CHAPTER ONE

INTRODUCTION

1.1 Background

The  century saw a dramatic decline in maternal and infant mortality, as well as the total fertility rate. These declines are associated with the achievements in family planning that took place in this country during that period. At the beginning of the twentieth century in the United States, the subject of birth control was not openly discussed. Nonetheless, public interest in and acceptance of birth control increased greatly between 1920 and 1960. Three primary factors fueled these rapid shifts in attitude toward family planning: (1) the changing role of women in American society; (2) concern about population growth; and (3) the availability of new, highly effective contraceptive methods, such as the birth control pill and intrauterine devices (IUDs) (Institude of Medicine, 2009).

In a sub-saharan country like Ethiopia the total fertility rate is about 4.6 children per woman with contraceptive prevalence rate (CPR) of 36% and an unmet need for family planning of 22% for married women and 24% for total women of age (15–9) years. If Ethiopia follows its current rate of growth, its population will be doubled in the next 30 years, hitting 210 million by 2060 (6). Most of the world’s population growth in the next, 40–50 years is expected to come from Africa and Ethiopia will take a large share for this growth. At present, contraceptive methods in Ethiopia, which is free of cost is provided in both governmental and NGO health facilities including hospitals, clinics, health centers, and health posts. But, Ethiopia is among countries with low contraceptive prevalence rate, which is only 36%. This

 resulted in high total fertility rate and unwanted pregnancy which intern affects the maternal and child health status (Admassu, 2021).

A study in Cameroon showed that the contraceptive prevalence was 63.1% [59.3-66.8] (400); of which 312 participants (78%) used a single method while 88 (22%) participants used contraceptives in combination. The most common methods in use were rhythm (196; 49%), male condom (109; 27.2%) and implants (63; 15.8%) (Emeh et al, 2021).

According to the World Health Organization (WHO), family planning is defined as “the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility” (WHO, 2008). The earliest method of contraception was coitus interruptus. Barrier methods like the use of a goat’s bladder as a female sheath was described in Roman literature and ancient Egyptian texts describe the use of vaginal pessaries. In the 17th century Casanova used condoms made of animal intestine. In the 1920s research confirmed the timing of ovulation and the role of the ovarian hormones, estrogen and progesterone in reproduction.

This led to the development of the rhythm method of contraception, based on the woman’s monthly variation in body temperature, and the development of the contraceptive pill. The first large scale trial of the pill took place in 1956. Intrauterine devices developed from metal pessaries used to cure painful periods. IUDs came into widespread use in the 1960s when flexible plastic devices became available. Sterilization was first used for eugenic reasons in the early 1900s, but by the end of the 20th century vasectomy and occlusion of the fallopian tubes were popular methods of birth control (Carol, 2005).

With reliable contraception scarce, people often practiced abstinence to avoid having children, according to the nonprofit sexual health organization Our Bodies Ourselves Today. After all, it was about the only available option to prevent pregnancy. Withdrawal, or stopping intercourse before ejaculation, is another long-used method, the group says. According to the sexual and reproductive health research group the Guttmacher Institute, the withdrawal method has a failure rate of up to 20 percent with typical use (typical use includes people who use the method inconsistently and incorrectly). Some romantic partners tried to time their sexual activity for times when the woman was less likely to get pregnant called fertility awareness methods, natural family planning, or the rhythm method, these approaches include tracking periods, internal temperature, and the consistency of cervical mucus to predict when the odds of pregnancy are lowest, according to Planned Parenthood.

In the last two decades, the percentage of women accessing contraceptives in both developed and developing countries has increased. The United Nations Population Funds reports that in 2019, 63% of women aged 15 to 49 were using some form of contraceptive method and 58% were using a modern contraception method. This has improved women’s opportunities to choose when and how many children the want to have, which can positively impact not only their right to health, but also their right to education, work and an adequate standard of living, amongst other human rights (Meryl, 2023).

The Health Belief Model (HBM), developed by Rosenstock and Becker in the 1950s, is a theoretical framework that examines individuals’ motivations to engage in specific health behaviors. It has been applied to understand family planning behavior and predict uptake of contraceptive methods. The HBM offers a valuable framework for understanding the cognitive factors influencing family planning decisions. It can inform interventions addressing perceived susceptibility, severity, benefits, and barriers to family planning methods (Asefa et al 2015).

The Theory of Planned Behavior (TPB), developed by Ajzen in 1985, talks on perceived behavioral control as a determinant of intention and behavior. It has been widely applied to understand and predict the use of family planning methods. The TPB provides a valuable framework for understanding the factors influencing individuals’ intentions and behavior regarding family planning. By addressing attitudes, subjective norms, and perceived control, interventions can help individuals make informed choices and adopt family planning methods effectively (Koning et al 2012).

According  to a study carried out in Akwa-Ibom state, Nigeria by Cosmos Augustine on the Attitude of rural women towards family planning, 7.14% (n=35) women agree that they practice family planning in the rural area, while 78% (n=195) strongly disagreed that women in the rural areas of Akwa Ibom State practice family planning. The remaining 12.5% (n=20) were undecided (Cosmos et al, 2021).

In the Buea Health District of Cameroon a study revealed that, out of 958 respondents, 97% have incorrect knowledge of contraceptives whereas only 3% of respondents had the correct knowledge of contraceptives. This implies that respondents’ knowledge of family planning methods is very low, only male condoms have a significant significance while long-lasting reversible methods represent little knowledge on it. Many of the respondents need in-depth knowledge of all the available long-lasting reversible methods, their side effects, advantages, and how long they can last. Majority of respondents 73% had an incorrect attitude toward contraceptive methods, whereas 27% of respondents had correct attitudes toward contraceptive methods (Layu et al 2022).

1.2 Problem statement

Family Planning services support people’s decisions about when, or if, they would like to have children by offering education, counseling and birth control methods. Planned pregnancies spaced two or more years apart result in healthier babies and fewer medical problems for the woman. Planning for a child will help you avoid the social, health, and financial problems you face if an unplanned pregnancy happens. However, it seems that illiteracy, lack of knowledge, fear of side effects, and other socio-cultural factors create obstacles in using family planning methods. These obstacles in turn create adverse impacts on women health and society. For instance, failure to use contraceptives can cause unintended pregnancies which would leave the women at the risk of pregnancy related complications resulting in maternal morbidity and mortality. Moreover, multiple pregnancies also cause financial and social distress resulting in lack of ability to fulfill basic needs of a child. During a visit to Mamfe the researcher encountered a family with 12 children, the spacing between the children was very close, the children looked malnourished and unkempt with their mother focusing on the baby at hand. This situation kept the researcher puzzled. On a community internship at the Integrated Health Center Mile 16 Bolifamba, the researcher came across women with minimal child spacing, the children did not look like they were adequately cared for. 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 attitudes of women towards family planning methods in the Mile 16 community.

1.3 Rationale

Family planning is an effective intervention to improve the wellbeing of both mother and child. The researcher wanted to know if the women of Mile 16 Community are aware of the consequences of lack of family planning.

1.4 Research Question

1.4.1 Main Research Question

• What are the attitudes of women 18-35 years towards family planning methods in Mile 16 Community?

 1.4.2 Specific Research Questions

• What is the level of knowledge on family planning methods in women of the Mile 16 Community?

• What is the attitude of women towards family planning methods in the Mile 16 Community?
• What are the consequences of lack of family planning in the Mile 16 Community?

1.5 Objectives

1.5.1 General Objective

To assess the attitude of women aged 18-35 years towards family planning methods in the Mile 16 Community.

1.5.2 Specific Objectives

• To assess the level of knowledge on family planning methods in women ofthe Mile 16 Community.
• To find out the attitude of women towards family planning methods in the Mile 16 Community.
• To determine the consequences of lack of family planning in the Mile 16 Community.