ACCESS AND UTILIZATION OF FAMILY PLANNING AMONG RURAL WOMEN

ACCESS AND UTILIZATION OF FAMILY PLANNING AMONG RURAL WOMEN JAMILU MUSA KANO STATE POLYTECHNIC ABSTRACT Family Planning has been described as the organized efforts to assure couples who want to limit their family size and space their children have access to contraceptive information and services and are encouraged to use them as needed. The paper intends to find out the information source about family planning, whether the women have ever discuss family planning with their husbands and the influence of the husbands on the women s access and use of the services. 200 women were studied in Rano local government area of Kano state, Northern Nigeria. The paper discovered that there are information sources in the area and that majority of the women have discussed and sought for family planning, but access were denied by some husbands and a good number of women today access the services secretly. This is a complete departure from the previous practices and is largely due to socio-economic factors. It was recommended that the National Campaign Programme towards family planning awareness and utilization as envisaged by the National Policy on Population for Sustainable Development should be implemented to its logical conclusion, to ensure wider information for potential users and husbands should be encouraged to permit and sponsor their wives to access and utilize family planning methods. This should be done under proper guidance with a view to promote reproductive health, infant and maternal survival. Key terms: Access, Utilization, Husband s permission, Family Planning methods, Source of information. INTRODUCTION Over the years, advances in medical technology have made it possible for women to plan their childbearing. Family planning has been described as the conscious and voluntary efforts of individual or couples to regulate their family size by way of spacing or limiting births through modern methods of contraceptives. The practice of family planning permits sexual intercourse between couples with little or no risk of conception and birth. The programme assures couples the access to contraceptive information, guidance and services especially as they seek to limit or space child bearing. It suggests the use of methods and devices to delay or prevent pregnancy due to one reason or the other and help women enhance their reproductive health. Family planning, therefore, is a means that enable women of reproductive age utilize the available services to improve their reproductive health and control their birth by delaying or preventing pregnancy. The services may be utilized by women wishing to plan their childbearing for several reasons. The desire to have smaller family size and birth spacing, enhance maternal health, fear of health complication, educational need, and age at marriage are some of the 1

common reasons for family planning across the world depending on the region (PRB, 1994; Barbara, 1997, Ashford, 2008). It is not easy to make conclusion as to the best method for family planning. But generally, it is considered that, all the methods can work effectively under guidance though there are problems of side effects as well. Most methods have a low rate of failure if used correctly and consistently, and are completely safe for the majority of users. Having choices and balanced information increases the likelihood that women and couples will choose a method and use it effectively. However, the methods vary according to their effectiveness, convenience, cost, side effects, risk, and benefits for the individual user. Users of the methods are best able to evaluate the relative importance of each of these factors based on their childbearing goals, health status, and living conditions (Ashford, 2008). Rano local government area being a predominantly rural Muslim community in northern Nigeria provides limited and differential access to family planning services among its women. Some of the factors may be related to the patriarchal nature of the community, where men provide the means of livelihood and therefore dominate major decisions especially those affecting reproduction. Like other rural communities in Nigeria, the area is characterized by concentration of schools, general hospital and roads in the main town making the majority of people disadvantaged in term of access and utilization of essential services. The majority of people in the area rely on seasonal agriculture as a means of livelihood. The low level income of people may limit the access of women to family planning services especially the modern type. Available data in Nigeria have shown that awareness of 1. To identify the source of information and its influence family planning methods is not sufficient to ensure the desired contraceptive prevalence. This research intends to study the factors associated with access to and utilization of family planning methods among rural women in Rano Local Government Area, Northern Nigeria. Statement of Problem In most surveys in Nigeria, findings indicate very high levels of desired fertility. According to the results of 2008 NDHS, the total fertility rate for Nigeria is 5.7. As expected, the TFR for rural women is significantly higher than that of urban women. On average, rural women will give birth to one and half more child during their reproductive years than urban women (6.3 and 4.7, respectively). This scenario can be detrimental to meaningful socio-economic development. For example, since effective family planning programme reduce fertility, they can help to relieve the pressures that rapidly growing populations place on economic, social, and natural resources. Population Action International (1993: 23) stressed that rapid population growth impedes economic growth and makes it more difficult to achieve improvements in education, environmental quality, and health. World Bank (1990: 8) reports that economic growth in Sub-Saharan Africa has lagged behind population growth. Millennium Development Goals (MDGs) recognized that transition from higher fertility and rapid population growth to lower fertility and slower population growth are the key factors toward increased economic growth and development. Aim and Objectives of the Research The general aim of the research is to study the extent of access to and the use of family planning services among rural women in Rano local Government area. The research has the following specific objectives: on the use of family planning among women in Rano local Government area; 2

2. To find out whether women have ever discuss the issue of family planning with their husband 3. To identify the role of the husbands towards women s access to and use of family planning methods. Methodology Married women of reproductive age (ages 15-49 years) in Rano Local Government Area constitute the target population of this research. Data collected from the medical personnel are meant to complement the data from the women. The sampling frame consists of the localities and names of the areas drawn from the Local Government Area comprising of the ten wards. The respondents of this study were drawn from the wards. The wards were alphabetically arranged from which five were selected systematically. At the second stage, the quarters of the selected wards (clusters) were also arranged alphabetically from which a sample of five were systematically selected from each. At third stage, a sample of eight respondents was selected from each selected quarter through the household, making 40 respondents from each ward and a total of 200 altogether. All the 200 respondents were married women. Literature Review Family Planning has been described as the organized efforts to assure couples who want to limit their family size and space their children have access to contraceptive information and services and are encouraged to use them as needed (Simmons 1986: 175). Family planning may be utilized by individuals or couples wishing to plan their childbearing for several reasons, which may include the desire to have smaller family size and birth spacing, health status of the mother, fear of health complication, educational need of the family, and age at first marriage. (PRB, 1994; Barbara, 1997, Ashford, 2008). In Nigeria, the number of people in need of health, education, economic and other services is large and increasing, which, in turn, means that the amount of resources, personnel, and infrastructure required to meet MDGs is also increasing (USAID, 2008). Also, high rates of population growth are largely the result of frequent childbearing or high fertility- often corresponding with a large unmet need for family planning. (p16) Complimenting this view, World Health Organization (1993: 6) revealed that: In recent decades, there have been tremendous advances in the development of safer and more effective contraceptives, and in the provision of affordable and accessible family planning services. Yet, still millions of individuals and couples around the world are unable to plan their families as they wish. It is estimated that over 120 million couples do not use contraceptives, despite wanting to space or limit their childbearing. It is also claimed that the development of family planning methods has made it easier and safer for women to avoid unintended pregnancies. According to Bongaarts (1995) tremendous progress has been made in the area of family planning services since the 1960s. Prior to the 1960s, it was limited to withdrawal and other ineffective traditional methods. The expansion of family planning services has been controversial in some countries. And there have been a number of obstacles to their use. Many women report that they fear adverse health effects from specific methods. Others want to practice family planning but are dissuaded by their husband s disapproval, their limited decision making powers, or family pressures to have more children (Miller et al., 1999: 13). Yet some demographers credit family planning programs with40% to 50% of the fertility decline in less 3

developed countries since the 1960s (Bongaarts, 1995: 23). Ashford (2008:1) submits that: The ability to decide freely and responsibly the number and spacing of one s children is recognized internationally as a human right. There is no best method of family planning, because women and couples may prefer different methods, and may change their preference over time according to their individual circumstances. Hence informed decision over family planning methods is encouraged. Potential users must know the methods, their cost, benefit and side effects. Yet family planning as a human right should be seen from the context of socio-cultural arrangements of people and societal ability to organize resources and services for realization of individual potentialities. In many parts of the world, women do not have the decision making power, physical mobility, or access to material resources to seek family planning services. Women s use of contraceptives is often strongly influenced by spousal or familial support of, or opposition to, family planning. Recent research in northern Ghana found that women who choose to practice contraception risked social ostracism or familial conflict (Adongo et al., 1997: 789-804). In some areas, women need their husband s permission to visit a health facility or to travel unaccompanied, which may result in limited use of contraceptives. The lack of good transportation and communication networks in the rural areas of less developed countries limits access to health care, schools and jobs. Women from low income household also have less access to family planning and other health services that might allow them to have fewer and healthier children (Gelbert et al, 1999: 27). PRB (2008) reports that: Modern contraceptive use has risen steadily over time in most of the developing world. In some countries in sub-saharan Africa, however, the adoption of family planning has been slow (such as in Senegal) or it has leveled off in recent years (such as in Kenya). With this differential utilization of family planning methods, it is certain that some socioeconomic factors are working to facilitate or hinder the acceptance of family planning methods. This however makes some countries more accommodative than others. The course of present and future fertility will be largely influenced by what people know, think and do regarding family size and family planning. Awareness, access and use of family planning in particular are essential especially when cultural practices permit. Among the major Nigerian ethnic groups, men dominate familial and social relations, including production and reproduction. The husband according to Abanihe, (1994: 150) whose obligation generally is to his descendants and ancestry, decides and dictates most things and his wife is expected to abide by his spoken decisions or perceived wishes. He further stressed that a wife is expected to bear many children as her contribution to the continuity and viability of her husband s line. Discussions between spouses on sexual matters, family planning or number of children are still rare in Nigeria, especially in rural areas and among the Muslim population. Socio-cultural norms and religious beliefs influence people reproductive health choice. In a study in Pakistan, researchers found that 76% of husbands and 66% of wives feared that God would become angry if they practice family planning (Population Council, 1997:61). Family Planning method may challenge biocultural beliefs. For example, women in some societies believe it is healthy to menstruate monthly, and therefore refuse to use injectable contraceptives that 4

often result in irregular bleeding, spotting, or amenorrhea (no monthly bleeding) (Makundi, 2001: 17). Fear, rumour, and myths about family planning methods can prevent women from seeking services. In one survey in Indonesia, clients believed that they could only get the truth about side effects from friends or relatives (Adongo et al, 1997). Rumours and myths about family planning may raise potential client concern about the side effects, safety, and effectiveness of different methods. In Kenya, one study participant said that using oral contraceptive can cause blood to flow out of the nose and mouth, and can cause delivery of children with two heads or no skin (Rutenberg and Watkins, 1997 as cited in Population Reference Bureau, 2002: 2). DATA PRESENTATION AND ANALYSIS Table 1: Age Distribution of Respondents Cumulative Age Frequency Percent Percent 15-19 11 5.5 5.5 20-24 14 7.0 12.5 25-29 63 31.5 44.0 30-34 51 25.5 69.5 35-39 32 16.0 85.5 40-44 16 8.0 93.5 45-49 13 6.5 100.0 Total 200 100.0 Table 2: Number of Children of the Respondents Number of Children Frequency Percent None 18 9.0 9.0 1-3 86 43.0 52.0 4-6 70 35.0 87.0 7-9 18 9.0 96.0 10 and above 8 4.0 100.0 Total 200 100.0 Cumulative Percent Table 3: Highest Level of Formal Education Attained by the Respondents Level of Cumulative Education Frequency Percent No Education Adult literacy Primary incomplete Primary complete Secondary incomplete Secondary complete Percent 36 18.0 18.0 29 14.5 32.5 44 22.0 54.5 21 10.5 65.0 3 1.5 66.5 34 17.0 83.5 Tertiary 33 16.5 100.0 Total 200 100 The tables above present the demographic data of the respondents. Most women fall within the ages of 25 39 with majority have 1 6 children. Only 33.5% have education from secondary level and above. It can be deduce that majority of the women are at the peak of reproductive age with high number of children and low level of formal education. 5

About information on family planning, only 165 women know about it while 35 have no idea. Out of the 165, 122 admit that they have family planning facilities in their localities ranging from Government centres, private chemists and traditional family planning providers. Table 4: Sources of Information about Family Planning From the media 81 49.1 From a friend/colleague 30 18.2 From the hospital 26 15.8 From my husband 22 13.3 From school 6 3.6 Total 165 100.0 Table 5: Type of Family Planning Methods Learnt From the Source. Modern 65 39.4 Traditional 37 22.4 Combination of the two 63 38.2 Total 165 100.0 Tables above indicate the source of the respondents information of family planning methods. It seems there are multiple sources but media play an important role. Because of the multiple sources, the respondents learnt both traditional and modern methods. The traditional method became the only option especially for respondents that have no modern facilities in their localities. Table 6: Whether the Respondents have ever Discuss family planning with their husband Yes 134 81.2 No 31 18.8 Total 165 100.0 Table 7: Whether the Respondents ever permitted by their Husbands to Access and Use Family Planning Services Yes 93 56.4 No 72 43.6 Total 165 100.0 Table 8: How the Positions of Husbands Affect the Respondents By giving me the courage to access and use family 93 56.4 planning By denying me total access to the 33 20.0 services Denying access to me but later find my 39 23.6 way secretly Total 165 100.0 From the above tables about 134 respondents have ever discussed family planning with their husbands while 31 did no. Out of the number only 93 were permitted by their husbands to use family planning methods. 6

One important issue that draw the attention is the fact 1. There is a wide range of information sources about that 39 of the women using family planning have no permission but secretly access and use family planning methods. A female respondent aged 27 was quoted verbally saying: We secretly practice family planning here; marriage life in the village is difficult. The best they (husbands) can do is to give you guinea corn for the dinner; the left 2. Despite the spread of family planning centers in Rano over dumame is your break fast. They don t care about the lunch, you are to source for your children. Look at our body; as if we don t have blood, when we look old, they marry another wife. Another female respondent aged 31 says: What our husbands need are the children that can work for them in the farm, but when you are pregnant they don t care about you. For example, about going to 3. Majority of the respondents have discussed family hospital, about what you need in your body etc. when you deliver, they don t care about you and the baby in terms of clothing, naming ceremony, and other necessary things. After the naming ceremony, you are to use what you get from your relatives and friends to feed the house for forty days. This is what they called albarkar suna (Dividend of naming ceremony). The above findings and comments indicate that socioeconomic conditions in the rural area are the push factor motivating the women towards the use of family 4. Not all women that are using family planning methods planning. It is therefore visible that poverty is a factor and the number of women accessing family planning methods will keep increasing. Major Findings Family planning methods (modern or traditional) are used by about two-third of the respondents in Rano Local Government Area for the purpose of birth spacing with pills and injection as the most commonly modern methods used. other findings of this research are: family planning methods (modern and traditional) in Rano Local Government Area; however, media (especially radio), friends and hospitals are the major sources of family planning information in the Area. These sources and the information acquired, to a large extent influenced the women s access to and utilization of family planning methods.. Local Government Area which make the services closer to most respondents, some of them complaint of distance on ground of their location, non-availability of family planning centre, high transport fare due to poor road network and inadequate transportation. This compelled them to use traditional methods which are more accessible in their localities. planning with their husbands. This is a complete departure from the previous situation where women exercise fear over discussing family planning with their husbands. Previously, the women themselves reject the idea especially in polygamous family. These days, women access the services themselves. This can be attributed to socio-economic factors and increased awareness of family planning programme, although a lot need to be done on the part of the husbands. are permitted and sponsored by their husbands. Some women used the methods secretly while others sponsored themselves. The research confirmed that all the women that are not using family planning methods have no permission from their husbands. Lack of husband s permission therefore, influences the women access to and eventual use of family planning. Not all women can secretly use family planning without the consent of their husbands. There is fear of divorce, social disapproval and stigmatization. 7

Recommendations Access to family planning methods is an important factor towards utilization of the methods in all societies. In view of these, this study recommends the following: 1. The National Campaign Programme towards family planning awareness and utilization as envisaged by the National Policy on Population for Sustainable Development should be implemented to its logical conclusion, to ensure wider information for potential users. 2. The use of media especially radio and television should be emphasized to sensitize people on the use and effectiveness of modern methods of family planning. A strategy should be evolved for a conference for Community Based Organizations, Youth leaders, traditional rulers, traditional service providers and religious groups with a view to discuss issues relating to health especially reproductive health and family planning so that a more proper understanding can be achieve and common stand developed. 3. The family planning centers located in the remote areas should be equipped with personnel and available drugs. It should also be made to have normal operation to avoid traveling to far distance by women in order to obtain prompt family planning services. 4. Husbands should be encouraged to sponsor and permit their wives to access and utilize family planning methods. This should be done under proper guidance with a view to promote reproductive health, infant and maternal survival. 5. Since education is a powerful factor towards positive attitude to health care system including family planning, Government should commit itself towards its Universal Basic Education scheme with a view to ensure access to basic education for all. This will facilitate faster understanding of health care issues, access and utilization. References Abanihe, U. C. (1994) Reproductive motivation and family size preference among Nigerian men Studies in Family Planning Vol. 25, No. 3 pp 149-161. Adongo, P. B. et al (1997) Cultural factors constraining the introduction of family planning among the Kassena-Nankana of northern Ghana Social Science and Medicine 45, no. 12 pp 1789-804. Ashford, L. (2008) Ensuring a wide range of family planning choices Washington D.C.: Population Reference Bureau Publication. Bangaarts, J. (1995) The role of family planning programmes in contemporary fertility transitions working paper No. 71, New York: The Population Council. Barbara, S. (1997) Family planning saves lives Third Edition, Washington D.C.: Population Reference Bureau Publication. Gelbard, A. et al (1999) World population beyond six billion, Washington D.C.: Population Reference Bureau Publication. Makundi, F.L.K.(2001) Quality care and accessibility of family planning services in Tanzania: Providers, client, and non-users perspectives, Washington, DC.: Population Association of America. Miller, E. R. et al (1999) Contraceptives safety: Rumours and realities, 2 nd edition, Washington D.C.: Population Reference Bureau Publication. National Population Commission (NPC) [Nigeria] and ICF Macro (2009) Nigeria Demographic and Health Survey, 2008. Abuja: National Population Commission and ICF Macro. Population Action International (PAI). Expanding 8

Access to Safe Abortion: Key Policy Issues (September 1993). Population Council (1997) Barriers to contraceptive use among Pakistan couples, Population Briefs 3, no. 3 p2 PRB (1994) Conveying concerns: Women write on reproductive health Washington D.C.: Population Reference Bureau Publication. PRB (2002) New perspectives on quality of care, no. 2 p2 Washington D.C.: Population Reference Bureau Publication. USAID (2008) Achieving the MDGs: The contribution of family planning Health policy initiative, USA: USAID publications. WHO (1993) Family planning World Health Organization Publication World Bank (1990) World Development Report 1990: Poverty New York: Oxford university press 9