Factors Influencing Attitude of Women of Childbearing Age toward Family Planning

Factors Influencing Attitude of Women of Childbearing Age toward Family Planning in Calabar Metropolis

Introduction

1.1 Background of the Study

There are many variables that determine the attitude of woman of childbearing age toward family planning; such variables could be viewed from Socio-economic factor, Cultural Factor Community norms, Religious affiliation, Gender role and Effectiveness of the services. Family planning is the technique that enables couples to determine when to have baby. There are a numbers of available family planning techniques (elaitan, 2011). Techniques commonly used include Oral pills, Depo Provera, Noristerat, IUCD, Condoms, Implant, and Sterilization etc.Family planning also known as birth control is most usually applied to couples who wish to limit the numbers of children they have and to control the timing of pregnancy (spacing children).

Family planning is when and how many children to have and the use of birth control techniques to implement such plans, so that they can give utmost care to the children, financially, psychologically and socially (United States Department of Agriculture, 2007). According to WHO, (2004) family planning is a way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitudes and responsible decision by individuals and couples in order to promote the health and welfare of family groups and thus contribute effectively to the social development of a Country.

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However, family planning is usually used as a synonym for child spacing birth control.  Family planning may encompass sterilization as well as pregnancy termination. It also includes raising a child with methods that require significant, amount of resources namely: time, social, financial and environment. Family planning measures are designed to regulate the number and spacing of children, within a family, largely to curb population growth, and ensure each family has access to limitedresources.

The concept of women of childbearing age toward family planning can be applied to a wide range of sexual and reproductive health decision. It focuses on whether to seek, to avoid pregnancy, whether to space and time one’s childbearing, whether to use contraception, what family methods to be used, and whether or when to continue or switch methods in family planning.

The attitude of women of childbearing age toward family planning focuses on the individual; however it also influences a range of outside factors such as: Social economic and Cultural norms, Gender roles, Social networks, Religiousand Local beliefs (Bosveld 2000).

To a large extent, these community norms determine individual childbearing preferences and sexual reproductive behaviour. It is usually though that community and culture affect a person attitude toward family planning desire for sex of children pressures to have children and whether or not family planning accords with customs and religious beliefs.

It has been observed that many couples, especially women who are directly exposed to risk of unwanted pregnancy, do not utilized available family planning services. Thus, the attitude of women toward family planning is not encouraging; it is this underutilization of family planning that the researcher delved to find out what may be responsible for the attitude of women of childbearing age toward family planning.

1.2     Statement of the Problem               

Reduction in population growth is believed to improve in country’s prospects for economic development which in turn is believed to enhance a county’s ability to improve the lives of the citizens. In the case of Nigeria, we can see the rapid growth of population according to (census 2006) population figure. There is no such socio-economic issue that is grave and pressing than that of the population growth.

Thus, to save the country from such grave problem it is essential that the population growth should be planned and well checked.The increasing growth of Nigerian population without a commensurate rate of economic development has become a serious problem requiring urgent solution.

Despite the population attention family planning has gained and it’s important to the society they are still underutilized. It is believed as observed by scholars that certain variables influence the attitude of citizens of childbearing age toward family planning services utilization.        This study thus focuses attention on investigating the factor that influences the attitude of women of childbearing age toward family planning in Calabar Metropolis.

1.3 Purpose of the Study

Generally, the purpose of the study is to investigate the factors influencing attitude of women of childbearing age toward family planning in Calabar municipality, the study specifically investigated:

  1. Deposition of women of childbearing age toward family planning in Calabar metropolis.
  2. The influence of socio-economic status on the attitude of women toward family planning.
  3. Whether religious affiliation influence attitude of women toward family planning.
  4. The influence of cultural norms on attitude of women towards family planning
  5. Whether educational status affects attitude of women of childbearing age toward family planning.

1.4 Research Question

The study provided answers to the following questions:

  1. What is the disposition of women of childbearing age toward family planning in Calabar metropolis?
  2. To what extent does socio-economic status influence attitude of women of childbearing age toward family planning?
  3. How does religious affiliation influence attitude of women of childbearing age toward family planning
  4. To what extent dose cultural norms influence attitude of women of child bearing age toward family planning.
  5. How does educational status affect attitude of women of childbearing age toward family planning in Calabar metropolis?

1.5 Research Hypotheses 

Based on the objective of the study, the following hypotheses were formulated to guide the study.

  1. Disposition of women of childbearing age toward family planning is significantly low in Calabar metropolis.
  2. Socio-economic status would not significantly influence attitude of women of childbearing age toward family planning.
  3. Religious affiliation would not have any significant influence the attitude of women of childbearing age toward family planning.
  4. There would be no significant influence of cultural norms on attitude of women of child bearing age toward family planning.
  5. Educational status of women, of child bearing age would not significantly influence their attitude toward family planning.
  6. Significance of study

The result of this study as envisaged will be of great assistance to women of child bearing age. Who are at the receiving end of consequences of using contraception or no utilization of available services?

This research work will also be of help to currently married women and their partners who have no knowledge about family planning.

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It will help them to equipped with skill on how to avoid unwanted pregnancy.

It may also give an insight on how they could make their choice on different family planning methods. In addition, it will foster their acceptance of family planning since both the modern and the traditional methods of family planning are provided.The study will create awareness and exposure on the need of child spacing and the number of children they can care for in terms of education among parents.

The study will also be significant to policy formulators and executors regarding the effective use of family planning.Finally, the research will be significant to reproductive health researchers as it may serve as a reference material.

    1.7. Delimitation of the study

This study investigated the factors influencing the disposition of women        toward family planning in Calabar metropolis. The study did not include their male counterparts. The study investigated selected variable such as: socio-economic status, religious affiliation, cultural norms and effect of educational status, besides the attitude of these women toward family planning.

    1.8. Limitation of the study

This study was limited by certain factors which limit the smooth conduct   of the study.These factors include:

Lack fund to carryout elaborate research work.

Uncooperative attitude willingness of some people to give responds consistently to the research instrument.

The time gap for the completion of this research was also short. The researcher had to work even at odd hours in order to completethe research on time

  1. 9 Definition of Terms

The following key terms have been defined for classification.

  1. Family planning: It is the decision made by a couple to bear the number of children they will be able to care for and to have them.
  2. Attitude: This refers to the behaviour of women toward family planning neither positive nor negative which influence their usage.
  3. Childbearing Age: This means the period women’s menstruation starts to the period of puberty to menopause.
  4. Knowledge: It refers to the degree of awareness and understanding of family planning and available family planning services.

                                                                     CHAPTER TWO

INTRODUCTION

This Chapter should be developed under the following sub titles:

  • Disposition of childbearing age toward family planning
  • socio-economic status and women’s attitude toward family planning
  • Religious affiliation and attitude of woman toward family planning
  • Cultural norms and attitude of women toward family planning
  • Effect of educational status on attitude of   women toward family
  • Summary of literature review

2.1 The Disposition of Childbearing Age toward Family Planning

Childbearing and contraceptive uses are among the most important reproductive health decision that many have to make (Gertner, 2009). Family decision and the attitude are most likely to meet these decisions based on accurate, relevant information, and are medically appropriate, that is, when they are informed choices (AUSC International, 1998).

Concepts of family planning

Family planning is the planning of when to have and use birth techniques to implement such plans. Other techniques commonly used include sexual education, prevention and management of sexually transmitted diseases, pre-conception counselling, management and infertility management (Olaitan, 2009). However, family planning is usually used as a synonym for the use of birth control. It is most adopted by couples who wish to limit the number of children they want to have and control the timing of pregnancy, also known as spacing of children (Olaitan, 2009).

Family planning may encompass sterilization, as well as pregnancy termination. It also includes raising a child with methods that require significant amount of resources namely:  time, social, financial and environmental. Family planning measures are designed to regulate the number and spacing of children within a family, largely to curb population growth and ensure each family has access to limited resources. The first attempt to offer family planning services began with private groups and often aroused strong opposition. Activists, such as Margaret Sanger in the U.S., Marie Stopes in England and Dhanvanthis Rama Rou in India, eventually succeeded in establishing clinics for family planning and health care. Today, many countries have established national policies and encouraged the use of public family services (The United Nations and World Health Organisation offer technical assistance, 2006).

The concept of informed choice in family planning can be applied to a wide range of sexual and reproductive health decisions. It focuses on whether to seek, to avoid pregnancy, whether to space and time one’s childbearing, whether to use contraception, what family methods to be used, and whether or when to continue or switch methods. The term family planning choice could also refer to the family decision making (Diaz et al., 1999).

The principles of informed attitude of women of childbearing age focus on the individual; however, it also influences a range of outside factors such as:  social-economic,cultural   norms, gender roles, social networks, religious and local beliefs. To a large extent, these community norms determine individual childbearing preferences and sexual and reproductive behaviour. It is usually thought that community and culture affect a person’s attitudes towards family planning, desire for sex of children, preferences about family size, family pressures to have children and whether or not family planning accords with customs and religious beliefs.

Community norms also reflect how much autonomy individuals have in making family planning decisions. The larger the differences in reproductive intentions within a community, the more likely that community norms support individual choices (Barnett and Stein, 2001).  Household and community influences can be so powerful that they can obscure the line between individual desires and community norms. For instance, in some culture, many women reject contraception because bearing and raising children is the path to respect and dignity in the society (International Planned Parenthood(Cherkaoui, 2000). In either country, most women use contraception because having small families is the norm (Mkangi, 2001; Lutz, 2003).

People are often unaware that such norms influence their choices. In other cases, they are particularly aware. For example, young people often decide not to seek family planning because they do not want their parents or other adults to know that they are sexually active, while many fear ridicule, disapproval and hostile attitude from service providers and others (Jejebhoy, 2004).

A person’s social environment usually has more influence on family planning decisions that influence the attributes of specific contraceptives. In Kenya, for example, when new clients were asked to give a single reason for their choice of a specific family planning method, most cited the attitudes of their spouse or their peers, or their religious value (Kim et al., 1998). In many countries, family planning programmes are part of the national economic and social development efforts. Efforts to foster equity in decision making and raise awareness about reproductive right of the family, community and society also promote informed choice of family planning (Jaconson, 2000). As a woman gain more autonomy, they are better able to claim their rights as individuals including the right to act and protect their own reproductive health.  People chose contraceptive methods that are commonly used in their community because they know that it is socially acceptable to do so, and they tend to know more about these methods (Rogers and Kincaid, 2004).

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Many women use the same family planning methods that others in their social network use (Godley, 2001). A 1998 study in urban Nigeria found that the more widely used method was the one that was popular in other cities and villages.  The entire community may be encouraged to one type of contraceptive based on the choices of early contraceptive users, rather than individual needs (Potter, 1999).

2.2     Socio-Economic status and women’s attitude toward family        planning

A myriad of different factors affect a person’s personal decisions about what types of family planning method, he should use: Attitude towards family planning. In Nigeria, men are recognised as the head of the family and they take most of the family decisions.

Effectiveness:  People who are not in a financial or emotional situation to have children might opt for the most effective type of family planning in order to avoid pregnancy. A couple or woman with a casual approach towards parenthood, such as not actively pursuing it, but not unwilling to take it on, might choose a less certain form of contraception, such as natural family planning.

Religion: Some religions, such as Catholicism, have restrictions on contraception based on the belief that it is God’s will to bring children into the world. According to Dixon-Muller (1999), religious believers or observers might choose to avoid certain methods of family planning, such as birth control pill, in an effort to live their lives according to the teachings of their religion.

Cost: Some forms of contraception, such as minor surgery (like vasectomy), carry a fairly significant amount of one’s time and is very cost as compared to other options, such as condom or the calendar cycle methods which are less expensive; hence, couples engage in them.

Health risk: For people with multiple sexual partners, the choice to use family planning devices helps them to keep healthy. For example, using condoms can reduce the chance of contracting sexually transmitted diseases.

Permanence: Some contraception choices, such as vasectomy, are usually permanent. So couples who do not  want  to have children at present, but would like to have one in the future, might want to choose a less – permanent option such as condoms or birth control pills.

Partner involvement: One has to consider the preferences of his or her partner when choosing a birth control option. For example, some men do not like to have sex using a condom. In that case, birth control pills might be a better choice for preventing an unwanted pregnancy, according to the National Institute of Health (Olaitan, 2009).

There are some contraceptive methods of family planning that are expensive, and some couples cannot afford to use or purchase them due to their financial situations in the society.  For instance, people in rural areas cannot afford to use the expensive contraceptive methods of family planning such as vasectomy, Intra-uterine devices (IUD) (which are small, flexible, plastic frame inserted in the vagina of women) and female sterilization method.

2.4 Cultural norms and attitude of women toward family planning  

This is the most important factor influencing the choice of family planning among couples. This includes: community norms, religious belief and gender role.

Community norms also prescribe how much autonomy an individual has in making family planning decisions. The larger the differences in reproductive intentions within a community, the more likely the community norms support individual choices.  Household and community influence can be so powerful that they can obscure the line between individual desires and community norms. For instance, in some culture, many women reject contraception because bearing and raising children is the path to respect and dignity in the society. People are often unaware that such community norms influence their choices. In other cases, they are particularly aware. For example, young people often decide not to seek for family planning because they do not want their parents or other adults to know that they are sexually active. Some couples in the community feel that bearing children is the major aim of their marriage, as tradition, customs and beliefs. In some northern part of Nigeria, especially the Islamic religion, they believe that bearing more children will indicate how wealthy they are, in which they tend to withdraw themselves from the use of family planning.

  • Effect of Educational status on attitude of women toward family

WHO studies have shown that women in many underdeveloped countries do not have enough knowledge about contraception. Hence, women in Tanzania know almost nothing about contraception and in Nigeria only 34% women have ever heard about contraception, while only 21% know about modern methods of contraception, the best known is a condom, then oral pills and an intra-uterus spiral. A study undertaken in central Serbia, Vojvodina and Kosovo has shown that 59% of women in central Serbia, 61% in Vojvodina and 44% in Kosovo were able to define contraception as the method for prevention of unwanted pregnancy. Different results were obtained in a study undertaken in the Municipality of Nis, where 62.9% of women aged 16-59 have not heard about contraception.

The higher the level of education, the higher the level of knowledge about contraception (WHO 2000). Gilliam and Hernandez (2007) in their study stated that providing effective contraceptive care to Latinas requires a better understanding of current contraceptive practices and barriers to successful contraceptive use. Women willing to use withdrawal: were more likely to believe it to be an effective method of contraception, to be married, and to communicate with their partners about sex; had less knowledge of contraception, and; were less likely to have used oral contraceptives. Demonstrates belief in efficacy of withdrawal, lack of knowledge of hormonal contraception and inexperience with hormonal contraception may be key factors related to willingness to use withdrawal among Latinas. Withdrawal may be a central method for many Latinas

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In Nigeria, between 1992 and 1993, a nationwide sensitization campaign was launched to assess the level of knowledge of family planning and how education, information and communication can facilitate the use of contraceptives. The campaign was based on evidence that family planning messages relayed through the mass mediaAcan influence contraceptive behaviour (Odimegwa, 1995). Consequently, tne results indicate that one quarter of new clients attending a family planning clinic identified a television campaign as their source of referral. Beyond Nigeria, a similar study was conducted in Philippines. For instance, studies by Westoff and Rodriquez, 1995 indicated that the use of mass media is capable of promoting sexual responsibility, thereby substantially increasing requests for contraceptive information among adolescents. They further added that other studies have shown that exposure to a mass media family planning campaign increases contraceptive use.

Radulovi, Sagric, Visnjic, Tasic, and Markovic (2006) stated that family planning is part of the entire demographic and population policy of each country and the planet as a whole. They studied to assess the influence of education level on the state of knowledge about contraception and family planning and the methods used for family planning. The study included 1,584 women, aged 15-49, living in the Municipality, 98 with primary education, 1,088 with secondary education, and 398 with a higher degree. Most of the interviewers with a higher degree gave the best definition of contraception.

Most of the interviewers reported that their source of information about contraception were newspapers and electronic media; the interviewees mostly choose a condom as the most efficient method of contraception.

One third of the women with primary education estimate their knowledge as unsatisfactory, which makes the highest percentage. The women with primary education use less protection from unwanted pregnancy than women with secondary and higher degree. The greatest number of women who choose traditional methods of contraception comes from the group of interviewees with primary education. The interviewees who use contraception mostly choose the method by themselves, without consulting a professional. The greatest number of interviewees with intentionally interrupted pregnancies has primary education.

Over the past decades, the Bangladesh family planning program has utilized a door to door community based distribution approach to provide contraceptives to clients in their homes (referred to here as domiciliary distribution). About 23,500 female field workers (family welfare assistants) in the government program and another 12,000 field workers within the family planning programs of the non-governmental Organizations, were employed to counsel, motivate and provide contraceptive services. They generally distributed oral contraceptive and condoms and in a number of places they also provided injectable contraceptives.

These field workers were supposed to visit once every two months all currently married women of reproductive age within their specified catchment areas( in general, 700-800 women per worker). They field workers were overseen by some 6,000 supervisors, 4,500 male supervisors (family planning inspection) within the government program and 1,500 supervisors (mostly female) in programs operated by non- governmental Organizations. The domiciliary distribution of family planning services has been widely recognised as a key factor in the success of the Bangladesh program ( Routh, Thwin and Banqui, 1997).

Kalipeni and Zulu (2005) in their study examined male-female differences in knowledge and attitudes towards traditional and modern methods of child spacing in Malawi in 1988. Their survey was based on the traditional methods of child spacing. The results show that most people in Malawi are knowledgeable about both traditional and modern methods of child spacing. Their survey revealed that more men than women report knowledge and practice of traditional methods. For modern methods, however, females are more knowledgeable than males of all the specific methods, with the exception of condoms.

The greater knowledge by women of female-based modern contraceptives appears to be a manifestation of the exclusion of males from the family planning programme. The level of knowledge on the practice of family planning methods do not translate into equivalent high rates of utilization for both modern and traditional methods of contraception. The study further demonstrates that, while women are involved in making decisions to use contraception, the proportion of men initiating such decisions is greater than that of women. In other words, women do not take independent decision on issues bordering the practice of family planning, particularly in the African continent. Traditionally, the major focus of condom-promotion strategies has been on increasing use outside marriage.

In another study by Maharaj and Cleland, 2004 to explore the extent and determinants of condom use within marital and cohabiting partnerships in KwaZulu-Natal, South Africa reveals that in focus-group discussions, in-depth interviews, and individual survey responses, knowledge of condoms was found to be high and was seen as an effective method of dual protection against the risk of pregnancy and disease. Consistent with numerous other studies, this study found widespread disapproval of condom use within marriage. Only 14 percent of men and 17 percent of women reported consistent or “occasional” condom use. Nevertheless, condom use is much higher among urban, more educated individuals than among their rural, less educated counterparts. Apart from education, perceived risk of HIV infection from the partner is the most powerful determinant of use within marital and cohabiting partnerships, particularly for women.

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