FACTORS MITIGATING AGAINST FAMILY PLANNING AMONGST WOMEN IN RURAL COMMUNITIES A CASE STUDY OF OBIBE EZENA COMMUNITY, OWERRI, NORTH, IMO STATE

CHAPTER ONE

INTRODUCTION

1.1     Background to Study

Family planning is one of the most ―health-promoting‖ and cost-effective activities in public health promotion and has the potential to avert approximately 30% of maternal and 10% of child deaths.1 Thus, FP contributes to achieving the Millennium Development Goals (MDGs) through healthier birth spacing and by reducing mortality and morbidity associated with pregnancy.2 Decades of research and investment in family planning programmes have resulted in dramatically improved programme coverage and biomedical technologies as well as significant (although uneven) increases in contraceptive uptake throughout most of the developing world.3 Contraceptive options—not all of which are available in many developing countries—include a variety of hormonal regimens and modes of delivery for women (e.g., pills, injectables, implants, patches, vaginal rings, medicated intrauterine devices) as well as improved male and female condoms, spermicides, cervical caps and other vaginal barriers, post-coital (emergency) contraception, improved fertility awareness-based methods, and simpler and more effective surgical techniques for tubal ligations and vasectomies.

Nevertheless, Demographic and Health Surveys (DHS) reveal that in many countries- including some with quite high rates of contraceptive prevalence -40% or more of women who recently gave birth reported that the pregnancy was wanted later or not at all.5 Proportions of married women with an unmet need for contraception also range up to 30 to 40% or more in a number of countries.6 Both of these situations reflect, to variable degrees, programme- and method-related inadequacies, including contraceptive failures due to a variety of reasons, as well as personal and situational factors such as partner’s opposition or women’s experiences or fears of side-effects that need to be addressed.7 Contraceptive information, needs and motivations evolve through the life course as male and female adolescents become sexually active before marriage or cohabitation (perhaps with several partners) or at the time of their marriage, and as couples decide if and when to begin childbearing (if they have not already accidentally done so); accumulate experiences with contraception (or its absence) and with pregnancy and childbearing; think about spacing and stopping; and are potentially faced with 10 or 20 more reproductive years at risk. Some women and men will divorce, remarry and decide to have another child; others will bear children (wanted or unwanted) outside of marriage or be motivated to avoid it. The environmental and contextual scenarios are many; the individual trajectories even more diverse. The challenge for educational and health sectors is to meet these changing needs with comprehensive information about pregnancy risks, acceptable contraceptive options, and correct and consistent use. Interventions include countering beliefs in ineffective methods and overcoming unrealistic fears about contraceptive side-effects that adolescents may already have acquired.

A sustained service package adapted to the specific and changing needs of individuals and couples and linked with other sexual and reproductive health inputs must be offered.8 The evidence base is by now quite extensive on how to create more user-friendly family planning environments, enhance client-provider interactions and other aspects of quality of care, and involve men as well as women in the discussion of contraceptive choices with respect to ease of use and need for partner cooperation, possible effects on sexual expression (e.g., coitus-dependent or independent methods), safety, efficacy, side-effects, acceptability, accessibility and cost.

Guidelines have been established for counseling clients such as unmarried adolescents who need dual protection; couples wanting to use a natural method; couples wishing to postpone their first pregnancy or space subsequent pregnancies; women or men who want to use a method without their partners’ knowledge; postpartum and breastfeeding women; women receiving post-abortion care; women who have had unprotected intercourse (including rape victims); individuals or couples looking for long-acting reversible or permanent methods; and women approaching menopause. The evidence base has also expanded greatly with respect to the medical aspects of contraception for male and female users. Method-specific medical eligibility criteria have been established for women of all reproductive ages who have particular health problems, such as heavy smokers and those with chronic diseases receiving long-term drug treatments (e.g. antihypertensive agents, antiretroviral drugs). Ongoing investigations are assessing the protective and risk factors of particular methods with respect to certain diseases (e.g., breast, cervical or testicular cancers, cardiovascular disease, endometriosis).

FACTORS MITIGATING AGAINST FAMILY PLANNING AMONGST WOMEN IN RURAL COMMUNITIES A CASE STUDY OF OBIBE EZENA COMMUNITY, OWERRI, NORTH, IMO STATE