KNOWLEDGE AND USE OF CONTRACEPTION IN OGOJA AND

OBUDU LGAs OF CROSS RIVER STATE, NIGERIA

Ugal David B. Ph.D

Department of Sociology
Faculty of the Social Sciences
University of Ibadan
Ibadan – Nigeria
Telephone: +2348057792492
Email: daveugal@yahoo.com

Abstract
Sexual behaviour in human societies is embedded in a complex web of shared ideas. Moral rules
and regulations, obvious associations and obscured symbols are part of the complex behaviour
patterns. Sexual behaviour varies from one culture to another, from one stage of development to
another as well as from one period of history to another. Many factors including biological,
social, political, educational, economic and religious affect sexual behaviour. This Study was
undertaken to assess the knowledge of women of modern contraception, examine the role of
culture in contraception use and find out the relation between background characteristics and
contraception use. The results of this study indicate that knowledge of contraception is relatively
low in both rural and urban centres of the study area. Given the importance of family planning to
the reduction of growing population, it is crucial to embark on an aggressive education and
enlightenment of the people on the need to use contraception in order to prevent unwanted,
unintended and ill-timed pregnancies. The media should be effectively harnessed to take its
rightful position in the dissemination of information to the people.

Background of the Study

Sexual behaviour in human societies is embedded in a complex web of shared ideas. Moral rules
and regulations, obvious associations and obscured symbols are part of the complex behaviour
patterns. Sexual behaviour varies from one culture to another, from one stage of development to
another as well as from one period of history to another. Many factors including biological,
social, political, educational, economic and religious affect sexual behaviour.
Nigeria is the most populous country in Africa, with more than 140 million people; it also has a
high annual rate of population growth (4.5%) and a total fertility rate of 6.0 lifetime births per
woman. Additionally, the country has relatively high levels of infant mortality (104 infant deaths
1
per 1,000 live births) and maternal mortality (800 maternal deaths per 100,000 live births). In
response to these and other serious demographic and health issues, the Nigerian government put
into effect a national population policy in 1989 reviewed in 2004 that called for a reduction in
the birthrate through voluntary fertility regulation methods compatible with the nation's
economic and social goals.
Despite high birthrates in most of Nigeria, government population and development policies
stress economic development rather than attempts to reduce fertility. The contraceptive
information and services offered to single women in most developing countries is compromised
by stigma attached to premarital sex (Ozumba et al., 2005).
Oye-Adeniran et al., (2004) indicated that large numbers of Nigerian women experience
unwanted or mistimed pregnancies and births. According to a 1997 survey of women in
southwestern Nigeria, at least 27% of women had ever been pregnant when they did not want to
be. Similarly, in a survey conducted in southwestern and northern Nigeria in the mid-1990s,
20% of women reported ever having experienced an unwanted pregnancy. Okonofua et al.,
(1999). The 2003 Demographic and Health Survey (DHS) found that of live births to women in
the previous three years, 15% were reported to be unplanned. It has been estimated that about
12% of all pregnancies in Nigeria (not including those that result in spontaneous abortion) end in
induced abortion, and another 9% result in unplanned births (Henshaw et al.,1998).
Unintended pregnancy poses significant public health risks. One consequence of unwanted
pregnancy is induced abortion. In the mid-1990s, the abortion rate in Nigeria was estimated at 25
per 1,000 women. At this rate, approximately 760,000 abortions will occur in 2006. Because
abortion is illegal in Nigeria except to save a woman's life, many procedures are conducted under
unsafe conditions and carry a substantial risk of maternal morbidity (Makinwa-Adebusoye et
al.,1997) and mortality. It is estimated that about 25% of women who have abortions in Nigeria
experience serious complications Oye-Adeniran et al., (2004). According to national surveys,
Nigerian women and couples want fewer children than they once did: Between 1990 and 2003,
the mean desired number of children declined from 5.8 to 5.3. (Bankole A et al., 2006). Even so,
levels of contraceptive use remain low: In 2003, only 7% of married women used a modern
contraceptive method and another 6% relied on a traditional or folk method (Hussain R et al.,
2005). The combination of low contraceptive use and smaller desired family size implies high
levels of unmet need for family planning in Nigeria. Indeed, among married women of
reproductive age, 32% do not want to have a child in the near future but are not using a modern
contraceptive method, and are therefore at risk of an unwanted pregnancy (Hussain et al., 2005).
Research on reasons for family planning nonuse in Nigeria generally points to women's
perceived lack of need for contraception, fear of side effects and opposition to contraception on
personal or religious grounds (NPC, 2004). Less is known about the circumstances surrounding
women's unwanted pregnancies and their reasons for seeking to terminate some of these
pregnancies. The limited evidence available from small studies in various parts of Nigeria
generally points to such reasons as a wish to space births, economic constraints, the desire to
remain in school and not being married (Oye-Adeniran et al., 2004). The purpose of this study is
to examine the current incidence of unwanted pregnancy among women of reproductive age in
eight states in Nigeria and to explore the factors associated with it. We utilize an approach that is
designed to minimize underreporting and to elicit reports of all unwanted pregnancies, regardless
of their outcomes. In addition, we explore women's reasons for not wanting a pregnancy, the
barriers they face to effective contraceptive use, and their use of abortion to terminate unwanted
pregnancies. Furthermore, we examine the level of risk of unwanted pregnancy and the reasons
given for not practicing contraception by women who are at risk.
Several studies have reported changes in Nigerians' knowledge of and attitudes toward family
planning. These studies, however, did not examine the association between attitudes toward
contraception and its use. Although studies have examined aspects of these issues in certain parts
of Nigeria, this study provides a more comprehensive analysis of the circumstances around
unintended pregnancies and the use of contraception. A better understanding of the underlying
and more immediate factors associated with unwanted pregnancy can inform the development of
programmes and policies that will help couples avoid unwanted or mistimed pregnancies
Study Objectives
The main objective of the study is to examine the knowledge and use of contraception among
women in Obudu and Ogoja Local Government Areas of Cross River States, Nigeria.
Specifically the study seeks to:
• Ascertain the women’s knowledge about contraception.
• Identify the types of contraception that they know.
• Examine how background socio demographic characteristics affect their use of
contraception.
• Explore how knowledge influences the use of contraception.
• Identify other factors that influence knowledge and use of contraception.
Research Questions
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 The research questions are;
1. What is the women’s knowledge about contraception?
2. Which contraception do women have knowledge/use?
3. Which background characteristics affect women knowledge and use of contraception?
4. Does Knowledge influence use of contraception use in any way?
5. What other factors influence knowledge and use of contraception?
Methodology
Study Area: The study area included two Local Government Areas of Northern Cross River
State, Nigeria. This region is made up of five Local Government areas but these two are the
oldest hence purposively selected as the main LGAs that the other three were created from. The
characteristics in all these LGAs are therefore found in these two. Ogoja LGA use to be the
provincial headquarters of Ogoja province. It has the features of an urban society as a result of
this while Obudu is the next oldest LGA in the Northern Cross River State.
Study Design:
Data for this study come from a community-based, cross-sectional survey of women conducted
in 2007–2008 in the two LGAs of Cross River State. The most urban state and the most rural
areas in each of the health zones were chosen; we used the rural-urban distribution of women in
the 1999 Nigeria DHS to make these determinations. From each LGA, we randomly selected
one urban and one rural community. Within each community, 10 enumeration areas were
randomly selected, and within each enumeration area, 10 households were selected for interview
using a systematic random sampling approach. We selected one woman aged 15–49 in each
household to be administered with the research instrument, yielding a total sample size of 1,423
women. Prior to administering the instruments, the research protocol—including the study
design, questionnaire, informed consent procedure and means of preserving respondents'
confidentiality—was reviewed and approved by Ministry of Health Ethical Committee Board of
the State.
Data were collected on respondents’ social, economic and demographic characteristics. To
ascertain women's socio-economic status, instrument asked a series of questions about household
assets and wealth. Using the approach developed by Filmer and Pritchett, we constructed a
wealth index variable indicating the level of wealth in each woman's household. As in the DHS,
women were asked which from a list of nearly 20 material goods (e.g., radio, television,
refrigerator and car) their household contained. A factor analysis to these data and classified
respondents into the low, middle and high tertiles of socioeconomic status.
In addition, participants were asked about their pregnancy and fertility behaviours and
preferences, contraceptive use history, sexual activity and experiences with unintended
pregnancy and induced abortion; however, obtaining information on unwanted pregnancies is
difficult. Women may be reluctant to report a birth as unwanted, and may be even more reluctant
to discuss unwanted pregnancies that they have terminated.
Our questionnaire led up to these issues by first asking women about other aspects of their
reproductive histories, including the numbers of pregnancies and live births they had had, and
their knowledge of and experience with contraception. Then, women were asked if they had ever
been pregnant when they did not want to be. If they responded in the negative the issue of
unwanted pregnancy again by asking "Has there ever been any time that a pregnancy would have
caused difficulties for you because of your circumstances or the opposition of someone else to
the pregnancy, even though you may have desired it?" Women who responded affirmatively to
either question were deemed to have had an unwanted pregnancy.
Method of Data Analyses: Univariate, bivariate analyses and multivariate logistic regression
analyses were performed to determine the prevalence of unwanted pregnancy and the factors
associated with that outcome. All estimates are weighted. Significance tests were undertaken
where appropriate. Because of this study's cross-sectional design and the fact that some women's
unwanted pregnancies had occurred years before the survey, the associations presented cannot be
interpreted as being causal. Date entry and analyses was done using the Statistical package for
Social Sciences (SPSS) version 15.
Results
Socio Demographic Characteristics of respondents
The table below displays the socio demographic characteristics of respondents in the
study. The age structure indicates a middle heavy age structure as is common in developing
areas. The highest is however the 25-29 age bracket with over 21 percent while the least is the
extreme end where population declines. A majority of respondents are women who are currently
married with 65 percent. This is within the framework of the assertion that child birth takes place
within wedlock while the least are those who are currently separated. Almost all the respondents
are Christians with over 95 percent reported to be Christians and a majority of these are
Catholics with 75.8 percent. This indicates that the area is a predominantly Christian area with
implications for contraceptive knowledge and use. The respondents are predominantly educated
with over 70 percent having secondary education and above. It is instructive that they are likely

5
change agents in matters relating to contraception.
The respondents are professionals with a high educational attainment. They are employed
in various occupations that require some professional training with civil servants as the next to
the professionals with 13 percent. They are employed in both public and private sectors of the
economy. As average income earners, a majority of the respondents earn between 11,000-20,000
naira.

Table 1: Distribution of respondents by Selected socio demographic Variables

Categories Frequency Percent
Age
128 9.0
< 20
20-24 240 17.0
25-29 306 21.6
30-34 268 18.9
35-39 164 11.6
40-44 138 9.8
45-49 78 5.5
50+ 93 6.6
Total 1415 100.0
Marital status
Single 349 24.7
Married 920 65.0
Cohabiting 40 2.8
Divorce 39 2.8
Widowed 44 3.1
Separated 22 1.6
Others 1 .1
Total 1415 100.0
Your religion
Catholic 1073 75.8
Protestn 264 18.7
Muslim 32 2.3
Traditnl 16 1.1
Others 30 2.1
Total 1415 100.0
Edu Qualification
122 8.6
Never attended school
Primary 183 12.9
Secondary 480 33.9
Degree 597 42.2
Others 33 2.3
Total 1415 100.0
Occupation
312 22.0
no response
Housewif 212 15.0
Professn 228 16.1
Clerk in govt 90 6.4
Empl in priv sector 82 5.8
Small trade 77 5.4
Artisan 35 2.5
Snr civil servant 184 13.0
Unskilld labour 97 6.9
No answer 90 6.4
Others 8 .6
Total 1415 100.0
Monthly Income
864 61.1
no response
 < 10,000 91 6.4
1,000-2,000 67 4.7
3,000-5,000 39 2.8
6,000-10,000 81 5.7
11,000-20,000 138 9.8
21,000-30,000 66 4.7
31,000-40,000 30 2.1
41,000-50,000 24 1.7
51,000 15 1.1
Total 1415 100.0
Residence
623 44.0
URBAN
RURAL 792 56.0
Total 1415 100.0
Age at First Birth
298 21.1
no response
< 20 283 20.0
20+ 834 58.9
Total 1415 100.0

This is common of professionals employed in different sectors of the economy. As a

young population, it is expected that only very few will earn over 50,000.00 naira representing
1.1 percent.
The residence of respondents is shown in the table as both rural and urban. Some 792 (56.0
percent) are residents of the urban areas while 623(44 percent) reside in the rural area. A
substantial percentage of residents started giving birth quite early with over 21 percent already
giving birth before their 20th birth day. This is an indication of a permissive society. The
knowledge of contraception must be crucial to help those who have debut sexual activity to
prevent unwanted and unintended pregnancies. This implies that the respondents structure is a
growing population.

Knowledge of Contraception
Most of the respondents have heard of contraception. Forty three percent of the respondents
reported to have heard about contraception. Though the source of information was not sought in
the questionnaire however, a majority of the respondents indicated that they heard about this
from friends and the mass media. The penetrating insight of the media on reproductive health is
crucial to this knowledge.
Condom is the commonest contraception that respondents use with 23.7 percent while the
least use is ovulation with 7.3 percent and others with 4.7 percent. The use of contraception is
very high among respondents despite the high non response to the first question on knowledge.
Over 60 percent of the respondents responded to be using one type of contraception or another.
This is indicative of a highly informed population as shown in table 1as highly educated persons.
7
 Table 2: Distribution of respondents by Knowledge/ use of Contraception
Categories Frequency Percent
Have You ever heard of Contraception 609 43.0
Type use
PILLS 223 15.8
INJECTION 253 17.9
CONDOM 336 23.7
OVULATION 103 7.3
OTHERS 70 4.9

Socio-Economic Characteristics and Contraceptive Use

Table 3 indicates that married women are the category with the highest number and
percentage of use of contraceptive. The singles are the next while those cohabiting are the least
of those who use contraception. This cohabit do so at either the instance of child birth or the
want of it. The table also indicates a significant relationship between marital status and the use of
contraceptives. This is also indicative that those who are usually in unions are the ones who want
to prevent unintended and ill-timed pregnancies since they use it more.
Contraceptive use is highest among those between 21-34 years. This age group is the
most sexually active by virtue of their age as young people for married or entering the sexually
active age. Those less than 20 years are the least in the use of contraceptive with 10.2 percent.
This is a sign that often they are outside marriage and engaged in sexual activity for fun. There is
a significant relationship between age and use of contraception.

Table 3: Distribution of Respondents by Socio demographic Characteristics and Contraceptive Use

X2 DF P
Have you ever used contraceptives? Total

Marital Status No response Yes No

Single 92 127 130 349
66.033 12 .000
6.5% 9.0% 9.2% 24.7%
Married 149 429 342 920
10.5% 30.3% 24.2% 65.0%
Cohabiting 1 8 31 40
.1% .6% 2.2% 2.8%
*DSW 10 45 51 106
.8% 4.3% 3.6% 7.6%
Total 252 609 554 1415
17.8% 43.0% 39.2% 100.0%
Age 75 144 149 368
<20 45.791 14 .000
5.3% 10.2% 10.5% 26.0%
21-34 101 207 205 574
7.1% 14.6% 14.5% 40.5%
35> 76 197 200 473
5.0% 13.8% 14.1% 38.0%
Total 252 609 554 1415
17.8% 43.0% 39.2% 100.0%
Religion
181 452 440 1073
CATHOLIC 12.544 8 .129
12.8% 31.9% 31.1% 75.8%
PROTESTN 52 127 85 264
3.7% 9.0% 6.0% 18.7%
MUSLIM 9 14 9 32
.6% 1.0% .6% 2.3%
TRADITNL 5 5 6 16
.4% .4% .4% 1.1%
OTHERS 5 11 14 30
.4% .8% 1.0% 2.1%
Total 252 609 554 1415
17.8% 43.0% 39.2% 100.0%
EDU.
34 40 48 122
Never Attended School 44.123 8 .000
2.4% 2.8% 3.4% 8.6%
Primary 37 57 89 183
2.6% 4.0% 6.3% 12.9%
Secondary 78 253 149 480
5.5% 17.9% 10.5% 33.9%
Degree 98 242 257 597
6.9% 17.1% 18.2% 42.2%
OTHERS 5 17 11 33
.4% 1.2% .8% 2.3%
Total 252 609 554 1415
17.8% 43.0% 39.2% 100.0%
Employed? 156 436 273 865
YES 72.747 4 .000
11.0% 30.8% 19.3% 61.1%
NO 96 173 281 550
6.8% 12.2% 19.9% 38.9%
Total 252 609 554 1415
17.8% 43.0% 39.2% 100.0%
RESIDENCE
URBAN 104 309 210 623
20.358 2 .000
7.3% 21.8% 14.8% 44.0%

RURAL 148 300 344 792

10.5% 21.2% 24.3% 56.0%
Total 252 609 554 1415
17.8% 43.0% 39.2% 100.0%
9
*Divorced, Separated and Widowed were added to increase reliability of test

Catholics are the highest religious category that use contraception with 31.9 percent.
There is a significant relationship between religion and use of contraceptive at 0.05 level of
significance.
The table also indicates that those who use contraception are those who have secondary
school education and above. The results show that those with secondary and tertiary education
have 17 percent contraception use compared with 2.8 percent for those who never attended
school. The change agent maxim mention earlier is brought to bear here, that is, those with
higher education are more likely to use contraception because information and exposure. There is
a positive significant between the variables.
Those who are employed are also more likely to use contraception. The table indicates
that those who are presently employed are over 30 percent likely to use contraception compared
with about 12 percent of those who are not employed.
The urban residents use contraception more that those in the rural areas. Three hundred
and nine representing 21.8 percent residents of urban centres use contraception as against those
in the rural areas. There is also a significance relationship between residence and the use of
contraception at 0.05 level of significance.
Knowledge and Use of Contraception
All respondents who have knowledge of a particular contraception use it far more than
those who do not know. From the table, it can be seen that respondent who have knowledge of
pills use it up to 48.1 percent against 36.1 percent among those who do not know it. The same
thing was through all other ones as those who know injection, condom and ovulation have 47.3
percent, 41.8 percent and 56.0 percent respectively compared to others that do not know them.
Table 4: Distribution of Respondents by Knowledge and Use
Knowledge X2 DF P
contra use Total
Yes No
PILLS Yes 681 511 1192 42.884 1 .000
48.1% 36.1% 84.2%
No 180 43 223
12.7% 3.0% 15.8%
Total 861 554 1415
60.8% 39.2% 100.0%
 INJECTION Yes 669 493 1162 30.863 1 .000
47.3% 34.8% 82.1%
No 192 61 253
13.6% 4.3% 17.9%
Total 861 554 1415
60.8% 39.2% 100.0%
73.174 1 .000
CONDOM Yes 592 487 1079
41.8% 34.4% 76.3%
No 269 67 336
19.0% 4.7% 23.7%

Total 861 554 1415

60.8% 39.2% 100.0%

OVULATION Yes 793 519 1312 1.024 1 .312

56.0% 36.7% 92.7%
No 68 35 103
4.8% 2.5% 7.3%
Total 861 554 1415
60.8% 39.2% 100.0%

MULTIVARIATE ANALYSIS
The multivariate analysis was done to find out the likelihood of contraception use using
all the variables in the bivariate analysis. The socio-demographic variables are used, this is
followed by the knowledge variables as they are regressed on the dependent variable that was
recategorise into use and non use. Meanwhile a response significantly higher than one is
interpreted as likelihood of use while responses lower than the reference category; the likelihood
of use is therefore low or poor.
The table indicates that the likelihood of contraception use is higher among those who are
age 35 years and above. This is because the odd ratio shows that this category of people is 1.189
times likely to use condom than those that are less than the reference category (those less than 20
years). Those within the age bracket 21-34 show a significant relationship with contraceptive use
while showing that the likelihood of contraceptive use is 6.90 times more likely than those who
are less than 20 years of age.
The table also shows that married people are more than once likely to use contraceptive
while those who are widowed, divorced or separated are more than twice likely to use

11
contraception. The former showed a statistical significance at 0.05 alpha level.
Protestants are more than once likely to use contraception with the others (Muslim,
Traditionalist, others) are not likely to use contraception. Those who have some education are all
more likely to use contraception than those with no form of schooling.
Those who are employed are more likely to use contraception because the reference
category which equals one is higher than those not employed. The urban residents are also more
likely to using contraceptives.
The table also indicates that those who have knowledge of the four types of
contraceptives are more than four times more likely to use them than those who do not know or
have knowledge of them. In fact there is a positive significant relationship between the
knowledge or contraception and use of same.
Table 5: Logistic Regression on selected variables

Categories Odds Ratio

Age
1.00
<20(ref)
21-34
.690*

35>
1.189

Marital status

Single(ref)
1.00

Married
0.606*

DSW
2.404

Religion

Catholic(ref)
1.00

Protestant
1.009*

Muslim
.552

Traditional
.450

Others
.326

Edu
1.00
No school(ref)
 Primary
.673

secondary
.892

Tertiary
.608

Others
1.486

Employed Yes(ref)
1.00

NO
.446*

Residence Urban(ref)
1.00

Rural
.951

Types Used Pills(ref)

5.257*

Injections
4.663*

Condoms
5.514*

Ovulation
2.209*

Others
2.451*

Ref-reference category, * Significant at P<0.05

Discussion
The results of this study indicate that knowledge of contraception is relatively low in both
rural and urban centres of the study area. This awareness is lower in Nigeria than it is in other
developing countries including Mexico, Kenya, India and South Africa (Ellertson etal., 2001;
Muia, 1999; Takkar et al., 2005; Larger etal; 1999)
The study also showed that condom was the commonest modern contraception followed
by pills. This corroborates the findings of Ozumba et al., 2005) who found that condom followed
by oral pills were the most popular contraceptive methods used because they can easily be
procured over the counter.
Presently married women were the most likely to use contraception in the study and this
finding is in line with the findings of Gilda etal, (2006) who found that married women are more
13
likely to use a contraceptive. Women who are in their twenties are the most likely to have used a
contraceptive. This explains that they are sexually active whether in marriage or not.
The Catholics are most likely to use contraception. This finding contradicts those of
Gilda etal, (2006) who found that “compared with Catholics, Muslim and other Christian had
odds of having had an unwanted pregnancy as a result of non use of contraception.
Education of respondents also played a very significant function in the knowledge and
utilization of contraception. This has been consistently stated as a function of use of study as it
shows that women with secondary education and above are more likely to use contraception as a
result of information they have on it (contraception).
Contraceptive awareness was more among the urban than rural respondent (Ozumba etal
2006). All respondent reported to have used these contraceptives that they have used these
contraceptives that they have heard about. This is a common trend because people are more
likely to use the method they are familiar with and not otherwise.
The multivariate analysis showed that the likelihood of using contraception was higher
among older women (Odds 1.189), DSW (2.404), Protestants (1.009), Catholics (1.00),
Employed (1.00), urban residents (1.00) and all those who have heard and use different
contraceptives.
This study has some limitation. For instance, the survey is relatively small conducted in
one part of Nigeria, the result require further investigation in other parts of Nigeria. It was also a
community based survey and the people do not have knowledge of contraception as shown by
results. Hence uptake of contraception may be lower here than other parts of the country.
CONCLUSION
Given the importance of family planning to the reduction of growing population, it is
crucial to embark on an aggressive education and enlightenment of the people on the need to use
contraception in order to prevent unwanted, unintended and ill-timed pregnancies. The media
should be effectively harnessed to take its rightful position in the dissemination of information to
the people. There is also need to examined and update the knowledge of providers themselves in
order to increase contraception coverage.
Service intentions are therefore necessary so that women know the different methods,
where to get it, and the appropriate time interval for its use.

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