Perceived Factors Influencing The Utilization Of Intrauterine Contraceptive Device Among Women Attending Immaculate Heart Hospital, Nkpor

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Perceived Factors Influencing The Utilization Of Intrauterine Contraceptive Device Among Women Attending Immaculate Heart Hospital, Nkpor


Abstract


Intrauterine Device is a method of contraception, which is underutilized in developing African countries including Nigeria despite the method being safe, long acting, reversible and effective in preventing unintended pregnancies. The main objective of this study was to determine the Perceived factor influencing the utilization of intrauterine contraceptive device among women attending immaculate heart hospital Nkpor. The specific objectives were to establish the level of Intra Uterine Device uptake among women seeking Family Planning services and to determine drivers and barriers to Intrauterine Device uptake among the study population. Data was collected using both quantitative and qualitative approaches where an interviewer administered questionnaires, focus group discussions and key informant interviews were used as the data collection tools.

Descriptive statistics were used to describe the variables while chi square tests assessed associations. Logistic regression was performed for variables that were significant at bivariate analysis. The uptake of IUD among respondent was 7.9%. The uptake of IUD increased with age with those above 30 years using the device more than those below 30 years. Parity was significant in uptake of the method with those having more than two children using the method more compared to those who had one or two children (p<0.0001). Majority of women (84.6%) were able to identify what an IUD is and how it is used. Awareness of the fact that the facility was providing the IUD significantly influenced the uptake. Myths, rumours and misconception were mentioned by 71.3% of women but having heard them was not associated with uptake of IUD (p=0.167), however they were cited to be barrier to IUD uptake by key informant.

The main myths, rumours and misconception that were mentioned included; One can conceive with IUD and give birth to a baby with device embedded in the body (35.8%), IUD can travel to other parts of the body (26.6%) and spread infections to other parts of the body (19.6%). The study recommends to the ministry of health a need to increase IUD uptake and Family planning programmes a need to focus more on young women and those of lower parity to increase the uptake of IUD. Health providers need to dispel myths, rumours and misconceptions and allay fears and concern about IUD.


Table of Content


Chapter One

Introduction

  • 1.1 Background of the study
  • 1.2 Statement of the problem
  • 1.3 Objective of the study
  • 1.4 Research question
  • 1.5 Hypothesis of the study
  • 1.6 Significance of the study
  • 1.7 Scope of the study
  • 1.8 Limitation of the study
  • 1.9 Definition of terms

Chapter Two:

Review of Literature


Chapter Three:

Research Methodology

  • 3.1 Research Design
  • 3.2 Population of the study
  • 3.3 Sample size determination
  • 3.4 Sample size selection technique and procedure
  • 3.5 Research Instrument and Administration
  • 3.6 Method of data collection
  • 3.7 Method of data analysis
  • 3.8 Validity and Reliability of the study

Chapter Four:

Data Presentation and Analysis

  • 4.1 Data Presentation

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • Appendix

Chapter One


Introduction

1.1 Background to the Study

The intra-uterine contraceptive device (IUCD) is used worldwide by 14% of married women (Speidel, Harper & Shields, 2008:197). The rate at which this device is used varies from country to country. Married and cohabiting women of reproductive age in developed countries have higher rates of IUCD usage, approximately two times higher than those in developing countries (Crosignani, 2008:198). Taking for example the Democratic Republic of Korea, a developed country, a utilisation rate of 78% of IUCD was reported in Crosignani’s (2008:198) study. IUCD utilisation rates of 63% and 59% were observed in the same study in Egypt and Cuba respectively. In relation to the sub-Saharan Africa region, Crosignani (2008:198) reported an IUCD utilisation rate of less than 2% among women of a reproductive age. Similar patterns of IUCD usage were revealed in Speidel et al’s (2008:197) study. They reported an IUCD utilisation rate of 7% in Latin America, 6% in Asia (excluding China) and 1% in Africa. The low rate of IUCD usage in Africa was a function of a number of factors. Lack of knowledge of IUCD and pelvic inflammatory diseases were noted as major barriers to the use of this contraceptive among women in the southern African region (Gutin, Mlobeli, Moss, Buga & Morroni, 2011:145; Jacobstien, 2007:363).

Taking a closer look at the Ethiopian context, the 2011 Ethiopian Demographic Health Survey revealed that only 29% of married women surveyed used modern family planning methods, such as injectables, implants, IUCD and pills (Central Statistical Agency of Ethiopia and International Coach Federation, 2012:96,98). It was noted that long acting reversible contraceptives, especially IUCD, were preferred by women with plans or intentions to space and limit their bearing of children (Espeut, Renju & Wubshet, 2010:9). It was further highlighted that most of the women lack information about the effectiveness of long acting contraceptive methods. For example, only 15% of all Ethiopian women were aware of IUCD.

Uptake of IUD in developing countries has been declining progressively over the last decade. The use of the IUD in relation to other contraceptive methods is reported to have either stagnated or declined (WHO, 2010) .In the year 2007, the IUD was used by an estimated 23% of the 721 million users of any contraceptive method; making it the most commonly used reversible method worldwide. When excluding China from the global estimates, IUDs account for 12% of all contraceptive use worldwide (United Nations, 2009). However, the IUD represents only 2% of modern method contraceptive use in sub-Saharan Africa, revealing the under-utilization of this method of contraception in the region despite it being such an important choice for women elsewhere (May et al, 2011). For example annual reports in Ghana showed a steady decline in the use of IUD from 3.3 to 1.9 percent between year 1995 and year 2001 among all women (WHO, 2010; Salem, 2006).

Increasing IUD uptake is particularly important in sub-Saharan Africa, where family planning uptake is often motivated by women’s desire to limit the number of births. Evidence from sub-Saharan Africa suggests there is a large discrepancy between the proportion of women who want to limit the number of births and the proportion using Long Acting and Permanent Methods (LAPMs). This implies large unmet need for LAPMs such as the IUD. Furthermore, contraceptive provision in many Sub-Saharan African countries has relied predominantly on short-term methods, such as oral pills, condoms and Injectables (UN, 2012).

In Nigeria while contraceptive prevalence has reached 58 percent, only 3.4 percent of married women are currently using the IUD (NHIS, 2015). It is therefore of great importance to understand uptake of IUD among women seeking FP services, so as to enhance its use and increase the CPR at the same time contribute to the health maintenance of women in reproductive ages by avoiding unplanned pregnancy and induced abortions.


1.2 Statement of the Problem

Intrauterine device is a highly effective, long term and reversible method of family planning but the method is underutilised both worldwide and locally (WHO, 2010). In Nigeria, the trends in IUD use show a decline from previous years. According to NHIS reports, IUD use in 1993, 2003 and 2008 was 4.2, 2.5, and 1.6 percent respectively among married women aged 15-49 years, showing a steady decline (NHIS, 2009). According to NHIS 2014, there has been an increase in IUD use with 3.4% of married woman using IUD but this increase has not matched the obvious benefits of IUD. Among the most commonly used contraceptives in Nigerian informal settlements, IUD is the least used at 4% compared to condoms (35%), pills (33%) and injection (19%) (Oketch et al, 2011) .Though contraceptive prevalence has been on the rise from 46% in 2009 to the current 58%, only 3.4 percent of married women are currently using the IUD (NMH, 2015). In addition, IUD was the least used modern contraceptive methods among married women, represented by 1.6% compared to Injectables (21.6%), pills (7.2%), sterilization (4.8%), implants (1.9%) and condoms (1.8%) (Alaii et al, 2012). It was also the least preferred method among those who intended to use contraceptive method in future at 1.9% as compared to 7.7% for implant which is also a long term contraceptive method. This trend therefore, creates a need to understand the uptake of IUD as well as drivers and barriers to IUD uptake. Primary health facilities in the country have been reported to be lacking grossly both in commodities and supplies as well as lack of trained personnel to offer IUD services and this has led to a declining trend in IUD uptake in the region (Okoro, 2009) but level four and above public health facilities have regular supplies and are ideal for provision of IUD. The study was carried out to determine the perceived factor influencing the utilization of intrauterine contraceptive device among women attending Immaculate Heart Hospital Nkpor.


1.3 Objective of the Study

The main objective of this is to determine the Perceived factor influencing the utilization of intrauterine contraceptive device among women attending Immaculate Heart Hospital Nkpor.

Specifically, the study aims;

  1. To establish the level of IUD uptake among women attending Immaculate Heart Hospital Nkpor
  2. To determine the drivers to IUD uptake among women attending Immaculate Heart Hospital Nkpor
  3. To determine the barriers to IUD uptake among women attending Immaculate Heart Hospital Nkpor

1.4 Research Questions

  1. What is the level of IUD uptake among women attending Immaculate Heart Hospital Nkpor?
  2. What are the drivers to IUD uptake among women attending Immaculate Heart Hospital Nkpor?
  3. What are the barriers to IUD uptake among women attending Immaculate Heart Hospital Nkpor?

1.5 Null Hypothesis

There are no significant associations between IUD uptake and socio-demographic or reproductive health factors among women attending Immaculate Heart Hospital Nkpor.


1.6 Significance of the Study

The purpose of this research was to determine the Perceived factor influencing the utilization of intrauterine contraceptive device among women attending Immaculate Heart Hospital Nkpor. The study provided knowledge on drivers and barriers to IUD uptake which will be used to guide policy on increasing the uptake of the method. The findings from the study will be used by decision makers in development of strategies to strengthen the uptake of IUD as a long term method of contraception that have a significant impact on CPR. The findings are useful to Ministry of Health Management Teams in their future planning in increasing IUD uptake as a method of contraception. The study is a requirement for the award of Degree in Public Reproductive Health.


1.8 Scope of the Study

The study was based on data collected from Immaculate Heart Hospital Nkpor, thus other facilities were excluded and this is a limitation because women also seek services in those facilities. There has been no other similar study in these facilities and the findings of this study will be useful to the management of the facilities in their future planning as well as the policy makers in addressing the barriers and enhancing the drivers identified. Majority of women seek family planning services in public facilities thus the findings may be used to cover a wider population of women.


1.9 Limitations of the Study

This research work is specifically on the Perceived factor influencing the utilization of intrauterine contraceptive device among women attending Immaculate Heart Hospital Nkpor. In the limitation on research work of this magnitude or nature can be carried out without limitation. Hence, during the course, certain constraints were encountered.

Cost:

The cost of thorough research is not what can be afforded by a student. The prices of materials needed for this work has gone up and transport fee has also gone up.

Time:

The time was one of the limitations in the process of carrying out this research work.

Scarcity of Literature:

The research encountered some problems in collection of literature especially on the bank History and operations. This are hindered the smooth running of this work.


1.10 Definition of Terms

Barriers to IUD uptake

Factors that prevent/hinder uptake of the IUD Contraceptive prevalence – percentage of women who are currently using, or whose sexual partner is currently using, at least one method of contraception. It is usually reported for married or in union women aged 15 to 49 years. A union involves a man and a woman regularly cohabiting in a marriage-like relationship

Contraceptive prevalence rate

Proportion of population of childbearing age (15-49) that is currently using either a modern or a traditional contraceptive method.

Drivers to IUD uptake

Factors that support uptake of the IUD

Family planning

Ability of individuals and couples to anticipate and attain their required number of children, spacing and timing their births

Family planning services

Educational, comprehensive medical or social activities which enable individuals to determine freely the number, spacing and timing of their children, and to select the means by which this may be achieved (WHO 2009)

Unintended pregnancies

Unintended pregnancies is defined as a pregnancy that the woman would have preferred to have at another time (mistimed) or would not have wanted at any time (unwanted)

Uptake

Acceptance and insertion of IUD

Women of reproductive age

Women aged 15-49 years.


Chapter Five


Summary, Conclusions and Recommendations

5.1 Introduction

This chapter summarizes the findings on the Perceived factor influencing the utilization of intrauterine contraceptive device among women attending immaculate heart hospital nkpor. The chapter consists of summary of the study, conclusions, and recommendations.


5.2 Summary of the Study

In this study, our focus was on the Perceived factor influencing the utilization of intrauterine contraceptive device among women attending immaculate heart hospital nkpor. The study is was specifically focused on examining the level of IUD uptake among women attending Immaculate Heart Hospital Nkpor; determining the drivers to IUD uptake among women attending Immaculate Heart Hospital Nkpor and determining the barriers to IUD uptake among women attending Immaculate Heart Hospital Nkpor.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 380 responses were validated from the enrolled participants where all respondent are women attending immaculate heart hospital nkpor.


5.3 Conclusions

With respect to the analysis and the findings of this study, the following conclusions emerged;

  1. The level of uptake of IUD among women attending Immaculate Heart Hospital Nkpor was 7.9%. The uptake is low in relation to obvious benefits of the method and in comparison to other methods of family planning but fairly high compared to uptakes which have been reported in previous studies done in the region.
  2. Concerning the drivers to IUD uptake, parity, awareness of IUD availability and a favourable perception about the device had significant associations with IUD uptake. Partner involvement was not influential in uptake of IUD, though majority of women involved their partners in choice of FP methods.
  3. Barriers or factors that hindered women from using IUD as described from qualitative data were women’s lack of awareness on IUD availability and their conceptual concerns as well as fear of the device. Myths, rumours and misconceptions including perceived side effect persist in the region and they limited the uptake of IUD. Lack of discussion on IUD during counselling sessions with FP providers was evident among FP users and this contributed to lack or little information among clients. This also indicates that there are missed opportunities that are lost for the uptake of the method.

5.4 Recommendation

Based on the findings the researcher recommends that;

  1. To the Ministry of Health and the partners, there is a need for continued promotion of IUD use among all women of reproductive age so as to increase the uptake of the method in the region. This may include use of satisfied clients as champions in demand creation, campaigns and interpersonal communication to improve the image of the IUD, and promote its choice and use as this study have shown that those who are satisfied would highly recommend the method to others.
  2. Family planning programmes need to focus more on the younger women and those of lower parity so as to increase the uptake of IUD. More emphasis about IUD use for birth spacing among this group need to be done. The programmes should endeavour to increase awareness of all the facilities providing the IUD in the region as well as improve perception of IUD of among all women.
  3. To the family planning providers, there is need to dispel myths, rumours and misconceptions among women of reproductive age. Discussion of IUD should be included when counselling all FP clients. Health care providers need to allay fears concerning IUD with proper counselling and accurate information

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