Asian Journal of Medical Sciences 2(4): 190-194, 2010
ISSN: 2040-8773
© M axwell Scientific Organization, 2010
Submitted Date: July 01, 2010
Accepted Date: July 31, 2010
Published Date: August 30, 2010
Barriers and Knowledge of Benefits Regarding Family Planning Methods Among
Women Attending Antenatal Clinics in a Southern Nigerian Community
1
O.A . Adeleye, 2 O.A . Akoria, 3 Z.O. Shuaib and 4 O.D. Ogholoh
1
Department of Community Health,
2
Departm ent of Medicine, U niversity of Benin T eaching H ospital, Benin C ity, Nigeria
3
Boston University School of Public Health, 715 Albany Street, Boston,
Massachusetts 02118, USA
4
Departm ent of Accident and Emergency,
University of Benin Teaching Hospital, Benin C ity, Nigeria
Abstract: This study was undertaken to elicit barriers and know ledge gaps regard ing the bene fits of fam ily
planning amo ng w ome n in Irrua, Edo State, Nigeria. Using a cross-sectional design, a structured qu estionnaire
was adm inistered to 180 consenting women attending an tenatal clinic sessions in a large hospital. The control
of family size, 72/180 (40.0%) and child spacing, 64/180 (35.6%) were the major benefits of family planning
stated. The most direct benefit to maternal health - absence of pregnancy complications - was the least
mentioned (5% ). A total of 18/180 (10.0% ) stated that family planning w as of no ben efit. No statistically
significant association was demonstrated between educational levels and the knowledge of family planning
benefits. Respondents aged 30 - 49 years were more likely than the younger ones to state child spacing as a
benefit of family planning methods [logistic regression: p = 0.004; OR = 2.61 (95% CI = 1.37 - 4.98)]. The
commo nest reasons for objecting to family planning were the fear of infertility, 28/114 (24.6%), incom plete
family size, 24/114 (21.1%), side effects of contraceptives, 19/114 (16.7%) and partners’ objection, 17/114
(14.9% ). This study d emon strates important knowled ge gaps with respect to family planning b enefits. T his
could reflect poor knowledge delivery or uptake on family planning. The findings suggest that women’s
knowledge and experiences regarding family planning are crucial to interventions on fertility control. O verall,
the study shows that the identified knowledge gaps and barriers reflect opportunities for holistic interventions
including needs-sensitive health education for males and females on family planning.
Key w ords: Barriers to family planning, benefits of family planning, child spacing, fear of sterility, health
education, Nige ria
INTRODUCTION
Contraceptive use is still low in many developing
countries, including N igeria, w here 2 3.7% of currently
married women had ever used one (NPC and ICF Macro,
2009). Over the past four decades, there have been
numerous publications on contraceptives and other family
planning methods. W hile culture, poverty and poor access
have been widely understood as militating against their
use (CD C, 20 00; Leke, 2000; USAID , 2008 ; NPC and
ICF Macro, 2009), studies presenting w omen ’s selfidentified barriers are relatively few . Much attention is
given to eliciting clients’ knowledge and utilisation gaps
regarding family planning methods, but specific attention
to eliciting their knowledge gaps regarding the benefits of
family plann ing is ofte n deficient. Yet, identifying
women’s self-reported b arriers an d ben efits is cen tral to
any intervention to promote their use especially in
developing countries (CDC, 2000; USAID, 2008).
Fortunately, available literature show s that carefully
conducted studies addressing these variables provide
impo rtant guides for intervention.
For example, a study conducted amon g the K anuris
in Nigeria revealed that few K anuri wo men u sed mo dern
methods of family planning, the barriers being objection
by their husbands, the fear of delayed return to fertility,
damage to the reproductive apparatus and the belief that
mode rn contraception was introduced to reduce M uslim
populations (Mairiga et al., 2010 ).
In another exam ple, the Suri pe ople o f Ethiopia
prevent and d elay pregnancies using natural family
planning methods. The desired benefit is that women
regain their strength following the injuries caused by
pregnancy and delivery, and that attention can be given to
the welfare of growing children. But these objectives are
often countered by lack of access to mode rn family
Corresponding Author: O.A. Adeleye, Department of Community Health, University of Benin Teaching Hospital, Benin City,
Nigeria
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Asian J. Med. Sci., 2(4): 190-194, 2010
Table 1: Age-educational level characteristics
Ag e in years
-----------------------------------------------------------Educational level
1 8-2 9 (% )
3 0-4 9 (% )
T ota l (% )
None and 1 0
9 (8.3)
11 (15.3)
20 (11.1)
2 0 and above
99 (91.7)
61 (84.7)
160 (88.9)
Total
108 (100.0)
72 (100.0)
180 (100.0)
planning methods and the desire fo r man y children w ithin
a sociodemographic context of threats to their tribal
survival (Eyayou et al., 2004 ).
In these exam ples, any approach to prom ote fam ily
planning use m ust take into consideration the specific
barriers and desired benefits identified in the
commu nities, rather than only preformed general lessons
on family planning. Indeed, in many hospitals in Nigeria,
a comm on practice is to deliver preformed general
messages on family planning methods to women
attending antenatal clinics with little bearing on locally
known and experienced barriers and bene fits. Thus, this
study aimed at eliciting w omen ’s self-reported barriers
and benefits of family planning methods. The findings
will be useful in planning and implementing need-focused
interventions and as a vital addition to the growing
literature in this specific aspect of safe motherhood and
reproductive health rese arch.
Data managem ent: Collected d ata w ere collated into
Stata/SE 10.0 for Window s (StataCorp, 20 07) wh ere
analy sis was also done. Data were presented in tables
along with the outputs of their analyses. Logistic
regression analyses were conducted starting with a
parsimonious model of associations with p<0.1 and using
backw ard selection. The level of sign ificance for all
analyses was a probability value of 0.05.
RESULTS
A total of 180 women participated in the study. Their
age-educational characteristics are sum marised in
Table 1. The older age group had a higher percentage of
lower levels of education.
The control of family size was stated by 72/180
(40.0%) respondents as a benefit of family planning, and
this was the mode. A total of 18/180 (10.0%) stated that
family plann ing w as of no benefit.
As shown in Table 2, there is no statistically
significant association between educational level and the
knowledge of family planning b enefits.
How ever, given the possibility of confounding arising
from the age-educational level distribution of the
participants, logistic regression analyses were conducted
(Table 3). The result showed that respondents aged 30-49
years were more likely than the younger ones to state
child spacing as a benefit of fam ily planning methods
[p = 0.004; OR = 2.61 (95 % C I = 1.37-4.98 )]. Personal
approval of family planning methods was found to be
directly associated with the knowledge of child spacing,
prevention of unwanted pregnancy and avoidance of
pregnancy complications as benefits of family planning.
It was, ho wev er, inversely associated with the perception
that family plann ing m ethod s we re not beneficial.
Respon dents of other religions were less likely than the
Catholics to state the absence of pregnancy complications
as a benefit of family planning methods [p = 0.040;
OR = 0.22 (95% CI = 1.37-4.98)]. Only 9/180 (5.0%) of
respo nde nts stated the absence of pregnancy
complications as a benefit of family planning.
A total of 74 /180 (41.1%) had, at some time in the
past, used a family planning method (data not show n). As
shown in Table 4, a total of 114/180 (63.3%) expressed
current objections to the use of family planning methods.
The commonest reasons for these objections were the fear
of infertility, 28/114 (24.6%), incomplete family size,
24/114 (21.1% ) and side effects of contraceptives, 19/114
(16.7% ).
METHODOLOGY
Study place and time: The study was conducted in Irrua,
Edo State, Southern Nigeria. Irrua is a semi-urban town
with poor infrastructural development and low incomeearning occupations such as petty trading. The study is a
part of periodic reproductive health surveys commenced
in 2006 and continuing in 2010.
Study population: The population consisted of women
attending antenatal clinics in Irrua Specialist Teaching
Hospital (ISTH ). Though a tertiary hospital, it offers first
line primary care services in different areas, including
reproductive health. It is a major health facility where
many wom en receive o rthodox an tenatal care services. In
Nigeria, group hea lth talks in antenatal clinics are the
major fora w here w ome n receive messag es on family
planning.
Study design: A cro ss-sectional descriptive design was
used. After computing a minimum sample size of 163, all
consecutive consenting women attending antenatal clinics
in the health facility were selected until the minimum
sample size was exceede d.
An interviewer-administered questionnaire was
initially designed and later used to collect respondents’
bioda ta and d ata relev ant to the study objectives. Openended, multiple-response questions w ere used to elicit
respondents’ knowledge of the benefits of family planning
methods and the reasons for their objections to the use of
family planning.
Ethical considerations: Permission to conduct the study
was given by the Departments of Community Health and
Obstetrics and G ynaeco logy, ISTH , Irrua. Voluntary
informed consent was individually obtained from
potential participants.
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Asian J. Med. Sci., 2(4): 190-194, 2010
Table 2: Distribution of the knowledge of benefits by educational level
B e ne fi ts kn o wn
Control of family size
Child spacing
Prevention of unplanned pregnancy
Absence of pregnancy complications
No ben efit
No idea
(Ab ility to m entio n at le ast on e be nefit)
Educational level
None and 1 0
2 0 and above
None and 1 0
2 0 and above
None and 1 0
2 0 and above
None and 1 0
2 0 and above
None and 1 0
2 0 and above
None and 1 0
2 0 and above
None and 1 0
2 0 and above
Frequ ency (% )[N= 180 (100 .0% )]
------------------------------------------------Stated
Not stated
6 (30.0)
14 (70.0)
66 (41.3)
94 (59.7)
5 (25.0)
15 (75.0)
59 (36.9)
101 (63.1)
4 (20.0)
16 (80.0)
57 (35.6)
103 (64.4)
1 (5.0)
19 (95.0)
8 (5.0)
152 (95.0)
4 (20.0)
16 (80.0)
14 (8.7)
146 (91.3)
2 (10.0)
18 (90.0)
8 (5.0)
152 (95.0)
14 (70.0)
6 (30.0)
138 (86.3)
22 (13.7)
p-value
0.33
0.30
0.16
1.00*
0.12*
0.31*
0.09*
*: From F isher’s exact probability test
Table 3: Logistic regression analyses: predictors of knowledge of benefits of family planning
Child spacing
Age
18 – 29
30 – 49
Personal approval of family planning
Prevention of unwa nted pregnancy
Personal approval of family planning
Absence of pregnancy complications
Religion
Ca tholic
Others
No ben efit
Personal approval of family planning
p-value
0.004
OR
2.61
95% CI of OR
-----------------------------------------------Lower
Upper
1.37
4.98
0.005
4.37
1.58
OR
3.09
95% CI of OR
-----------------------------------------------Lower
Upper
1.21
7.90
p-value
OR
95% CI of OR
-----------------------------------------------Lower
Upper
0.040
0.22
0.05
OR
0.04
95% CI of OR
------------------------------------------------Lower
Upper
0.01
0.15
p-value
0.019
p-value
0.000
Table 4: Reasons for objecting to family planning methods
Barriers
Frequ ency (% )*
Fea r of ste rility
28 (24.6)
Incomplete family size
24 (21.1)
Th ey h ave side e ffects
19 (16.7)
Partn er is ag ainst it
17 (14.9)
Exp erienced previo us co ntracep tive failure
7 (6.1)
Against my religion
5 (4.4)
As soc iated with pro misc uity
3 (2.6)
Th ey ar e co stly
1 (0.9)
Reason unspecified
19 (16.7)
*: The responses were obtained from 114 respondents and multiple
responses were allowed
12.09
0.93
society in transition - the younger having higher levels of
formal education than the older. The relatively higher
percentage of respondents with lower educational level
among the older ones did not, however, confer
significa ntly lower knowledge of the benefits o f family
plann ing. Rather, the older age group had better
knowledge of child spacing as a benefit of fam ily
planning. Age-related reproductive health experience may
explain this difference. The importance of personal
approval of family planning as a predictor of knowledge
of their benefits is not straightforward because the
temporal relationship between the variables is uncertain.
But, it may suggest a mutually reinforcing association the knowledge of benefits leading to approval and vice
versa.
The top three kno wn family plann ing be nefits in this
study - control of family size, child spacing and
DISCUSSION
The study demonstrates key issues in respect of
barriers and knowledge of ben efits rega rding family
planning among women who seek antenatal care in a
healthcare facility. The dem ographic pattern shows a
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Asian J. Med. Sci., 2(4): 190-194, 2010
prevention of unplanned pregnancy – were the top three
in a similar study in Calabar, Nigeria (Etuk and Ekanem,
2003). One possible explanation is that these benefits
readily come to mind, especially given the semantics of
the term ”family plan ning” and the direct effects of the
methods. It may also reflect the emphasis placed on these
benefits during health talk sessions at antenatal clinics.
Even then, it is worrisom e that there are important
knowledge gaps with respect to family planning benefits,
with less than half mentioning any of the bene fits. This
may reflect poor knowledge uptake on the subject or
lassitude towards family planning.
It is rema rkable that the most direct be nefit to
maternal health - absence of pregnancy complications –
was the least mentioned (only 5% of the respondents).
This is despite the fact that benefits to women and
children (e.g., the reduction in maternal and child
morbidity and mortality) are major reasons for promoting
the use of mo dern family planning methods (Jokhio et al.,
2005; Royce, 2006; Singh et al., 2009). It is possible that
women in this population hold the wellbeing of the family
and the child above theirs. This relative self-undervaluing
or altruism may hav e cultural roots, especially w ith
respect to the status of women. Indeed, Eguavoen et al.
(2007) and Bankole et al. (2009) have opined that
wom en’s achievement of social status and dign ity are
important factors in improving maternal health.
The World Health Organization (WHO, 2009) has
emphasized lack of access to effective family planning
interventions as a m ajor limitation to the utilization of
family planning methods. Th e perspectives of respondents
in this study suggest that kno wledge of com mun ity
perceptions and experiences about the effec ts of fam ily
planning is crucial to interve ntions on fertility control.
This is particularly important since almost half of the
responses were on concerns regarding preservation of
fertility and achieving d esired family sizes.
The non-involvement of men in family planning
interventions has been highlighted as a drawback to the
success of the interventions (WH O, 2009). Non-consent
of partners to family planning methods ranked next to
fertility concerns as barriers to family planning use in this
study. If one considers that concerns about the effect of
family planning on fertility may also have been hinged on
inform ation originating from partners of resp ondents in
this study, the importance of partners’ dispositions
towards family planning interventions would be further
appreciated. This finding underscores the importance of
mainstreaming males, married or not, in public health
interventions to improve the uptake of family planning
interventions. The importance of educating males on
reproductive health issues, starting as early as possible in
their formative years, has been highlighted (Adeleye and
Oko nkw o, 2010).
The respondents w ho ex pressed no reason for their
objection to family planning represent a unique group.
Firstly, they m ay rep resent a group of the population of
women who ‘for no reason’ are biased against family
planning. Secondly, they may represent women who hold
strong views against family planning methods which they
are unwilling to share for fear of being ridiculed,
misunderstood or misrepresented. Thus, they may
represent women in the proverbial ‘valley of decision’
who, with access to the right interventions, m ay bu y-in
and becom e advoc ates for the use of effective family
planning interventions.
The interplay between barriers and the knowledge of
the benefits of family planning is therefore central to the
understanding of family planning needs of women and
families.
CONCLUSION
Overall, the study shows that important knowledge
gaps exist with respect to family planning benefits and
that these, along with the identified barriers, reflect
opportunities for holistic interven tions tha t will touch on
male educ ation on fam ily planning, men-women relative
statuses and religion. The findings also highlight the fact
that interventions to improve the uptake of family
planning methods which do not exp licitly address barriers
and knowledge of benefits are not likely to be successful.
In this rega rd, there is the need to identify group-specific
characteristics including experiences and perceptions
regarding family plann ing prio r to undertaking
interventions to improve utilization so that such
interventions address real needs rather than being m erely
generic. A brief framework tha t may be useful in
developing health communication messages aimed at
addressing these n eeds is presented in Appendix A .
ACKNOWLEDGMENT
The authors acknowledge the women who
participated in this study for the time and effort they
sacrificed.
A p p en d ix A :
Benefit-barrier-sensitive fram ew ork for d eve lopin g h ealt h
communication messages on family planning:
Wh en women’s perceived and exp erien ced ben efits o f and barrie rs to
fam ily planning are known, this knowledge can be chann elled to
promote family planning use by using the following as a guide:
C
Diagnostic stage: Elicit, as applicable,
B
experienced, perceived and other known bene fits of f amily
planning
B
the reasons for objections to family planning methods and
challenges experienced with the use of family planning
methods
C
Th erap eutic stage : Alig n fam ily pla nnin g m essa ges with
audiences’ real n eed s an d pr om ote family planning by discussing:
B
unstated b en ef it s o f f am il y p la nn in g , i nc lu d in g ho w they
cou ld be directly beneficial to them (e.g. reduction of
maternal and child death)
B
solution s to ov ercom e the ba rriers
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Leke, R.J.I., 20 08. Family planning in Africa south of the
Sahara. Foundation for Medical Education and
Research, Geneva. Retrieved from: http://www.
gfmer.ch/Books/ Reproductive_health. (Accessed
date: June 01, 2010).
Mairiga, A.G ., A.A . Kullima, B. Bako and M.A. Kolo,
2010. Sociocu ltural factors in fluencin g
decisionmaking related to fertility amon g the Kanuri
tribe of north -eastern N igeria. Afr. J. Prm. Hea lth
Care Fam. M ed., 2(1).
National Population Commission (NPC) [Nigeria] and
ICF Macro, 2009. Nige ria De mog raphic and Health
Survey 2008. National Population Commission and
ICF Macro, A buja, N igeria.
Royce, R.A., 2006. Birth spacing - the long and short of
it. JAM A, 295: 1837-1838.
Singh, S., J.E. Darroch , L.S. Ashford and M . Vlassoff,
2009. Adding it up: the C osts an d Benefits of
Investing in Family Planning and Maternal and
New born Health. Guttmacher Institute and UNFPA,
New York. R etrieved from: http://ww w.guttm acher.
org/pubs/AddingItUp2009.pdf. (Accessed date: June
30, 2010 ).
StataCorp, L.P., 2007. Stata/SE 10.0 for Windows. 15stude nt Edn ., Perpe tual license: Clement
Adebamow o, Serial No.: 81910516846.
United States Agency for International Development
(USA ID), 2008. Increasing Access to Family
Planning Among Indigenous Groups in Guatemala.
USAID, Washington DC.
WHO, 2009. Why Africa Must Reposition Family
Plann ing. R etrieved from : http://ww w.afro.who.int/
en/media-centre/pressreleases/582-why-africa-mustreposition-fam ily-plann ing.htm l. (Accessed date:
June 29 , 2010).
REFERENCES
Adeleye, O.A . and C .A. O konkwo, 201 0. Ideal child
ender preference in men’s worldview and their
knowledge of related maternal mortality indices in
Ekiado lor, southern N igeria. Asian J. M ed. Sci., 2(3):
146-151.
Bankole, A., G. Sedgh, F. Okonofua, C. Imarhiagbe,
R. Hussain and D. W ulf, 2009. Ba rriers to Safe
Motherhood in Nigeria. Guttmacher Institute, New
York.
Centers for Disease Control and Prevention (CDC ), 2000.
Fam ily Planning Methods and Practice: Africa. 2nd
Edn ., United States Department of Health and
Human Services, CDC , National Center for Ch ronic
Disease Prevention and Health Promotion, Division
of Reproductive Health, Atlanta, Georgia.
Eguavoen, A.N.T., S.O. Odiagbe and G.I. Obetoh, 2007.
The status of women, sex preference, decisionmaking
and fertility control in Ekpoma community of
Nigeria. J. Soc. Sci., 15(1): 43-49.
Etuk, S.J. and D. Ekanem, 2003. Knowledge, attitude and
practice of family planning a mon gst w ome n with
unplanned pregnancy in Calabar - Nigeria. Nig. J.
Physiol. Sci., 18(1-2): 65-71.
Eyayou, Y., Y. Berhane and L. Zerihun, 2004.
Sociocultural factors in decisions related to fertility
in remotely located communities: the case of the Suri
ethnic group. Ethiop. J. Health D ev., 18(3): 171-174.
Jokhio, A.H., H.R. Winter and K.K. Cheng, 2005. An
intervention involving traditional birth attendants and
perinatal and m aternal mortality in Pakistan. N. Engl.
J. Med., 352: 2091.
194