CHAPTER I

1.1 GENERAL INTRODUCTION AND BACKGROUND:

Family planning can be defined as the use of modern contraceptives or natural techniques for either restraining or spacing pregnancy.

Intrauterine device (Iuds), injectable, implants, male and female condoms, pills, male and female sterilization diaphragm and emergency contraception are the modern method of contraception similarly others may also include periodic abstinence and withdrawal method. Most individuals and couples due to economic, social and other reasons anticipated and attained their preferred number of children and also for spacing and timing of their births (WHO 2012).

Population growth or increase comes about because of the interplay of the three main demographic variables namely fertility, mortality and migration. This growth can be high, low, stable and all this have socio-economic development implications on the county’s and owing to the standard of living of the people of Cameroon is a country which can be said to have high population growth demographically with nearly five (4.4) being its current total fertility rate ( Cameroon statistical service 2010).

The current rate is an improvement upon that of the previous years as given by the Cameroon demographic and health surveys, researchers and stakeholders are still convinced that the country has the potential to grow high because of its large based population. A look at the age structure of Cameroon’s population within the age of 0-14 years, 53.3 percent within the age of 15-64 years and 3.7 percent in the age of 64 and over (Cameroon statistic service, 2010).

The use of contraceptives is one of the main determinants of fertility levels. Since 1970, there has been an increase use of contraceptives and its used widespread globally. Despite this enormous improvement, differences exist in its progress across geographical localities and some challenges linger in terms of increasing its level of usage and knowledge about contraceptive use to meet existing demands in areas and in terms of making available and adequate variety of contraceptive methods to increase the ability of couples wishing to use contraception to do so in a consistent and efficient manner.

A number of sub-Saharan African countries have a constant high rate of unmet demand for family planning. The increase rate of fertility in Cameroon and other sub-Saharan African countries together with a decline in mortality has given rise to unprecedented rapid population growth contributing to poverty, low quality of life and increased levels of population. Data gathered form 2010 population and housing census questionnaires gave Cameroonian population to be 24,658,823. This figure represents an increase of 30.4% over the 2000 census population of 18,912,079 (Cameroon Statistical Service, 2010 population and housing census).

The relative high fertility in Cameroon is largely attributed to a low level of contraceptive use (Cameroon statistical service, 2010). Contraceptive is defined as the practice of method of intended to prevent or space future pregnancy. There has been a projection in the overall contraceptive prevalence at the global levels demands to increase from 63% to 67% between the year 2000 and 2025 so as to make possible reduction of total fertility rate from 2.8 children per woman to 2.3 children per woman as projected in medium variant of the 2002 revision of the United Nations Population Projection (United Nations, 2002).

The Cameroonian government has made conscious effort to increase the knowledge on contraceptive and its use since 1975. A lot of efforts have been made to support family planning programmes and the distribution of contraceptive either directly through government facilities by the Ministry of Health (MoH) or indirectly through support of activity of non-governmental organization such as family planning associations. A national use of 33% has been estimated even though 43% of married women in the country desired to space their children and an additional 24% need to limit births. The disparity of use of family planning methods among urban and rural, the rich and poor put many women in the most deprived area at a disadvantage (Cameroon Statistical service, 2003).

According to the 2008 demographic and health survey indicates that women in Cameroon have an average of 4 children and the average children per woman ranges from 3 in the urban areas to 5 in rural areas. A major factorunderlying the high fertility rate in Cameroon is the low percentage of modern Contraceptive (Cameroon Health Service). Unfortunately, in Cameroon only 25% of current married women are currently using contraceptive (Cameroon Statistical Service, 2008).

1.2 STATEMENT OF RESEARCH PROBLEM

In 2019, There were about 1.9 billion women of child bearing age (15-49 years) worldwide and 270 million where actively practicing family planning and 842 million had an unmet need for contraception( United Nations Family Planning, 2019).

In 2016 a community based descriptive study was done in Gambia assessing the knowledge of child bearing women on contraceptive method in which 16.3% in the rural areas has a knowledge of on contraception and 17.7% in urban areas (Diego et al 2016). He went further to outline that the number of unwanted pregnancies increased from 18,000 frs to 20,000frs.

In addition, according to macro (2017) 56% of births in Cameroon Occurred in rural areas compared to 44% in urban communities.

In Mabunji, 676 per 100,000 women aged 15-49 get unwanted pregnancies with an estimated 32% of maternal deaths attributed to unsafe abortion(Adhikari, 2019).

Adequate knowledge of family planning can reduce many of these mistimed and unwanted pregnancies while at the same time it could reduce the number of unsafe abortions as well as mortality rate (Campbell 2017).

Kengfang (2010) stated that the number of adolescence deliveries were 8222 at the Yaoundé teaching hospital. There was also a low contraceptive prevalence among married women. Women with uneven distribution 2.6% in North Cameroon, 3.3% Far North, and 17.6% in Adamawa (Dzossa, 2004).

The investigators haven also witnessed an incidence in my community I saw it very necessary to enlighten the people on the importance of family planning. In Buea in the year 2019 a man who was married with 7 children narrated a story to me that his wife gave birth to their first 3 children normally and the 4^th child was born through a caesarian section had kids at very close intervals/spacing of 5 to 8 months apart. After the 7^th birth she had a complications. After each births the mother uterus was not fully recovered. With the poor living standard and knowledge deficit the man was unable to train the children and they became irresponsible.

With the above statistics the investigator saw it very important to assess the knowledge on women aged 18-45 on F/P in Mile 16- Bolifamba Community (Buea) of Cameroon where the information is not readily available.

1.3 RESEARCH OBJECTIVE

1.3.1GENERAL OBJECTIVES:

The main aim of the study is to assess the knowledge, attitude and practice of women of childbearing ages 18-45 year on F/P (current family planning procedures among women in their productiveness age) in the Bulu-Buea Municipality.

1.3.2 SPECIFIC OBJECTIVES:

1)  To determine the prevalence of contraceptive method among women of reproductive age in Bulu-Buea Municipality.

2) To determine the association between demographic factors, knowledge, attitude.

 3) Practice of family planning among women in their reproductive age in Bulu-Buea Municipality.

1.4 RESEARCH QUESTIONS:

1. What is the proportion of women who are currently using contraceptive in their reproductive age in Bulu0Buea Municipality?
2. What is the level of knowledge of the use of contraceptive among women in their reproductive age in Bulu-Buea Municipality.
3. What is the association between demographic factor and knowledge, attitude and practice of family planning among women of reproductive age in Bulk?

            This study adapts the healthcare utilization model as the conceptual framework. This model has aspects which are peculiar to the study and well-suited with the objective of the study: demographic characteristics such as age, marital status, educational levels, ethnicity and parity are potential factors that could influence knowledge about family planning (Akilimali et al. 2018). Knowledge about family planning can in turn leads practice thus there is a positive relationship between knowledge and practice in family planning (Enewold et al, 2010).