CHAPTER ONE

INTRODUCTION

1.1 Background Study

As historical sources illustrate, contraceptive use has existed since the time of early human beings (Robinson, 1990; Whiterlaw, 2000). Women and men have used contraceptives to prevent pregnancy and control fertility for centuries (McLaren, 1990;Walby, 1990) although the effectiveness of the methods is contested during the early periods(Riddle, 1997). Well organized modern contraceptive provision in the health systems started around 1960 (Cleland, 2008). At that time, international agencies primarily promoted programs in developing countries using a demographic rationale: to harmonize population growth with the economic development and natural resources in a given region or country (Robinson & Ross, 2007). The programs later embraced two other rationales that had already been adopted in many western countries. These are the health rationale and the human rights rationale, introduced in the 1980s and 1990s, respectively (Robinson & Ross, 2007).

Since the 1950s, the world’s population has experienced many drastic social, economic and political changes that have impacted in the areas of population growth and reproductive health (UN 2014a; Bongaarts 2015). The world’s population has risen steadily over the years, and in 2012 the population grew past the 7 billion mark. This growth in population has by no means been evenly distributed, as reports show that most of the population growth occurred in developing countries (UN 2014a; Bongaarts 2015).

Contraception and the prevention of an unwanted pregnancy are important issues for most heterosexually active women of child-bearing age. Since the introduction of the pill in the early 1960s, contraceptive use has become increasingly accepted and even expected for many women. While a variety of contraceptive methods have been developed in recent years, such as the oral contraceptive pill, the intrauterine device (IUD), and hormonal implants, women assume most of the responsibility for their successful use (Bongaarts, 2006).

The various programs aimed at promoting contraceptive use and awareness among young people reinforces a rights-based approach to family planning. Contraceptives reduce the need for emergency contraceptives and abortion; as women are the main users of contraceptives, both researchers and health service providers have focused almost exclusively on women (UNAIDS 2015b). With modern developments, men became excluded from contraceptive decisions (Edwards, 1994), whereas male and receiver/female condoms are the only modern contraceptive method that provide protection against STIs, including HIV and unintended pregnancies simultaneously (UNAIDS, 2015b).

Across the developing world, about 222 million women who want to avoid pregnancy are not using a method of contraception; despite the progress in some areas of the world; yet little change has been witnessed in the past decade (Carr et al., 2012). In Ibadan -Nigeria for instance, between May to December 1995 most women were aware of the use of family planning but only 12.0% had ever visited a family planning clinic (Obisesan et al., 1998). This therefore means that the effective use of modern family planning in most developing countries have increased but at a slow rate.

A study carried out how university students in Ghana perceive the use of emergency contraception, 43.2% of the 194 respondents have heard of modern contraceptive method. Only 11.3% of the respondents indicated correctly the appropriate time within which emergency contraceptive pills are to be taken after unprotected sex. Most of them were using traditional methods of contraception such as enema, douching after sex, and taking concentrated sugar solutions (Baiden et al., 2002).

According to Kongnyuy et al., (2007), awareness of emergency contraceptive pills by Cameroonian student is still low and the method is still underused due to inadequate knowledge or medically inaccurate knowledge of emergency contraceptive pills. A total of 49 out of 664 respondents (7.4%) reported that they or their partners have used emergency contraceptive pills. The use of contraception by men makes up a relatively small subset of the above prevalence rates. The modern contraceptive methods for men are limited to male condoms and sterilization (vasectomy).  Although much diversity, customs and taboos still exist in Sub Saharan Africa, all the countries share a cultural vein which is in support of high fertility. Rwanda has the highest fertility rate (5.5) while Mauritius has the lowest (4). Ethiopia, Kenya, Nigeria, Zaire and Tanzania make up almost 50% of the population of Sub Sahara Africa. Their fertility rates lie between 67.7%. Contraceptive use remains 10% among married women, followed by the IUD, injections (Depo -Provera) and female sterilization. In Kenya, 33% of women use a contraceptive method. Only 6% of married women in Nigeria use a family planning method. (Shah, 1994).

Previous studies suggested that variations in contraceptive use are typically derived from individual and household factors. The use of modern contraceptive methods such as; oral hormonal pills, condoms, intrauterine devices, diaphragm, injections and sterilization has traditionally been low in Sub Sahara Africa, but there is evidence of an increase during the past decade . During the 1970s the self-reported use of modern contraceptives among married women increased in East Africa by 1% and 17% by 1999. In West Africa it increased by 0.5% each year to 8% by 1999 (Stephenson et al., 2007).Benn and Richardson (1984) examined women’s experiences with contraception which was guided by the assumptions that contraception was easy, safe, comfortable, and problem free. Almost without exception, women expressed “dissatisfaction with available methods” (Benn & Richardson, 1984), the range of contraceptive choice, medical encounters, and occasionally also with the attitudes of their partners (Lowe, 2002; Rosenfeld, Zahorik, Saint, & Murphy, 1993).

Improving the reproductive health of young women in developing countries requires access to safe and effective methods of fertility control, but most rely on traditional rather than modern contraceptives. Fertility is not likely to decline at a fast sustained pace unless a large and growing number of couples are ready, willing and able to use modern contraception methods. Readiness is the subjective need or desire to postpone child bearing. Willingness refers to an attitude in favor of contraception and of certain contraceptive methods in particular while ability refers to being familiar with contraceptive methods and their supply sources and having reasonable access to them (Cleland, 2010).

Despite the fact that the use of family planning methods and services is very essential in sustaining the reproductive health of women, most women especially at the local level have different experiences in using it; which have constraints or deprived them of using these methods. Understanding how and why women make the choices they do is important, as inconsistent or irregular use of contraception is associated with greater risk of unplanned pregnancy (Webb & Holman, 1992). Healthcare professionals who work with women considering their contraceptive options need to be aware of not only the complexity of issues that influence women in making these choices, and the range of potential factors affecting correct or consistent use of their chosen method, but also of the importance of these issues for women.

Contextually, the Ministry of Public Health is responsible for implementing health policies in Cameroon, as stated in Decree No.95/040 of December 7, 1995. The main objectives of primary health care delivery in Cameroon are outlined in the “Statement of the National Primary Health Care Reorientation Policy”. This policy incorporates community participation, respect for human rights, and validation of the relationship between health and development, and the basic rights to healthcare and health information (Center for Reproductive Rights 2003). The Cameroonian Ministry of Public Health together with the Ministry of Social Affairs and the Ministry of Women’s Affairs and the Family, were directly involved in the implementation process of this project (Center for Reproductive Rights 2003, 71; Katzive et al. 1999, 6). Also, the government has since developed a “Sectorial Health Strategy 2005-2015” and a “National Reproductive Health Policy” in efforts to reduce the high level of maternal and neonatal mortality in Cameroon. All these are indications of the fact that the practice of contraception is vital for protecting Cameroonian women’s health and enables them to plan the size of their families and the timing of births.

1.2 Problem statement

Many developing countries, including Cameroon have implemented the use of contraceptives as an important strategy for addressing the health of the population as well as social and economic issues. Abortion is a key proximate of maternal mortality in Cameroon and associated complications have serious public health implications for the country. Cameroon has recorded 25%of maternal mortality because of unsafe abortion practices among women of the reproductive age group (15-45) during national health survey.

Unintended pregnancies and related consequences such as unsafe abortion results from the non use of contraceptives. Women often die from consequences of unplanned pregnancies and specifically unsafe abortions. The problem to be addressed in this study is to know the women in Buea Municipality knowledge, attitude and practice in taking contraceptives in order to limit the consequences that are associated with unplanned pregnancies and its effects on maternal mortality of the population as well as well as social and economic issues.

1.3 Research Questions

1.3.1 General Research Question

What are the knowledge, attitude and practice of the use of contraceptives in Buea?

1.3.2 Specific Research Questions

1. What is the knowledge and types of contraceptives use by women in Buea (Molyko)?
2. What is the attitude of women in the use of contraceptives in Buea?
3. What are the practices or challenges faced by women in the use of contraceptives in Buea?

1.4 Research Objectives

1.4.1 General Objective

The general Objective of this study is to assess the knowledge, attitude and practice of women in the use of contraceptives in Buea.

1.4.2 Specific Objectives

The specific Objectives of this study include;

1. To assess the the knowledge and types of contraceptives use by women in Buea.
2. To assess the attitude of women towards contraceptives use in Buea.
3. To evaluate the practice and challenges faced on the use of contraceptives by women in Buea.

1.5 Research Hypothesis

1.5.1 Main Hypothesis

Women in Buea have a negative attitude towards the use of contraceptives

1. There are different types of contraceptives used by women in Buea.
2. Women in Buea have diverse knowledge about the use of contraceptives.
3. Women in Buea have a lot of challenges in the use of contraceptives.