu, 2007), there is a strong traditional norm of high fertility as children are the raison d’etre of marriage which also results in higher fertility in the rural communities than the urban communities of the nation. The women’s autonomy in the Family planning decision- making, her participation and concern are not the issue to be thought of by the spouse.

However, the result showed that they did not consider their family and in laws in making Family planning decision for them as a factor that affects their family planning decision. This contradicted May, (2014) view that another aspect of the cultural tradition that influences the child- birth decisions of women is the extended family system and that family planning decision could be more of group effort than we could imagine. May, (2014) explained that the extended family has a great influence on the nuclear family members in the child-bearing decision making process which was not the case in this study.

Biological factors that influenced the decisions made by women on family planning matters

The result shows that none of the biological factors affect the women family planning decisions. It implies that the women perceived that each of the factors would not all affect or would affect their family planning decision not so much hence the women didn’t have any need for reproductive assistance to enable them mother / father children as their natural inalienable rights (Westoff and Freyka, 2007)

Religious factors that influenced the family planning decisions of women

Concerning the religious factors, finding shows that the highest that affected family planning decision of women in Nsit Ibom LGA was the fact that their religion does not allow abortion or support family planning thereby confirming what McIntosh & Finkle, (2005) said that conversely, religious beliefs and practices do prevent some persons from accepting or practicing fertility regulation techniques as a means of making reproductive decisions. Thus, the concept of family planning and artificial contraception, reproductive health decisions and any form that follows the policies, tenets and decisions of the Programme of Action of the Cairo Conference (ICPD) 1994, were opposed by the Holy See, The Papacy of the Catholic Church (McIntosh & Finkle, 2005).

Implication of the study for nursing

Gender inequality, is a universal phenomenon which largely confronts women. It has been observed that in no society do men and women receive the same rewards. Globally, women do not enjoy equality with men in terms of political, legal, social and economic rights. The 1995 World Bank report acknowledged the same fact that gender inequality also manifests itself in Family planning decision-making hence gender inequality in decision-making constitutes a major concern in this study. Family planning decision of women is a global concern because of the social and environmental impacts of population growth and maternal mortality (Ronsmans & Graham, 2006).

Furthermore Marger,(2008) admitted gender differences in Family planning decision making and attributed the underlying reasons to power relation and traditional gender roles. He commented that women are often pressured by husbands and relatives to have large families and maintained that society had not recognized and made use of women’s knowledge and capabilities. In most developing societies, most women have no option than to succumb to the dictates of their spouses, friends and kinsmen with no control over their Family planning decisions (May,2014). The high value traditionally placed on children, has sustained the high fertility rate in the region and made it resistant to the forces that brought about decline in fertility in the developed countries.

Majority of women of Family planning age in the study communities lack control over their Family planning decisions due to lack of knowledge which is a pre-requisite to informed decision making in their families. Nurse Midwives are therefore encouraged to utilize every opportunity to educate women about Family planning issues and the need for effective decision making in issues that affect their well being especially in the rural areas of the states of the federation. It is the responsibility of the nurse to educate women on the need for active participation in decision making on family planning issues. The education of the woman and family members when oppurtuned should address the theme such as; concept of Family planning decision making, women reproductive health needs and vulnerability to health complications, the ideal family size, need for family planning, education of children and complications of high fertility including maternal mortality and it’s externality on the environments.

The education sessions must consider the reality of the subject, and aim to provide knowledge to promote independent women who can be active in their Family planning decision making process. The nurse plays an important role in health education and is responsible for articulating the scientific knowledge and ensure the development of autonomy in decision making of individual women


5.2 Limitations of the study

It was not an easy task to access the respondents. Several visits were made before obtaining the required sample size.

It was also very rigorous and time consuming collecting data as most of the respondents could not read ibo nor comprehend the English version of the questionnaire. Each question in the questionnaire had to be interpreted and the answer recorded in the questionnaire.

Paucity of literature as concerned indigenous study on family planning decisions of women was also a limitation to the study


5.3 Conclusion

The empowerment and autonomy of women to enable them to take active part in their child-bearing decisions, decide as to when to marry and give birth and either to space or limit their births have been given much prominence at major international and national seminars and conferences on population, women and Development over the years. Particular reference could be made to the Programme of Action at the ICPD of Cairo, 1994 (UN, 1995), and the World Conference on Women in Beijing, China in 1995 (UN, 1996), where governments were expected to apply all the protocols signed and principles and policies agreed upon to the letter. These notwithstanding, many women in rural communities of most countries in the developing world especially in sub-Sahara Africa (SSA) face the same problems that were discussed in the international circles such as poverty, male dominance, marital instability, high birth rate, ineffective participation in their child-bearing decisions, pregnancy and birth complications among others, and their effects on the women and their children.

The study also revealed that women of the study communities do not independently make decisions in their Family planning issues and most women are not educated hence education is a pre- requisite for effective reasoning and informed decision making.

Therefore midwives have a role to play by health educating women on the need for their involvement in decision making with regards to their fertility and also the need for family planning as an effective way to reduce their family size, unsafe abortion, maternal mortal and achieve their MDG 4 $ 5 target.


5.4 Recommendations

The need for women to make decisions with regards to their fertility is of utmost important for effective growth of the community, state and nation wide cannot be over emphasized hence most birth complications are commonly been experienced by women. Based on this, the researcher recommends the following;

  1. The LGA assembly, in collaboration with NGOs should encourage, institute and implement programmes and activities that will enhance adolescent and youth development. These programmes should inculcate in them the concept of responsible sexual behaviour, the small family size norm, pursuit of careers, values of responsible adulthood and mutual respect for the opposite sex.
  2. At the community levels, reproductive and maternal health programmes should not be left to the Ministry of Health alone. The Local Government Assembly, NGOs, Faith -Based Organizations (FBOs) and Community- Based Organizations (CBOs) should be funded to undertake regular outreach programmes through public education and community durbars and the training of peer educators in the field who will serve as channels of communication and education to support the efforts of the Ministry of Health in the rural communities.
  3. To promote women’s autonomy and control over their bodies, there is the need for men to be involved in maternal and child health programmes and be conscientized on the need to allow their wives in child birth decisions and participation in family issues.
  4. Women’s education, which has been generally and specifically identified as the antidote for fertility reduction should be given extra boost by promoting non-formal education programmes in the rural communities for the unfortunate illiterate female population and those with very low level education to rake them out of the ignorance syndrome to enable them become conscious of their sexual and reproductive rights.
  5. Religious institutions which play key role in conjugal relations and marriage contraction have to encourage effective communication among couples. Effective communication is needed to ensure that women are able to negotiate on issues that threaten their lives and also if possible change their stake on family planning programmes.
  6. The role of the media, both print and electronic is fundamental in reproductive health awareness creation and public education. The public needs to understand and appreciate the positive implications of women’s participation in reproductive health decision-making. The benefits that could be derived from such participation include prevention of unwanted pregnancy, unsafe abortion, increase access to education and employment, prevention of large family size, spacing and timing ofFamily planning and the prevention of pregnancy related complications such as maternal mortality. The ability of women to participate in reproductive health decision-making would not only enhance their bargaining power but also reduce their vulnerability to STD’s including AIDS from diseased or high risk-partners. Other harmful traditional practices such as female circumcision could also be reduced.
  7. Women’s participation in Family planning decision-making will further be enhanced if reproductive health interventions such as antenatal and postpartum health care and other health packages such as National Health Insurance Scheme which guarantee free access to healthcare services are instituted, properly implemented, promoted and sustained

The effective implementation of these recommendations will not only help in achieving community development, but also the attainment at the fifth component of the Millennium Development Goals (MDG) that aims at improving maternal health (WHO,2012 ).


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