Attitude, myths and educational status of women affect women’s
intention to use long acting and permanent contraceptive methods in
Southern Ethiopia.
Mengistu Meskele1, Wubegzier Mekonnen2
ABSTRACT
Background: In Africa the utilization of long acting and permanent contraceptive methods (LAPMs) has not
kept step with that of short-acting methods, such as oral contraceptives and injectables. The utilization of
contraceptive methods in Ethiopia has also been dominated by short-term methods. The study aims at
assessing the association of short term user women’s awareness, attitude and barriers with their intention to use
LAPMs in Southern Ethiopia.
Methods: A cross-sectional study design, using both quantitative and qualitative methods, was conducted in
public health facilities of Wolaita zone, Southern Ethiopia in April, 2013. The sample size was 416. Data were
entered into EPI Info version 3.5.3 and analyzed by SPSS version 16.0. Binary logistic regression model with
crude and adjusted odds ratio along with their 95% confidence interval were used to measure degree and
significance of association.
Results: Only 156(38%) women had the intention to use LAPMs. More than half (n=216) had a negative
attitude to use these methods. Moreover, nearly two-third (n=276) had myths and misconceptions about such
methods. The women who had positive attitude were (AOR =2. 47: 95% CI (1.48, 4.11) times more likely to
desire LAPMs compared with a woman who had a negative attitude on these methods. Women who had no
myths and misconception on LAPMs were (AOR= 1.71: 95% CI (1.08, 2.72) times more likely to use LAPMs
compared with those who had myths and misconceptions. The odds of women’s intention to use LAPMs were
(AOR=2. 10: 95% CI (1.11, 3.98) and AOR=2.80: 95% CI (1.15, 6.77) times higher among women who
attained secondary and higher level of education compared with women with no education, respectively.
Conclusion and recommendations: Most of the women had low intention to use LAPMs. Similarly, more
than half of the participants had a negative attitude, myths & misconception on these methods. The
government should focus on empowering women and increasing their educational level. There must be great
emphasis on educating communities to change the attitude, myths and misconceptions on these methods.
Keywords: Long Acting and Permanent Methods, Intention, Attitude, Myths, Ethiopia
1
Background
More than 200 million women in the developing world want to avoid pregnancy but are not
using modern method of contraception [1]. The level of unintended births could be on average
27% less if the effective long acting and permanent methods (LAPMs) were in use [2].
Moreover, avoiding barriers to use contraceptives and enhancing the demand for family planning
could avert 54 million unintended pregnancies, more than 79,000 maternal deaths and one
million infant deaths each year [1]
In spite of their high effectiveness, the use of provider-dependent LAPMs of contraception
including intrauterine devices, hormonal implants, female sterilization, and vasectomy has
lagged behind [3]. These methods are between 3 and 60 times more effective than short acting
methods during a year of typical use. Access deters wider use of such methods in Africa [4].
Only 2.7 million women are currently using these methods in Sub-Saharan Africa [5]. Thus, the
use of LAPMs has not kept pace with short-acting contraceptive methods [6].
Ethiopia ranked the 12th and 2nd most populous country in the World and Africa respectively. The
total population of the country was 87.1million according to 2012 population and economic
development data sheet [7]. The total fertility rate was 4.8 in 2011; but modern contraceptive
prevalence rate (CPR) among married Ethiopian women was 27% [8].
The utilization of contraceptive methods was totally dominated by the use of short-term methods
such as pills and injectables in Ethiopia (8). The most widely used methods were injectables
(21%) followed by implants (3.4%), pills (2.1%), and female sterilization (0.5%), IUD (0.3%),
and male condom (0.2%). The prevalence of LAPMs was very low [8]. The discontinuation rate
of short term contraceptives was higher than that of LAPMs. The discontinuation rate for all
methods was 37%, the highest of which was observed for pills (70%), followed by male condom
(62 %). Thus, such discontinuation rate of short term contraceptive methods was inefficient and
expensive to family planning program and resulted in many unintended pregnancies
[5].Meanwhile, implants had a discontinuation rate of only 5% (8).
Wolaita Zone, one of thirteen zones in Southern Ethiopia, is one of the most densely populated
parts of the country with a crude population density of 374.8 persons per square Kilometers. The
highest and lowest population density was shown in Boloso Sore and Humbo Woreda; with 798
2
and 163 persons per square kilometer respectively indicating high population pressure, and
competition for natural resources. Thus, availing contraceptive methods particularly the most
effective ones such as LAPMs is very important [9]. Ethiopia aimed to shift the method mix of
contraceptives on LAPMs [10]
Absence of family planning method mix has been a challenge in Wolaita zone and the country at
large which called for a focus on long-term methods in the Health Sector Development Program
(HSDP IV) of Ethiopia [11]. Thus, this study will contribute to fill the information gap to scale
up family planning program with focus on the most effective methods of LAPMs.
Methodology
This study was conducted in Wolaita zone, in Southern Nations Nationalities and Peoples region
of (SNNPR) Ethiopia. Based on the most recent census (2007), the projected population of the
zone was 1,750, 079 on July, 2012.
Facility based cross-sectional study with quantitative and qualitative methods were used. The
study population for the quantitative method included short term family planning clients of
selected health centers in Wolaita zone. On the other hand, key informant in-depth interview was
administered on knowledgeable short term family planning users and service providers. The
study period was January 2013.
Six health centers (three from urban and another three from rural areas) was selected. The three
rural health centers were randomly selected while all of the three in urban Wolaita were included.
The total of 411 short term family planning user women was included in this study. Samples
were allocated to each health center based on sampling proportionate to size of family planning
clients. Short term family planning users who were visiting selected health centers during the
study period were interviewed until the allocated sample size to each facility was reached.
Structured questionnaire was developed in English by reviewing different literatures which was
then translated to the local language (Amharic) and back to English to check for consistency.
One client and a family planning service provider were interviewed from each selected health
center.
3
The quantitative data were entered and cleaned using in EPI Info version 3.5.3.which was then
exported to SPSS version 16 for analysis. Intention to use LAPMs has binary outcome.
Knowledge score was computed based on the ten knowledge questions; so that “Yes” is coded as
1 and “No” as 0. The score is calculated by adding values given to each of the ten questions.
Then, it was categorized as low, moderate and high knowledge. Likewise, attitude was recoded
to have three categories (disagree, indifferent, agree). To assess the association between the
outcome variable of interest and attitude, the composite variable was dichotomized using the
mean of ten attitude questions. Furthermore, bivariate and multivariate binary logistic regression
model with crude and adjusted odds ratio along with their 95% confidence interval were used to
see the independent associations of each factors with intention to use LAPMs of family planning.
In the qualitative study the data was audio taped, transcribed, translated and coded with Open
Code version 3.6 and inductive content analysis was applied. Ethical clearance was obtained
from the Research Ethics Committee of School of Public Health College of Health Science,
Addis Ababa University.
RESULTS
Out of 411 interviewed women 126 (30.9%) were from rural areas while the majority 285
(69.3%) were from urban areas. Households of 208 (50.6%) women had a family size of 1-4
persons while 203 (49.4%) of them had a family size of greater than or equal to five persons in
their families, with a mean household size of 4.9 ( +1.9 SD) and median household size of 4.
Two hundred two (49.14%) of the mothers were below the mean age (26.7 years) while 399
(97.1%) of them were married, more than half 254 (61.8%) were protestants and 128 (31.1%)
were orthodox Christians by religion. Almost a great majority 370 (90%) of women were
members of Wolaita Ethnicity groups. One hundred thirty five (32.8%) mothers did not attend
formal education (Table 1).
Almost half of women 208 (51.23%) were married between the ages of 12-17 years. The mean
and median age at first marriage were 17.6 (+ 2.47 SD) and 17 respectively.
4
Seventy four (18%) respondents experienced miscarriage, abortion, or stillbirth. Three fourth
(n=55) of women had one abortion in their lifetime; but the rest had two and more abortions.
Most women had joint decisions on the number of children they wanted to have 237 (57.7%);
while 38 (9.2%) and 136 (33.1%) of women reported that the decisions were made by their
husbands and themselves alone respectively (Table 1).
Only 116 (28.2%), 37(9%), 222(54%), 361(87.8%) women reported their awareness on female
sterilization, male sterilization, IUCD and implant respectively. Based on the composite
knowledge score, 165 (40.1%), 160 (38.9%) and 86 (20.9%) of women had low, moderate and
high knowledge scores respectively. The qualitative part of this study also showed that family
planning clients had low awareness on LAPMs. There were key informants who didn’t hear
IUCD & vasectomy. Among those who were aware on such methods, there was a belief that
considers living in rural areas as a hindrance to use such methods as it cannot go with the type of
workload which rural families had to undergo. Knowledge on IUD was poor. Fear to use female
sterilization and vasectomy were even rampant. Some clients said that though they did not have
enough knowledge on such methods; they also believed that health extension workers strived to
bring about change. The situation was explained by 32 years old married women as: “We got
health information from health extension workers. I am using Depo Provera. I used to 6-7 year
interval between every birth by using Depo Provera. I used implant sometimes ago but was not
comfortable. I heard about loop but I am living in a rural area and I have a work load which
deters me. So loop is not the best method for me. I heard about female sterilization too, but not
vasectomy. The reason for not using IUCD is because, I am not educated. Our community has no
knowledge on loop and vasectomy. I tried implants but it has side effects”. Providers also
mentioned lack of awareness on LAPMs in these communities. According to them women knew
implant & IUCD but not vasectomy and female sterilization.
Attitude and intention of women to Use LAPMs in Wolaita, Southern Ethiopia
More than half (n=216) of the women had negative attitudinal towards LAPMs. Women were
asked on their agreement on certain attitude questions. In this line, 283(68.9%) of them agreed
that using implants need proper diet; while a quarter of them (n=102) believed insertion and
removal of implants is highly painful. More than one-fifth (n=86) felt insertion of intrauterine
contraceptive device interfere with privacy. About 69 (16.8%) of women conceived that using
5
IUCD restrict normal daily activities. Similarly, one quarter 109 (26.5%) of women agreed that
female sterilization is dangerous. Misconceptions were also prevailing in the study community.
A third of study women (n=137) believed that implant might freely move in the body other than
the site of insertion and cause severe pain. When women were asked on their approval
125(30.4%) of them agreed that it is not good to use LAPMs. Fifty seven (13.9%) of women
believed that discussing about LAPMs contraceptive methods with their husband or friend is not
necessary. Meanwhile 8 (1.9%) women understood that using LAPMs could not deter large
family size. Ninety eight (23.8%) of women agreed that operation of women for female
sterilization is unacceptable (Table 2).
The qualitative finding was also in line with the
quantitative study. Key informant clients and providers alike believed that most of the
community has a poor attitude towards LAPMs. But very few clients and providers believe that
the community had good attitude which can be enhanced through intensive awareness creation.
For instance, a 25 year old married client from urban health center explained: “I have a negative
attitude on LAPMs. Four years ago I heard some rumors that a woman had a mental illness after
implant insertion. After I knew the woman’s mental sickness was affected, I had a bad attitude
towards use of LAPMs .I need to know more about LAPMs. I need to know more if any person
with good knowledge on LAPMs teaches me.”
All of the 50 (12.2%) women who used LAPMs in Wolaita zone used implant. The other LAPMs
were not used in the study area. On the other hand, only 156 (38%) women had the intention to
use any of the four LAPMs in the future. Implant was still the method highly favored for future
use 143 (91.7%) followed by IUCD 9(5.7%) and female sterilization 5 (3.2%) (Table1).
Myths and Misconceptions to use LAPMs in Southern Ethiopia
More than two-third (n=276) of women had different myths and misconception on LAPMs. One
hundred nighty one (71%) of women perceived that implant would cause hypertension while
162(58.7%) believed that implant could move around freely in the body and lost at the day of
removal, 187(67.8%) felt that implant causes illness, 116(42%) thought that IUCD resulted in
illness, 147(53.2%) perceived that implant leads to anemia while 196(71%) of women believed
that implant add body weight.
6
Moreover, a third (n=32) of women perceived that implant might cause infertility, 3.2% believed
that it would burn the whole body, 6.4% felt that it changes facial skin color to black while 3.2%
believed that using implant interferes with routine activity for persons engaged in energy
demanding jobs. Yet again 16% had the misconception that LAPMs cause irregular menstrual
bleeding, 4.3% alleged that using implant needs balanced diet, 9.6 % assumed that implant might
be the source of dizziness and 6.4% presumed that IUD dries vagina. Some 3.2 % even accepted
the notion that using Implants and IUD lead to twin pregnancy while a few (1.1%) reputed that
after IUD and Implants insertion health professionals refuse to remove the method before the
actual removal time when clients want to be pregnant. Moreover 3.2% alleged LAPMs to cause
delivery complications and 9.6% had other kinds of misconceptions in the study area (Table 3).
The qualitative finding strengthened some of the findings in the quantitative study. Key
informants had also implicated that implant’s body burning and movement characteristics. They
also mentioned that implant causes weakness, itching and it is not suitable for a person who has
work load. As implant and sterilizations presumed to require major operations they were believed
to have caused pain to clients. Informants also reiterated that LAPMs might cause cancer and
mental illness. Moreover, there was also a belief that health professionals bulges the uterus
outward at the time of loop insertion and vasectomy make males impotent. A health provider (a
23 years old midwife nurse) explained the misconception as follows: “Client women report that
implant moves to the abdomen and it is not found in the insertion site. It moves to other body
parts from the insertion site. It interferes with routine work. If users of implant develop any
headache or abdominal cramp they associate it with family planning methods.”
Factors associated with women’s intention to use LAPMs in Wolaita, Southern Ethiopia
After adjusted for socio-demographic and reproductive health characteristics of women and their
knowledge, women who had positive attitude were (AOR =2. 47: 95% CI (1.48, 4.11) times
more likely to have intention to use LAPMs compared with a woman who had a negative
attitude. On the other hand, women who had no myths and misconception on LAPMs were
(AOR= 1.71 (1.08, 2.72) times more likely to use LAPMs compared with those who had myths
and misconceptions. The odds of women’s intention to use LAPMs were (AOR=2.10: 95% CI
(1.11, 3.98) and AOR=2.80: 95% CI (1.15, 6.77) times higher among women who attained
7
secondary and higher level of education compared with women with no education, respectively
(Table4).
DISCUSSIONS
This study identified different factors affecting women’s intention to use LAPMs in Southern
Ethiopia. Only 38% of women intended to use LAPMs. This finding is less than a study
conducted in Ambo, Ethiopia where 56.1% women had intention to use LAPMs [12]. The
difference could be due to disparities in the study settings. The low intention in this study area
could be due to the prevalence of various myths and misconceptions. Moreover, implants were
the most favored LAPM at the time of study and in the future which is in line with the finding of
EDHS 2011 [8]. This might be attributed to the trainings given to primary health extension
workers on Implanon insertion [10], availability of variety of choices in implants in terms of
duration of use (Implanon, Jadle, and Norplant), availability of service at every level of health
facilities. However, it is in contradiction to the finding in Pakistan that showed higher level of
intention to use female sterilization. Female sterilization was also the most widely used LAPM
worldwide, accounting for approximately (20%) of all contraception, followed by IUD [13, 14].
More than a quarter (28.2%), 9%, 54% and 87.8% of women heard about female sterilization,
male sterilization, IUCD and implants respectively which was consistent with the findings of a
study conducted in Butajira, South Central Ethiopia, in which knowledge on vasectomy was the
lowest (8.2%) and implants was the highest (74.4%). Moreover, this finding was consistent with
EDHS 2011, in which the prevalence of knowledge on vasectomy and implant were 11.2% and
67.8% respectively. However, knowledge on IUCD (13.1%) and tubaligation (19%) in Butajira
were much lower than this study finding. In this finding women’s knowledge on IUCD and
&implant are higher than those studies of Butajira and EDHS 2011.This could be due to the fact
that the government is scaling up implant and IUCD training for HEWs to insert Implanon which
raised community’s awareness [10,15,16].
In this study, more than half (n=216) of women had a negative attitude to use LAPMs. This
finding is consistent with the study finding of Mekele, Northern Ethiopia where 53.6% of the
8
married women had a negative attitude towards the use of LAPMs [17]. It is further augmented
by the findings of the key informant in-depth interviews. Informants believed that their
community had a negative attitude to use LAPMs. This could be due to the existence of different
myths and misconceptions in the community; which might lead the women to such a negative
attitude to use LAPMs.
When we deal with factors associated with use of LAPMs in the future the likelihood of its
utilization was (AOR=2.10: 95% CI (1.11, 3.98) and AOR=2.80: 95% CI (1.15, 6.77) times
higher among women who attained secondary and higher level of education compared with
women with no education, respectively. This study was consistent with the findings of other
studies in Pakistan, Rwanda and Mojo, Ethiopia [14, 18, 19]. This could be due to educated
women’s access to information from different sources, like school, leaflet, newspaper, media and
internet. In contrast to this finding, a study conducted in Bale zone, Goba, Ethiopia showed that
there was no statistical significance association between education and use of LAPMs [20].
After adjusting for socio-demographic and reproductive health characteristics, women who had
positive attitude were (AOR =2. 47: 95% CI (1.48, 4.11) times more likely to desire LAPMs
compared with a woman who had a negative attitude on these methods. This finding was
consistent with a study in Ambo, Ethiopia [12] and was also supported by key informant
interviews. This could be due to lack of adequate health information and counseling on long
acting and permanent methods in the community as well as the various myths and
misconceptions on the methods.
The prevalence of myths and misconception in this study area was 67.2%. This finding is
consistent with the study done in Ghana in which 63% of clients said that it was because of the
rumors that clients might did not choose IUD. On the other hand, this finding is higher than the
study conducted in East Shoa Zone, Batu, Ethiopia where only about a third had myths and
misconception. This difference could be due to the study setting, duration and variations in
cultures [21, 22]. Women who had no myths and misconception on LAPMs were (AOR= 1.71
(1.08, 2.72) times more likely to use LAPMs compared with those who had myths and
misconception.
9
Conclusion
In this study more than half of women had a negative attitude to use LAPMs. Moreover, women
had low intention to use LAPMs in Wolaita zone. Secondary and higher level of education,
positive attitude to use such methods and those who had no myths and misconceptions were
significantly positively associated with women’s intention to use LAPMs. Furthermore, the
various myths and misconceptions and low awareness to use the methods were barriers to use
LAPMs. The government should scale-up girls’ education and avail different schemes to
empower women. Front line primary health workers and programmers should have focused
awareness creation programs to change the attitude, myths and misconceptions on LAPMs.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
1
MM has taken a principal role in the conception of ideas, developing methodologies and writing
the article.2 WM guided in the conception and design and involved in the analysis and
interpretation of findings. Both authors read and approved the final version of the manuscript.
Author’s information
1
MM is MPH in Reproductive Health in School of Public Health Wolaita Sodo University.
2
WM is Ph.D. in Public Health, Assistant Professor at School of Public Health, Addis Ababa
University.
ACKNOWLEDGEMENTS
United Nations Population Fund (UNFPA) funded this research through its collaborative project
with Addis Ababa University and hence it deserves acknowledgement. We also extend our
sincere gratitude to study participants, data collectors and supervisors.
10
Endnotes
1
Correspondence: mengistu77@gmail.com
2
correspondence: wubegzierm@gmail.com
1
School of Public Health, College of Health Sciences, Wolaita Sodo University, Ethiopia.
2
School of Public Health, College of Health Sciences, Addis Ababa University, Ethiopia.
References
9. References
1. Bongaarts J. Family Planning Programs for the 21st Century: Rationale and design
[http://www.popcouncil.org]. New York, NY 10017 USA: Population Council; 2012.
2. Bradley S., Croft T., Rutstein S. The Impact of Contraceptive Failure on Unintended Births
and Induced Abortions: Estimates and Strategies for Reduction. DHS Analytical Studies No. 22.
Calverton, Maryland, USA: ICF Macro. September 2011.
3. U.S. Agency for International Development: Using Quantification to Support Introduction and
Expansion of Long-Acting and Permanent Methods of Contraception a [database on the
Internet].USAID | deliver project, task order 1, and Engender Health/The Respond Project.
October 2010 [cited 9/23/2012].
4. Department of International Development: Improving Reproductive, Maternal and Newborn
Health: Reducing Unintended Pregnancies 31. December 2010.
5. John M. Investing in the Future: The Case for Long-acting and Permanent Contraception in
Sub-Saharan Africa. December 2007.
6. Family Health International: Addressing Unmet Need for Family Planning in Africa.The Case
for Long-Acting and Permanent Methods. 2007.
7. Population and Economic Development 2012 Data Sheet: Population Reference Bureau.2012.
[cited 09/18/2012].Available on www. P r b.org
8. Central Statistical Agency [Ethiopia] and ICF International: Ethiopia Demographic and Health
Survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency
and ICF International; 2012.
11
9. Wolaita Zone Finance & Economic Main Department: Socio-Economic Profile of Wolaita
Zone: Wolaita Sodo. 2011.
10. Admasu K. National Guideline for Family Planning Services in Ethiopia Federal Democratic
Republic of Ethiopia Ministry of Health October ,2011.
11. Federal Democratic Republic of Ethiopia Ministry of Health: Health Sector Development
Program IV 2010/11 – 2014/15. October 2010.
12. Negewo D. Assessment of factors affecting women’s intention to use long acting and
permanent contraceptive methods among family planning clients of public health facilities in
Ambo town, Oromia National Regional state, Ethiopia. MPH thesis. Addis Ababa University
June, 2010.
13. USAID: Long-Acting and Permanent Methods of Contraception: Meeting Clients’ Needs
Issue brief. August 2006
14. Agha S. Intentions to use contraceptives in Pakistan: implications for behavior change
campaigns. BMC Public Health 2010; 10 (450):1471-2458.
15. Mekonnen W., Worku A. Determinants of low family planning use and high unmet need in
Butajira District, South Central Ethiopia. Reproductive Health. 2011; 8(37).
16. Calverton M, USA: CSA and ICF International. Ethiopia Central Statistical Agency and ICF
International.2011 Demographic and Health Survey: Key Findings 2012.
17. Alemayehu et al. 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 and Childbirth 2012; 12:6.
18. Family Health International: Expanding Contraceptive Use in Rwanda. Research Brief
December 2010.
19. Gizaw A. Family planning service utilization in Mojo town, Ethiopia: A population based
study. Journal of Geography and Regional Planning June 2011; 4(6):355-63.
12
20. 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. Reproductive health 2012; 9: 26.
21. Petters S. Long Acting and Permanent Contraceptive Methods: Evaluating Provider Training
in Central Region, Ghana. May, 2008.
22. Haile A. Demand for long acting and permanent contraceptive methods and associated
factors among family planning service users, East Shoa Zone, Batu town, Ethiopia June 2009.
13
Table 1: Distribution of respondents by socio- demographic and other characteristics in Wolaita
zone, Southern Ethiopia April, 2013
Characteristics (n=411)
Frequency
Age
15-24
25-34
35 and above
126
249
36
30.7
60.6
8.8
Educational status
No education
Primary education
Secondary education
Higher education
135
142
96
38
32.8
34.5
23.4
9.2
Hose hold size
1-4
5 and above
208
203
50.6
49.4
Decision on the number of children
Husband
Myself
Together
38
136
237
Percent
9.2
33.1
57.1
Awareness of female sterilization
116
28.2
Awareness of male sterilization
37
9
Awareness of IUD
222
54
Awareness of Implants
361
87.8
Intention to use LAPMs
156
38
Methods intend to use in the future
Implants
143
91.7
IUCD
9
5.7
Female sterilization
5
3.2%
14
Table 2: Distribution of respondent’s attitude to use LAPMS in Wolaita zone, Southern
Ethiopia, April, 2013
Characteristics (n=411)
Disagree
Not sure
Agree
# (%)
# (%)
# (%)
89 (21.7)
39 (9.5)
283 (68.9)
The insertion and removal of implants is highly painful 113 (27.5)
196 (44.7)
102 (24.8)
Insertion of IUCD causes loss of privacy
173 (42.1)
152(37)
86(20.9)
Using IUCD restricts normal routine activities
162(39.4)
180(43.8)
69(16.8)
Operation for female sterilization is dangerous
115 (28)
187 (45.5) 109 (26.5)
Implant freely move in the body& cause severe pain
197(47.9)
77(18.7)
137(33.3)
For me, it is not good to use LAPMs.
231(56.2)
55(13.4)
125(30.4)
Using implants needs proper diet
Discussing LAPMs with husband (friend) are not necessary 334(81.3) 20(4.9)
57(13.9)
LAPM not preventing one from having large family size
356(86.6)
47(11.4)
8(1.9)
Operation for female sterilization is unacceptable.
153 (37.2)
160(38.9)
98(23.8)
Positive attitude: (Answered >the mean score)
Negative attitude: (Answered <the mean score)
15
195(47.4)
216 (52.6)
Table 3: Distribution of respondents’ myths and misconceptions about LAPMs in Wolaita zone, Southern
Ethiopia, April, 2013
Characteristics
Frequency
Percent
Women who think there are barriers to use LAPMs (n=411)
265
64.5
Myths and misconception heard on LAPMs (n=411)
276
67.2
The implant would cause hypertension (n=276)
191
71
Implant moves freely in the body& lost at time of removal (n=276) 162
Implant causes illness (n=276)
58.7
187
67.8
IUCD Causes illness (n=276)
116
42
Implant causes anemia (n=276)
147
53.2
Implant causes anemia (n=276)
97
35.1
Implant cause weight gain (n=276)
196
71
LAPMs cause infertility (n=94)
32
34
LAPMs burn the whole body (n=94)
3
3.2
LAPMs change the skin (facial) color black (n=94)
6
6.4
It interfere with activities if one has work load (n=94)
3
3.2
LAPMs cause menstrual bleeding excess and irregular (n=94)
15
To use LAPMs one needs balanced diet (n=94)
4
4.3
LAPMs cause weight loss and dizziness (n=94)
9
9.6
IUCD dries (damages) vagina (n=94)
6
6.4
Using LAPMs lead to twin pregnancy (n=94)
3
3.2
After LAPMs insertion health professionals refuse to remove (n=94)
Using LAPMs make labor difficult (n=94)
1
3
Others (n=94)
9
16
16
1.1
3.2
9.6
Table 4.Factors associated with women’s intention to use LAPMs in Wolaita zone, Southern
Ethiopia, 2013
Intention to use LAPMs
Characteristics (n=411)
Age
15-24
25-34
35 and above
Yes, N (%) No, N (%)
COR (95%CI)
AOR (95%CI)
59 (46.8)
85(34.1)
12(33.3)
67(53.2)
164(65.9)
24(66.7)
1.00
0.59 (0.38, 0.91)*
0.57 (0.26, 1.23)
1.00
0.86(0.47, 1.53)
0.89(0.34, 2.31)
Household
1-4
5 and above
92(44.2)
64(31.5)
116(55.8)
139(68.5)
1.00
0.58 (0.39, 0.87)*
1.00
0.81 (0.47, 1.41)
Educational status
No education
Primary education
Secondary education
Higher education
40(29.6)
41(28.9)
51(53.1)
24(63.2)
95(70.4)
101(71.1)
45(46.9)
14(36.8)
1.00
0.96 (0.57, 1.62)
2.69 (1.58, 4.64)*
4.07 (1.91, 8.67)*
Decision on the number of children
Husband
8(21.1)
30(78.9)
Myself
44(32.4)
92(67.6)
Together
104(43.9) 133(56.1)
1.00
1.79 (0.76, 4.23)
2.93(1.29, 6.67)*
1.00
1.53 (0.62, 3.80)
2.215 (0.93, 5.29)
Knowledge score
Low knowledge
Moderate knowledge
High knowledge
109(66.1)
101(63.1)
45(52.3)
1.00
1.37 (0.72, 1.79)
1.77 (1.04, 3.02)*
1.00
0.75 (0.43, 1.31)
0.74 (0.36, 1.52)
154(71.3)
101(51.8)
1.00
1.00
2.31 (1.54, 3.47)*
2.47 (1.48, 4.11) **
56(33.9)
59(36.9)
41(47.2)
Attitude score (Composite)
Negative attitude
62(28.7)
Positive attitude
94(48.2)
Heard myths and misconception
Yes
95(34.4)
No
61(45.2)
181(65.6)
74(54.8)
1.00
0.85 (0.48, 1.48)
2.10(1.11, 3.98) **
2.80 (1.15, 6.77) **
1.00
1.00
1.57 (1.03, 2.39)*
1.71 (1.08, 2.72) **
*Statistically significance in COR: P-value<0.05, **statistically significance AOR: P-value<0.05
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