ATTITUDE TO AND PRACTICE OF MODERN FAMILY PLANNING AMONG WIDOWS OF REPRODUCTIVE AGE IN LOGO LOCAL GOVERNMENT AREA OF BENUE STATE

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Abstract

The purpose of the study was to find out the attitude to and practice of modern family planning methods among widows of reproductive age in Logo Local Government Area (LGA) of Benue State.  To achieve the purpose of the study, twelve research questions were posed and six hypotheses were postulated to guide the study.  Literature pertinent to the study was reviewed.  The study utilized cross-sectional survey research design.  The instrument used for data collection was the researcher designed questionnaire.  Data was collected from 228 respondents and used for the study.  To answer the research questions posed for the study, the data was analysed using percentages and means.  The hypotheses were verified using Chi-square, t-test and ANOVA Statistics at .05 level of significance.  The following results were obtained: Attitude of widows of reproductive age to other women who practice modern family planning, and to those who provide modern family planning services were positive.  Attitude of widows of reproductive age to their possible practice of modern family planning, and attitude of young and old widows of reproductive age to modern family planning based on their age were negative.  Widows of reproductive age with four or less children had positive attitude towards male condom (= 2.51) only while those with more than four children had positive attitude towards injectables (=2.51) and male condom ( = 2.51) only.  Those with primary education had positive attitude towards male condom (= 2.52) only.  Those with secondary education had positive attitude towards injectables ( = 2.50) and male condom ( = 2.52) only.  Widows of reproductive age with tertiary education had positive attitude towards male condom (= 2.53) only.  Widows of reproductive age with non-formal education had negative attitude towards all the components of appliance method of modern family planning.  Regarding practice of appliance methods, majority of the respondents (54%) aged 33-49 years had practised male condoms. Majority of the respondents (52%) with four or less children had practised male condom. Majority of the respondents (53% and 55%) with more than four children had practised injectables, and male condoms respectively. Majority of the respondents (56% and 71%) with secondary education had practised injectables, and male condoms respectively. There was no significant difference in the attitude of young and old widows of reproductive age towards modern family planning methods.  Parity exerted no significant difference in the attitude of widows of reproductive age to modern family planning. Level of education had no significant difference in the attitude of widows of reproductive age to modern family planning. There were significant differences in the practice of pills and injectables between the young and old widows of reproductive age; there were no significant difference in the practice of injecatable, female condom, male condom, and IUCD between young and old widows of reproductive age.  Parity had significant difference in the practice of pills, injectables, and surgical method by widows of reproductive age; parity had no significant difference in the practice of female condom, male condom, and IUCD by widows of reproductive age.  Level of education had significant difference in the practice of pills, male condom, and surgical method whereas level of education had no significant difference in the practice of injectables, female condom, and IUCD by widows of reproductive age in Logo Local Government Area. On the basis of conclusion drawn from the major findings, it was recommended that due to variations in the attitude to and practice of modern family planning (MFP)  by widows of reproductive age, Government should expand and intensify education on MFP programmes so as to bridge the existing gap. It was also recommended that non-governmental organization and community based organizations should embark on behaviour  change programmes to educate widows on MFP in order to improve their attitude to and practice of MFP in the area of study.   

   

CHAPTER ONE

Introduction

Background to the Study

            Adewale, Umoh, Iwere and Gbadegesin, (2005) opined that attitude and practice towards modern family planning have attracted much attention in recent times. This is due to increase in unwanted or unplanned pregnancies, induced or criminal abortion, maternal mortality, sexually transmitted diseases, human immune-deficiency virus (HIV) and acquired immune-deficiency syndrome (AIDS) prevalence among women of child-bearing age.

            There is no one universally acceptable definition of attitude. However, Anderson (1981) opined that attitude is a moderately intense emotion that prepares or predisposes individuals to respond consistently in a favourable manner, when confronted with a particular object. Okafor (1991) stated that attitude is concerned with one’s feeling towards an object, person or thing. Cornachia, Station and Irwin (1999) asserted that an attitude refers to mind-set to action, an internal readiness to behave or act. Simpson and Weiner (2000) defined attitude as a way of feeling, thinking or behaving. Aitken (2000) argued that there is no standard definition of attitude, but in general terms, he perceived the term to imply a learned predisposition or tendency on the part of the individual to respond positively or negatively to some objects or situation. According to Mann (2002), attitude implies a relatively enduring organization to internalized belief that describes, evaluates and advances actions with respect to an object or situation with each belief having cognitive, affective and behavioural components. He further stated that each one of these beliefs is a predisposition that suitably activates results in some preferential response towards the attitude-object or situation or toward the maintenance or preservation of the attitude itself.

            Attitude in the context of the present study is belief, feeling, thinking, ideas or emotion that predisposes an individual to respond when faced with a particular object. For instance, what a widow believes, feels or thinks about modern family planning becomes her attitude towards modern family planning.

            Practice, on the other hand, is something done habitually or customarily (Webster, 1980). According to Simpson and Weiner (1991), practice is a habitual action-custom. Hornby (2001) opined that practice means to do something regularly as part of one’s normal behaviour. With regard to the present study therefore, it means using modern family planning methods regularly, as part of ones normal sexual behaviour. Practice of modern family planning may not only be beneficial to women whose husbands are living alone but also to widows of reproductive age.

            A widow is defined as a woman whose husband has died and who has not married again (Hornby, 2001). Okafor (2004) viewed a widow as a woman who is married to a man and loses him to death. According to Igbudu and Okoro (2010), a widow of reproductive age is a woman in the age bracket of 15-49 years, whose husband has died and who has not married again. A young widow of reproductive age is a woman aged between 15 and 32 years, whose husband has died and who has not married again. An old widow of reproductive age is a woman aged between 33 and 49 years, whose husband has died and who has not married again.

            The Logo widow of reproductive age in the context of the present study, is a woman whose husband has died and who has not married again or inherited by the late husband’s relation. Widows of reproductive age are chosen for the present study because, they are thought to be sexually active and are more likely to be prone to unwanted pregnancy, illegitimate children, abortion, sexually transmitted infections (STIs), human immune-deficiency virus (HIV) and acquired immune-deficiency syndrome (AIDS) than their married counterparts whose husbands are alive.  In addition, widows are usually subsumed within the general categorization of women or ever married women in most studies in family planning, hence the need to study them   specially, in the present study.

            Furthermore, the researcher’s personal observation of the death of three          young widows due to criminal or induced abortion in Logo Local Government Area (LGA), also informed the present study. Besides, a widow was hospitalized for having abortion complications. In addition, five widows who were not even inherited by their late husband’s relation gave birth to children, two years after the death of their   husbands. The situation created a serious social problem as for the paternity of those children in such families. The children were termed illegitimate children in such families, even though they were answering the names of their mother’s late husbands. Oye-Adeniran, Adewole, Umoh, Iwere and Gbadegesin (2006) noted that such children were said to be vulnerable to abuse, neglect and discrimination, especially those with doubtful paternity, who would be regarded as bastards.  There seems to be need for modern family planning among widows of reproductive age.

            Modern family planning refers to modern contraceptives method other than traditional or natural family planning methods (NSO, 2004). Park (2007) defined modern family planning, as preventive methods that help the woman avoid unwanted pregnancies. They include all temporary and permanent measures to prevent pregnancies resulting from coitus. Modern family planning methods may be broadly grouped into two classes, namely: spacing methods and terminal methods. These methods are further categorized into three sub-categories namely, non-appliance, appliance, and surgical methods.

            Oreachata (2007) referred to non-appliance methods as non-manipulative methods of family planning such as pills which are taken orally to prevent pregnancy. Non- appliance methods include hormonal methods (oral pills). Okoye and Okoye (2007) noted that oral pills which are hormone-based contraceptives are the most popular and also the most effective non-appliance methods of family planning in the World. They further observed that the first time to start taking your first package of birth-control pill is the day your period begins. 

            According to Park (2007), appliance methods refer to any contraceptive instrument, drug, preparation or thing designed to, prepared or intended to prevent pregnancy. Spermicides are surface active-agents which attach themselves to spermatozoa and inhibit oxygen uptake and kill sperms. They include among others: foams, creams, suppositories, and soluble films.

            Okoye and Okoye viewed male condom as a rubber or processed collagenous tissue sheath that fits over the erect penis and acts as a barrier to the transmission of semen into the vagina and also prevent the transmission of HIV and other sexually transmitted infections.

            They described female condom as a soft plastic that resembles a diaphragm and condom combination. It consists of a soft, loose-fitting sheath with two flexible rings similar to those of a diaphragm. One of the rings is put into the vagina which serves as internal anchor and the second ring remains outside the vagina to make it possible for the man to find the entrance of the vagina which is now covered by a sheath. It is an effective barrier to sexually transmitted infections (STIs) and semen into the vagina.

            The Diaphragm is a vaginal barrier. It is a dome-shaped rubber cap with flexible rim. It is inserted into the vagina, before intercourse, to cover the cervix. The spermicidal could be placed on the dome of the diaphragm, to serve as reinforcement. Diaphragm could be inserted at anytime within the monthly cycle (Okoye & Okoye, 2007).

            Intra-uterine contraceptive devices (IUCDs) are small plastic or stainless steel or flexible polyethylene nylon device, that can be inserted by a doctor through the cervix, into a woman’s womb to prevent pregnancy. Almost all brands of IUCDs have one or two strings or threads tied to them. The rings hang out through the opening of the cervix into the vagina. The strings which can be felt by a woman help her to check whether the IUCD is still in place or not. They also aid removal of the device by a health-care provider (Okoye, 2006).

            The injectable depoprovera is a contraceptive given every three months as a single injection to women who want to prevent pregnancy. It contains the hormone, progestin, similar to the natural hormone that a woman’s body produces. The injection, when given, releases the hormone slowly into the woman’s blood stream up to three months or more. The injection prevents pregnancy by preventing ovulation from occurring, thickening the cervical mucus, thereby making it difficult for the sperm to pass through it, and inducing reduction or thinning of the endometrial lining  (inner surface of the womb). By this action, depoprovera can cause amenorrhea (absence of menstruation) on a long use (Okoye & Okoye, 2007).

            Implant is a subdermal contraceptive capable of preventing a woman from becoming pregnant for five years.  The commonly used implant is norplant which consists of six small plastic capsules similar to sticks of matches. The capsules contain 35mg each, of levonorgestrel. Implant is entirely a hospital procedure. The procedure requires a minor incision and the capsules are implanted beneath the skin of the forearm or upper arm. After the insertion, the minor incision is closed with gauze and plaster. No stitches are required and the capsules are not visible on the skin. Both the insertion and removal, require the expertise of a trained health personnel, mainly doctors. Interestingly, return of fertility is almost immediately after the device is removed (Okoye & Okoye, 2007).

            Abortion simply means termination of pregnancy. World Health Organization, WHO (1971) defined abortion as termination of pregnancy before the embryo or foetus attains the age of viability. Okoye(2006) stated that abortion could be spontaneous or induced. Spontaneous abortion is defined as natural or unaided termination of pregnancy before foetal maturity. Spontaneous abortion is commonly referred to as miscarriage. Induced abortion is defined as artificial or intentional termination of pregnancy, using any of the numerous methods against the laws of the country (Nigeria). This may include the use of drugs, mechanical devices manipulations or instrumentation. This however carries the highest risk of complications and maternal death.

            Surgical or terminal methods of family planning on the other hand, are simple or minor surgical operations for permanent contraception. Surgical or terminal methods comprise of male sterilization (Vasectomy) and female sterilization (tubal ligation). The present study was concerned with oral pills, injectables, female condom, male condom, IUCDs, and surgical method. These methods were chosen for the present study because they were the only family planning methods in use in Logo LGA at the time of the study.

             There are various demographic factors that influence widows’ attitude to and practice of modern family planning. The present study was concerned with demographic factors of age, parity, and level of education.

            Age has been identified by some studies as one of the strong factors that influence attitude to and practice of modern family planning. In a study by Chacko (2001) among married women, in four villages in rural West Bengal, India; it was found that, one of the factors that most influence a woman’s use of contraception  include her age. Specifically, Chizororo and Natshalaga (2003), reported that the younger women liked the female condom more than the older ones. Ngom and Maggwa (2005) postulated that age significantly increases a woman’s likelihood of using modern contraception.

            Reports from researchers indicate that parity influences a woman’s chances of using modern family planning. Chacko (2001) found that the number of living sons a woman has, greatly influences her use of modern contraception. Oyedokun (2007) reported that number of children ever born was also found to be a significant factor that influences women’s attitude to and practice of contraceptive.

            Studies have revealed that level of education has strong influence on attitude to and practice of modern family planning. Kaba (2000) pointed out that educational status of women was found to have an impact on contraceptive use. Those women who have some level of education were found to have better knowledge and tend to use contraceptives. Philippines National Demographic and Health Survey, PNDHS (2000) revealed that women with an elementary school education were more likely than those with more education or with none at all to want no more children and thus tend to use modern contraception. These variables were surveyed and some behaviour-change theories applied, to explain widows, attitude to and practice of modern family planning.

            This study was anchored on three theories. These are theory of reasoned action (TRA), theory of planned behaviour (TPB) and self-efficacy theory. The theory of reasoned action (TRA) which suggests that a person’s behaviour-intention depends on the person’s attitude about the behaviour and subjective norms, was the theory of anchor for widows’ attitude to modern family planning.

            Widows who develop negative attitude to certain methods of family planning are likely not to use such methods, whereas widows who believe that using certain methods of modern family planning protect them against unplanned pregnancies and sexually transmitted infections (STIs) will likely use such methods. Similarly, the theory of planned behaviour (TPB), which states that peoples’ evaluation of or attitude towards behaviour, are determined by their accessible belief about the behaviour, was another theory of anchor for widows of reproductive age’s attitude to modern family planning. The intention or belief of widows to use modern contraceptives, predicts contraceptive use by them. When a widow intends not to use contraceptives, it translates into non-use of contraceptive. Self-efficacy theory which holds that any change in behaviour must be preceded by a conviction that one can efficiently carry out the desired behaviour was applied to verify the findings regarding Logo widows of reproductive age’s practice of modern family planning. Logo widows of reproductive age may be more likely to practice modern family planning when they believe that they are capable of executing those practices successfully.

            The study was conducted in Logo Local Government Area (LGA) of Benue State. The Local Government located in the North-Eastern part of the State is a typical rural local government.  There are two autonomous communities that make up Logo L.G.A. They are Gaambe-Tiev and Ugondo, with five council wards each. The culture of wife-inheritance seems to be fast disappearing in the LGA and widows are left alone to carter for themselves and their children. The task of caring for self and children alone, appears to be cumbersome among widows in the LGA. In an attempt to find helpers, some of them may fall victims of some boyfriends who might not be willing to use any device to protect them from HIV, STIs or unwanted pregnancies. HIV and STIs appear to be on the increase among Logo widows of reproductive age. Unwanted pregnancies, criminal abortion and unwanted children seem to be common among widows of reproductive age in the LGA. It is likely that some widows of reproductive age have died due to criminal abortion while some are being hospitalized as a result of abortion complications. Following from the above characteristics of these widows, the study on attitude to and practice of modern family planning among widows of reproductive age in Logo Local Government Area (LGA), becomes imperative.

Statement of the Problem

            Modern family planning methods are considered a first line of defence against unwanted pregnancy, sexually transmitted infections (STIs) and human immune-deficiency virus (HIV). The consistent and correct use of modern family planning methods reduce greatly unwanted pregnancies, STIs and HIV among women of reproductive age in any nation thus enhancing their health. However, it appears that attitude and practice of modern family planning among women of reproductive age in Nigeria is low and it varies by demographic and socio-economic characteristics. This calls for a study to verify what obtains in Logo LGA.

ATTITUDE TO AND PRACTICE OF MODERN FAMILY PLANNING AMONG WIDOWS OF REPRODUCTIVE AGE IN LOGO LOCAL GOVERNMENT AREA OF BENUE STATE