CHAPTER ONE

INTRODUCTION

1.1Background

Family planning refers to a conscious effort by a couple to limit and space the number of children they have through the use of contraceptive methods. Family planning (FP) is an important strategy in promoting maternal and child health(Obeagu et al, 2023).  It improves health through adequate spacing of birth, avoiding pregnancy at high-risk maternal age and high parity. It is often used as a synonym for birth control, however. It does have a wider view, dealing with birth control, reproductive health, as well as premarital and preconception counseling.  Despite the fact that contraceptive usage has increased over a period of time, there exists a Knowledge Attitude and Practice gap regarding contraception Family planning deals with reproductive health of the mothers (CSA, 2016).The widespread adoption of family planning represents one of the most dramatic changes of the 20th century. The growing use of contraception around the world has given couples the ability to choose the number and spacing of their children and has tremendous lifesaving benefits, yet despite the impressive gains, contraceptive use is still low and the need for contraception is high in some of the world’s poorest and most populous places. Over 200 million women in developing countries do not desire pregnancies and they fail to use modern contraceptive methods (Obeagu et al, 2016).This is in spite of the fact that several contraceptive methods, such as pills, implant, injectable, IUCDs, voluntary surgical contraception (VSC) and condoms which hinder the transmission of sexually transmitted infections (STIs) as well as the risks, pains, and costs associated with abortions. Notably, abortions in developing nations account for a large number of pregnancy-related deaths among mothers and infants (Ibekwe et al,.2022).

According to the World Health Organization in 2018, Family planning aids in avoiding undesired pregnancies and abortions, preventing sexually transmitted diseases and improving the quality of life of mother, fetus and family as a whole. Contraceptive use can also improve child survival and maintain good physical and emotional health in the family. Clearly, irrespective of its considerable benefits, family planning practices are not being carried out by most of the developing countries.

Each year worldwide, more than 20 million women experience ill health as a result of pregnancy. There are various methods of contraception that include sub-dermal implants, copper-T and other IUCDs, pills and so many others (Adhikari, 2009). The introduction of modern contraceptive techniques over the recent decades and the increasing availability of safer and more effective methods of preventing pregnancy have permitted people around the world to exercise their choice, make responsible decisions with respect to their reproduction and enjoy the benefits of family planning (Ghazal-Aswad et al, 2011). The current prevalence of contraceptive use is thus approaching 60 % worldwide, and in the less developed countries, almost 53 % of couples are using some form of contraception. Results from the present study, conducted in a typical rural Sub Sahara Africa (SSA) setting, reveal a 65.3 % prevalence of contraception practice, highly superior to the 24 % reported by the Cameroon DHS in 2011, and nearly two times the specific prevalence in the West Region of the country (33.7 %) .Besides, the overall prevalence of contraception practice in Cameroon has not changed from 2004–2011: 26 and 24 % respectively, questioning therefore the efforts that have counseling interventions should be undertaken everywhere (media, churches, schools, health centers among others), with special emphasis on the advantages of modern contraceptives (Huezo, 2016).

In Africa the prevalence of contraceptive use has increased ranging from 36% to 58. However, many of today’s poorest countries mainly in sub-Saharan Africa (SSA), still have high fertility and high unmet needs for family planning, and their populations are projected to double in the next few decades. Moreover, in most African countries, high fertility and rapid population growth represent a bigger threat to achievement of the Millennium Development Goals than infectious diseases such as HIV/AIDS(Cleland et al ,2016).For many years, donors and governments focused attention on family planning in West Africa to both improve maternal and child health and enhance economic development. However as fighting HIV/AIDS became a priority in the region, family planning received less attention. Most experts agree that Sub Sahara Africa is undergoing a transition to fewer births per woman, although the use of family planning has increased slowly and remains relatively low. Early age marriages, the social desirability of many children, and limited access to education are some of the factors that keeps fertility from decreasing more rapidly (John Caldwell et al,2012).

In Cameroon the maternal mortality continue to remain unacceptably high yet the prevalence of modern contraception has shown only slow increase(Kelodjioue samuel, 2015).Despite the availability of a wide range of contraceptive methods, contraceptive use is low and the rate of unintended pregnancies continue to remain high, particularly in developing countries. The main contraceptive methods in use in Cameroon includes implants, intra-uterine device(IUD), combined oral contraceptives (COC), hormonal injectable methods and condoms. There appear to be an increase in the use of traditional methods in Cameroon. While the general contraceptive use in Cameroon has increased from 16.1% in 1991 to 23.4 in 2011 and traditional methods decreased from 11.8% in 1991 to 8.9% in 2011.Main reasons for non-use of contraceptives by those in need of contraception include health concerns, infrequent sex opposition from others, lack of access or knowledge. Other reasons for use of a particular contraceptive method in Cameroon includes the effectiveness of the method, its financial and geographical accessibility, its ability to prevent sexually transmitted infections and whether or not it is prescribed by a medical personnel. Although Cameroon remains committed to increase the adoption of modern Family Planning strategies among rural and poor populations. Women in these areas are less exposed to less informed about Family Planning due to poor access to healthcare services. Therefore, the promotion of family planning, especially in countries with high birth rates, has the potential to reduce poverty and hunger, and avert 32 % of all maternal deaths and nearly 10 % of childhood deaths. It may also substantially contribute to women’s empowerment, achievement of universal primary schooling, and long-term environmental sustainability(Cleland et al, 2016).     

1.2PROBLEM STATEMENT

Access to family planning services remains a public health challenge in many parts of the world. An unmet need for family planning results in unintended pregnancies and illegal abortions which may sometimes lead to dead. This has major health and social implications and is often the leading cause of maternal and child mortality in low income countries. In 2019, 270 million women of reproductive age had an unmet need for family planning methods, with the highest numbers reaching 87 million in Southern Asia, 28 million in Eastern Asia, and 23 million in South-Eastern Asia. An estimated 214million women of reproductive age lack access to family planning methods resulting in an estimated 67 million unintended pregnancies,36 million induced abortions and 76,000 maternal deaths each year(Bitzer Johannes et al,2016). .Among the 1.9 billion women of reproductive age group (15–49 years) worldwide in 2021, 1.1 billion have a need for family planning; of these, 874 million are using modern contraceptive methods, and 164 million have an unmet need for contraception. The proportion of the need for family planning satisfied by modern methods, Sustainable Development Goals (SDG) indicator 3.7.1, has stagnated globally at around 77% from 2015 to 2022 but increased from 52% to 58% in sub-Saharan Africa(UN DES, 2022).

 In Africa, this was highest in the Eastern region, with 22 million women having an unmet need for family planning methods. There are approximately 213 million women in Sub Sahara Africa, of those women 89% would like to avoid pregnancy and 60% have unmet need for contraception .The contraceptive prevalence rate(CPR) in Rwanda fell from 13% in 1992 to only 4% in 2000(Konje Joseph et al,2016).In Cameroon maternal mortality remains unacceptably high and despite the availability of a wide rang e of contraceptive methods, contraceptive use is very low. In a study carried out in 2018 in Cameroon the use of contraceptives was recorded as follows; condoms(3.6%), injectable(2.5%), oral pills(1.3%), implants(0.5%),IUDs(0.2%).Despite the launching of family planning programs in Cameroon, the country’s  family planning knowledge and practice remains relatively low and its total fertility rate is still considerably high compared to other African countries(Ngwa et al,2013)During my clinical experience I came across a family with 12 children, This situation kept the researcher puzzle. The researcher noticed minimal child spacing, the children did not look like they were adequately cared for. Moreover, multiple pregnancies also cause financial and social distress resulting in lack of ability to fulfill basic needs of a child. This kept the researcher worried that despite the knowledge on different family planning methods women do not use them, so this prompted the researcher to carry out an investigation into the knowledge, attitudes and practice of women towards family planning methods in the Great Soppo Community.

1.3RATIONAL

Therefore this study aims at analyzing if the women of Great Soppo Community have an idea or good knowledge on family planning and how the react when the are being told about family planning, if the make use of these family planning methods and influence the uptake of family planning methods in other to improve on the wellbeing of both mother and child.  

1.4RESEARCH QUESTIONS

1)What is the  level of knowledge on family planning methods amongst women in the Great Soppo Community?

2)What is the attitude on family planning amongst the women of the Great Soppo Community?

3) What is the practice of family planning methods amongst women of the Great Soppo Community?

1.5 RESEARCH OBJECTIVES

GENERAL OBJECTIVES: To assess the knowledge, attitude and practices of women aged 18-35years towards family planning methods in the Great Soppo Community.

SPECIFIC OBJECTIVES

1) To assess the level of knowledge on family planning methods amongst women in the Great Soppo Community.

2) To assess the attitude of women of the Great Soppo Community towards family planning methods.

3) To assess the practice of family planning methods amongst women in the Great Soppo Community.