Contraceptive Acceptance Pattern and Trend in a Tertiary Hospital in

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1 Original Article Contraceptive Acceptance Pattern and Trend in a Tertiary Hospital in Nigeria Udealor PC*, Ezeome IV, Ugwu EO Department of Obstetrics &Gynaecology, Faculty of Medicial Sciences, College of Medicine, University of Nigeria Enugu Campus/University of Nigeria Teaching Hospital, Ituku-Ozala, Enugu state, Nigeria. Date Accepted: Date Received: Abstract Background: Nigeria has a very low contraceptive usage despite the high fertility rate. Studying the contraceptive acceptance pattern and the women s choices of contraception will provide information that could enable health care providers and stakeholders improve availability and access to contraception. Objective: To evaluate the pattern of contraceptive acceptance and trend in a Nigerian tertiary hospital. Methodology: A retrospective review of the records of the family planning clinic of University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu over a 4 year period, from Results: A total of 1319 out of 1372 new clients accepted different contraceptive methods within the period under review giving an acceptance rate of 96.1%. There was a sharp drop in the number of acceptors from 573 in 2006 to 187 in Thereafter, there was a gradual rise to 242 in 2008 and then 317 in The mean age was 34.7 ± 4.3 years while the modal parity was 3. The most commonly accepted method over the period was intrauterine contraceptive device (IUCD) 530 (40.2%), followed by the implants 432 (32.8%). Only 2 (0.2%) chose bilateral tubal ligation. Conclusion: The contraceptive acceptance rate among new family planning clients in UNTH Enugu is high. IUCD was the commonest contraceptive method accepted by the women, and there were fluctuations in clients attendance during the period under review. Women enlightenment and community mobilization are needed for stability in acceptance and utilization of family planning methods. Keywords: Contraceptive Methods; New Acceptors; Trends, Tertiary Hospital Introduction Nigeria has a very low contraceptive usage despite the high fertility rate. [1] Contraceptive use was 18.8% among women of child bearing age (15-49) in a study done in Nigeria [2] and an estimated million women in the developing world still need one form of contraception or another but cannot access them. [3] Family planning is regarded as an important preventive health measure in view of the association of high fertility with maternal and infant morbidity and mortality [4] especially in developing countries like Nigeria where infrastructural and logistic problems combine to make grand multiparty a high obstetric risk factor. Also, our women give birth to so many children putting them at risk of increased maternal morbidity and mortality. Factors significantly associated with utilization of contraceptives are availability of family planning services, parity, knowledge of contraception and need for Access this article online Quick Response Code: Website: DOI: child spacing. [5] The available contraception methods for females at the family planning clinic of UNTH, Ituku-Ozalla Enugu, Nigeria within the period under review included intrauterine contraceptive device (IUCD), injectable hormonal contraception, implants (which included norplant, jadelle and implanon), barrier methods like condoms- male and female, oral contraceptive pills and bilateral tubal ligation (BTL). These contraceptive methods are freely available in the hospital and are given to the women at highly subsidized and affordable prices. Address for correspondence: Dr. Peter C. Udealor Department of Obstetrics & Gynecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria Enugu Campus, Enugu state, Nigeria. peter.udealor@unn.edu.ng. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. How to cite this article: Udealor PC, Ezeome IV, Ugwu EO. Contraceptive Acceptance Pattern and Trend in a Tertiary Hospital in Nigeria. Int J Med Health Dev 2017; 22(2): XX 2017 International Journal of Medicine and Health Development 113

2 Studying the contraceptive acceptance pattern and the women s choices of contraception will provide information that could enable the health care providers and stakeholders improve on availability and access to contraception. The objective of this study is therefore to evaluate the contraceptive acceptance pattern and trend in the largest tertiary hospital in south eastern Nigeria. Materials and Methods The study was a retrospective review of the records of new clients that registered for contraceptive services at the family planning clinic of UNTH, Ituku-Ozalla, Enugu, Nigeria over a 4 year period, from 2006 to Permission was obtained from the medical records department of the hospital before the folders were retrieved, and ethical clearance obtained from the institutional review board of UNTH. The records of all new acceptors of family planning services were retrieved and reviewed. Relevant data were extracted therefrom. The data included the client s age, parity and contraceptive methods accepted. The data was analyzed using SPSS version 20. [12] Results A total of 1319 out of 1372 new clients accepted contraceptive methods within the study period giving an acceptance rate of 96.12%. The mean age of the clients was 34.7 ± 4.3 (range 17-44) yrs. The modal age range was 35-39yrs which constituted 29.2% of all new clients. All the clients were parous with a modal parity of 3. Fifty (3.8%) were primiparous, 480 (36.4%) were multiparous while 789 (59.8%) were grand-multiparous. The distribution of the contraceptive methods by the age and parity are shown in Tables 1 and 2 respectively. Table1. Distribution of Contraceptive Methods by Age Group of New Acceptors Age group Pill Injectables IUCD Implant BTL Total (%) (0.2%) (2.4%) (19.3%) (23.9%) (29.2%) (24.9%) Total (100%) % 6.3% 20.6% 40.2% 32.8% 0.2% 100% Table 2: Distribution of Contraceptive Methods by Parity of Clients Parity Oral pills Injectables IUCD Implant BTL Total(%) (3.8%) (36.4%) > (59.8%) Total (100%) Five hundred and seventy three (573) out of 593 of all the new clients accepted contraceptive method in 2006 giving an acceptance rate of 96.6%. There was a sharp drop to 187 out of 195 that presented in 2007, giving an acceptance rate of 95.9%. There was then a rise in the number in 2008 to 242 out of 254 with an acceptance rate of 95.3%, and a further rise in 2009 to 317 out of the 330 with an acceptance rate of 96.1%. The yearly distribution in variations in the number of new acceptors of contraceptive methods is as shown in Figure 1. The contraceptive methods accepted were oral pills 83 Int J Med Health Dev Volume 22 Issue 2 December

3 (6.3%), injectables 272 (20.6%), IUCD 530 (40.2%), implants 432 (32.8%), and BTL 2 (0.2%). Figure I Yearly distribution of new acceptors of contraceptive methods (573(43.4%) (187(14.2%) (242(18.3%) (317(24.1%) Int J Med Health Dev Volume 22 Issue 2 December

4 The grand multiparous women used mainly long lasting contraceptive methods like IUCD and implants while the primiparous women used mainly IUCD and injectables. The distribution of new acceptors by contraceptive methods is as shown in Figure 2. Figure II Distribution of new acceptors by contraceptive methods Oral Pill Injectables IUCD Implant BTL (83(6.3%) (272(20.6%) (530(40.2%) (432(32.8%) (2(0.2%) Int J Med Health Dev Volume 22 Issue 2 December

5 Discussion The contraceptive acceptance rate among new family planning clients in UNTH, Enugu was high but the number was poor. There were fluctuations in the acceptance of contraceptive methods by new clients within the study period. The sharp drop in 2007 was partly due to the relocation of the hospital from its old site which was in the heart of Enugu metropolis to the permanent site which happened to be located in a village, at the outskirt of Enugu metropolis and partly as a result of the availability of other facilities that offer family planning services in the heart of Enugu town. Less than one quarter (25%) of women of reproductive age use modern contraception in Nigeria despite the high level of awareness. [2,5] Cultural barriers, religion, cost, husband/partnśr s refusal and fear of side effects have been identified as factors contributing to low usage of family planning services in Nigeria. [6] There has been a gradual increase in the number and rate of acceptors after the initial sharp fall, though it has just gotten to a little above half of the number in the first year under study. This gradual rise may be related to the increasing awareness of the populace about the new location of the hospital and also possibly due to the increasing global access to information, communication and technology (ICT). Only five methods of contraception out of the many available methods were accepted by the new clients namely the oral contraceptive pills, the injectables, the IUCDs, implants, and BTL. The mostly used method of contraception by the new clients was IUCD followed by the implants and then the injectables. These methods are associated with very low failure rates. [7] The reason for the choice of IUCD and implants may be due to their long acting nature and the fact that they do not require repeated hospital visits. These findings are consistent with reports from other parts of Nigeria [8-10] except in Primary health centre Gindiri, Jos, Nigeria where the oral contraceptive use was most common. [4] The common use of IUCD as observed in this study is similar to reports from Ethiopia. [11-14] Women of all reproductive age group accepted contraceptive methods at the centre under study though age group was the predominant age group. In the study from Jos, North central Nigeria, years was the predominant age group. [4] Multiparous women constituted the majority (96.2%) of the new acceptors. No nullliparous woman accepted any form of the contraceptive methods as was observed in Jos, Nigeria. [4] Older women accepted contraceptive methods more readily than the younger women in this study and they preferred long lasting contraceptive methods like IUCD, injectables, implants and BTL. This finding may be related to the earlier observation that contraceptive behavior is affected by the availability of family planning services, parity, knowledge of contraception and need for child spacing. [2] Reversible contraceptive methods were used by the majority (99.8%) of the clients possibly because of the fear that there may be need for future pregnancy in the event of death of their children or remarriage to another spouse. Female condom which is available in the family planning clinic was not used by any of the clients. This may be due to inadequate information about its availability in the center or because of the associated higher failure rate when compared to other methods chosen by the women. The limitation of this study includes the fact that it was a single hospital study and as such limits generalization of the findings to the entire population. This study being retrospective in design is also limited to the extent to which records about the patients were previously collected and kept. In conclusion, the contraceptive acceptance rate among new family planning clients in UNTH, Enugu was high but the number was poor. There were fluctuations in clients attendance within the study period. Majority of the new acceptors used the long lasting contraceptive methods including IUCD and implants, and no nulliparous woman attended the clinic or received any contraceptive methods during the study period. We therefore recommend that women enlightenment and community mobilization are needed for stability in acceptance and utilization of family planning methods. The public enlightenment campaign should include that contraception is for all sexually active women of reproductive age and not limited to married and parous women. References 1. Onuh SO, Otoide VO, Umeora OUJ, Okogbenin SA, Igbaje A, Igberase GO. Knowledge, Attitude and practice of family planning methods amongst married women in rural Nigerian community. Tropical J Obstet Gynaecol 2004; 21(suppl):s3. 2. Umbelli T, Mukhtar A, Abusalab MA. Study of Unmet need for family planning in Dar As salam, Sudan. East Mediterr Health J 2005; 11(4): Ross JA, Winfrey WI. Unmet need for contraception in the developing world and the former Soviet Union: An updated estimate. Int FAM Plan Perspective2002;28(3): Mutihir JT, Dashala HL, Madaki JKA. Contraceptive pattern at a comprehensive health centre in a sub urban setting. Tropical J Obstet Gynaecol 2005;22(2): Orji EO, Onwudiegwu U. Prevalence and determinants of contraceptive practice in a defined Nigerian population. J Obstet Gynaecol 2002; 22(5): Oye Adeniran BA, Adewale TF, Umoh AV, Oladokun A, Gbadegesin A, Odeyemi KA et al. Sources of Contraceptive commodities for users in Int J Med Health Dev Volume 22 Issue 2 December

6 Nigeria. PLOS medicine 2005; 2(11) e 306: Newton J. Contraceptives: Regional perspectives, issues and unmet needs-the European perspectives. Int J Gynae Obstet 1998; suppl 1: Udigwe GO, Udigwe BI, Ikechebelu JI. Contraceptive practice in a teaching hospital in south east Nigeria. J Obstet Gynaecol 2002; 22(3): Ozumba BC, Ibekwe PC. Contraceptive use at the family planning clinic of university of Nigeria teaching hospital Enugu. Public health 2001; 115(1): OlatinwoAW, Anate M, Balogun OR, Alao MO. Intrauterine contraceptive device (IUCD): Sociodemographic characteristics of the acceptors, acceptability and effectiveness in a teaching hospital in Nigeria. Niger J Med 2001; 10(1): Central Statistical Agency of Ethiopia and ICF International. Ethiopia demographic and health survey Addis Ababa, Ethiopia and Calverton, Maryland, USA: UNAIDS; Takele A, Degu G, Yitayal M. Demand for long acting and permanent methods of contraceptives and factors for non-use among married women of Goba Town, Bale Zone, South East Ethiopia. J Reprod Health 2012; 9: Haile A. Demand for long acting and permanent methods of contraceptives and associated factors among the family planning service users in Batu town, Central Ethiopia. Ethiop Med J 2012; 50(1): Alemayehu M, Belachew T, Tilahun T. Factors associated with utilization of long acting and permanent contraceptive methods among married women of reproductive age in Mekelle town, Tigray Region, North Ethiopia. BMC Pregnancy Child Birth 2012; 12:6. Udealor et al.: Contraceptive acceptance pattern in Nigeria Int J Med Health Dev Volume 22 Issue 2 December