CHAPTER ONE
INTRODUCTION
1.1Â Â Â Â Â Â Background to Study
Family planning is widely acknowledged as an important intervention towards achieving Millennium Development Goals (MDGs) four (4) and five (5) as it has proven to reduce maternal and child mortality. Family planning can prevent unwanted pregnancies and unsafe abortions. Some family planning methods such as condom usage can protect individuals from Sexually Transmitted Infections (STIs) including HIV/AIDS. Family planning has also been found to promote gender equality as well as promote educational and economic empowerment for women. Despite the enormous benefits of family planning services, the uptake of the service still remains low in Sub-Saharan Africa. This has resulted into high rates of unwanted pregnancies, unplanned deliveries, unsafe abortions and maternal mortalities in Sub-Saharan Africa of which Nigeria is no exception. The low uptake of family planning is largely blamed on many factors. It has been observed that the awareness of the availability of family planning services has a great influence on the uptake of family planning services. Additionally, even though some women are aware of the availability of family planning services, they are not properly informed about the various forms of family planning methods and how they work. Some of the women who went for family planning services were not adequately counselled on the side effects of some of the family planning methods. For example, in Uganda, some women stopped using contraceptives after they experienced what they perceived were side effects of the contraceptives.
Although most people are aware of the benefits of family planning services, they complained that it was difficult to access family planning services as such services were provided by health facilities that were far from their homes. In addition, religious inclination has been noted to be a major constrain to the uptake of family planning services in Africa. Also, some individuals perceived that family planning services were meant for only married couples whilst others fear that they will become sexually promiscuous if they go for family planning services once they cannot become pregnant. In Nigeria, some efforts have been made by the government of Nigeria and non-governmental organizations through the implementation of various programmes to improve the coverage of family planning services in the country. Although some successes have been chucked in the area of awareness of family planning services in the country, the unmet need for family planning still remains high. The Nigeria Demographic and Health Survey (GDHS) observed that a large number of women have an unmet need for family planning as the acceptor rate for family planning services remains low.
Family planning is an important preventive measure against maternal and child morbidity and mortality. It is an essential component of primary health care and reproductive health. It plays a major role in reducing maternal and neonatal morbidity and mortality. It confers important health and development benefits to individuals, families and communities and the nation at large. It helps women to prevent unwanted pregnancies and limit the number of children, thereby enhance reproductive health. By this, it contributes towards achievement of Millenium Development Goals (MDGs) and the Target of the Health for all Policy.13 The MDGs call for 75% reduction in maternal mortality and two-thirds reduction in child mortality between 1990 and 2015. As such effective utilization of family planning services is critical for the attainment of these goals thus improving health and accelerating development across the regions.15Access to family planning also has the potential to control population growth and in the long run reduce green gas house emission with it associated risk.13 Similarly it has been estimated that preventing unwanted pregnancies by the use of family planning would avert a total of 4.6million Disability Adjusted Life Years.16 Despite the importance and benefits of family planning, it has been estimated that about 17% of all married women globally would prefer to avoid pregnancy but are not willing to use any form of family planning.17 As a result, 25% of all pregnancies are unintended particularly in developing region of the world. This results to an estimated 18million abortion taking place each year, thereby contributing to high maternal morbidity and injuries.14,17 Sub-Saharan Africa which is home to only 10% of the world’s women, contributes annually, 12million unwanted or unplanned pregnancies and 40% of all pregnancy related deaths worldwide. The contraceptive prevalence in sub-Saharan Africa is low, estimated at 13%, in spite of the evidence of the pivotal role of family planning, while in Nigeria the estimation is 8.0% with 17% unmet need for family planning. This greatly contributes to the high rate of unintended pregnancies leading to induced abortion with its consequent complications. Despite the fact that Nigeria constitutes only 2% of the world’s population, it has been shown to account for 10% of the world’s maternal deaths. There is relatively high fertility rate in suburban and rural Nigeria despite the efforts of government and other non-governmental family planning services providers. Even though the fertility rate is high, acceptance and utilization of modern family planning methods has been low due to various reasons. In Africa, provision of family planning services is hindered by poverty, poor co-ordination of the programme and dwindling donor funding. Additionally, traditional beliefs favouring high fertility, religious barriers, fear of side effect and lack of male involvement have contributed significantly in weakening family planning interventions among women.
