CHAPTER ONE

INTRODUCTION
1.1 Background of the Study
Developing countries are characterized by rapid population growth which is usually due
to high fertility, high birth rates, and low contraceptive prevalence rate. In Sub-Saharan Africa,
the rate of population growth is high compared to the rest of the world. Consequently, the
number of people in need of health and education and basic infrastructure, among other public
benefits, is enormous. This in turn requires large amounts of resources and personnel, and it may
be an impediment toward the realization of the Millennium Development Goals. The
International Conference on Population and Development in 1994 affirmed the importance of
providing family planning within a rights-based framework and as part of a comprehensive set of
services to meet individual reproductive health needs that would also address broader
development concerns (Oyedokun, 2007).
Promotion of family planning in countries with high birth rates has the potential of
reducing poverty and hunger, while at the same time averting 32% of all maternal deaths and
nearly 10% of child mortality. Unintended pregnancy poses a major challenge to reproductive
health. Each year, over 210 million women around the world become pregnant, among which
36% are unplanned and/or unwanted, (WHO, Geneva: 2004). Nigeria currently has a high rate of
maternal mortality, and more than 40% of these maternal deaths are due to complications of
unsafe abortions as a response to unwanted pregnancy. The fertility rate in Nigeria is 5.7 children
per woman. The use of contraceptives has been found to be low at 13% in 2007 and with a
minimal increase of 3% in 2012 and 15% in 2017. This is very low compared to other countries
such as the US and Pakistan, (National Population Commission, 2018).
National Policy on Population for Sustainable Development launched in February 2005
by the Federal Government of Nigeria was based on the principle that achieving a higher quality
of life for people today should not jeopardize the ability of future generations to meet their own
needs (Health Policy Initiatives (HPI), 2005). The main targets of the program were to reduce the
national population growth rate to 2 percent or lower by 2015, reduce the total fertility rate by at
least 0.6 children every 5 years by encouraging child spacing through the use of family planning,
and increase the use of contraceptives for modern methods by at least two percentage points per
year through the use of family planning. If access to family planning services was increased, the

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unmet need for family planning could be addressed, thereby reducing the risk of maternal deaths,
slowing the population growth rate, and reducing the costs of meeting Millennium Development
Goals in terms of universal primary education, which is influenced by the number of children in
need of education (Moreland & Talbird , 2006).
Eko (2013) opined that family planning services offer various benefits to the household,
country, and the world at large. They permit individuals to influence the timing and the number
of births, which is likely to save lives of children. By reduction of unwanted pregnancies, family
planning services can reduce injury, illness, and death associated with child birth, abortions, and
sexually transmitted infections (STIs) including HIV/AIDS. Furthermore, family planning
contributes to reduction in population growth which subsequently leads to poverty reduction and
preservation of the environment as well as demand for public goods and services. In spite of all
the advantages and availability of family planning services, there is still persistently high fertility
in Nigeria. Although there is widespread awareness with regard to contraception in Nigeria, there
is no proportional increase in the adoption of the contraception measures, a pointer to the fact
that there are other variables that determine the uptake of contraception in Nigeria (Nigeria
Demographic and Health Survey 2013).
Previous studies have explored the determinants of contraceptive use among women of
reproductive age; in most cases they have included both demographic and socioeconomic
factors. Adebowale et al., (2010) found age, religion, residence, education, ethnicity, and media
exposure to family planning as significant predictors of current use of any contraceptive method.
Positive attitude to reproductive health issues have also been said to increase contraception use
and it was concluded that changes in attitude toward contraception may increase practice of
contraception in Nigeria (Odimegwu, 2000).
Contraceptive usage has been associated with improved maternal and child health (MCH)
outcomes. Despite significant resources being allocated to programs, there has been sub-optimal
uptake of contraception, especially in the developing world. The use of contraception helps
couples and individuals realize their basic right to decide freely and responsibly if, when and
how many children to have. It is important therefore, to eveluate factors that determine uptake
and utilization of contraceptive services so as to inform effective programming and as well
determine the usefulness of the practice in relation to child birth rate among married women in
Ushongo Local Government Area of Benue State.

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1.2 Statement of the Problem
The importance of family planning in addressing a range of challenges in developing
countries is now widely accepted. Family planning is a key factor in achieving the Sustainable
Development Goals. And getting it right can help countries in meeting related targets such as
education, particularly for women and girls. If done properly it can prevent unintended and high
risk pregnancies that often lead to the deaths of mothers and babies. It is important for other
reasons too: it can reduce women’s dependency by allowing them more opportunities to work.
And lower population growth, combined with a good political climate leading to improved and
sustainable economic development (Nwokocha & Michael, 2016).
Contraceptives lie at the heart of proper family planning. But its use can be shaped by
several factors. This includes cultural norms and values as well as the desires and decisions of
couples. Myths and misconceptions also play a role, including beliefs that people who use
contraceptives end up with health problems or permanent infertility, or, at one extreme, that
contraceptives reduce sexual urge, and at the other extreme they increase promiscuity among
women. Other contributing factors include low access to health care facilities and the patriarchal
nature of societies ( Isiugo-Abanihe & Ezebunwa, 2008).
Even though the trends of family planning indicators, total fertility rate and contraceptive
use in Nigeria have been improving, there is a challenge of increasing access to many women
who desire to limit or space births. The non-use of contraceptives by these women has a
commensurate effect on their total well-being and that of their children. Contraceptive use in the
country is incredibly low. The biggest contributor to the low uptake has been a lack of
knowledge about the various available options, combined with misconceptions about the use of
contraceptives. (Michael & Odeyemi, 2017).
But understanding what we mean by “knowledge” is key to unlocking Nigeria’s problem.
We all accept that human behaviour is generally affected by what people know. A reasonable
deduction would therefore be that knowledge about contraception should be an important
predictor of contraceptive use. The reasonable assumption would be that the more people know
about contraceptives, the more they would use it (Michael & Odeyemi, 2017). Nigeria’s 2013
demographic health survey showed that this isn’t the case (National Population Commission,
2018). About 85% of women and 95% of men reported knowing a contraceptive method. But
just 15% were using it. The unmet needs of women wishing to stop or delay births by not using

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contraception are 16%. There’s nothing to suggest that the situation has improved since the 2013
report. This is clear from Nigeria’s continued rates of population growth as well as maternal and
infant deaths.

In reference to the above findings, the researcher intends to find out the level of
knowledge and acceptability and further assess the contraceptive prevalence as well as examined
the predictors of contraceptive use among married women in relationship to the number of
children in Ushongo Local Government Area in Benue State, with a view to make appropriate
recommendations that will enhance the uptake of family planning services.
1.3 Research Questions
The following research questions have been formulated to guide and facilitate the collection of
relevant data.
1. What is the number of children by married women in Ushongo Local Government Area?
2. Do married women in Ushongo Local Government Area utilize contraceptive methods?
3. What is the effect of number of children on contraceptive use among married women in
Ushongo Local Government?
4. What can be done to inculcate knowledge of contraceptive use among married women in
Ushongo Local Government Area
1.4 Objectives of the Study
The general objective of this study is to assess the number of children and contraceptives use
among married women in Ushongo Local Government Area of Benue State. Specifically, the
study seeks to:
i. Examine the number of children among married women in Ushongo Local Government
ii. Examine the use of contraceptive among married women in Ushongo Local Government
Area.
iii. Examine the effect of contraceptive use among women in Ushongo local government.
iv. Make recommendations to improve the use of contraceptive among women in Ushongo
Local Government Area.
1.5 Research Hypotheses
The following hypotheses will be tested.
i. There is no significant relationship between the use of contraceptive and the number of
children among married women in Ushongo Local Government.

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1.6 Significance of the Study
This study is deemed significant in a variety of ways. Unplanned and unintended
pregnancies account to a large extent the poor state of health of women and children in most
developing nations. The choice of women to control their own health and that of their children is
challenged by Social and environmental factors, Demographic characteristics, cultural and
religious beliefs, and economic and educational levels of the female population. These can also
affect the selection of a contraceptive method. In this population-based study, we aimed to
compare the factors that influence the choice of contraception which mitigate their ability to
decide independently and freely on their reproductive and sexual choices. There are still
unanswered questions based on local settings that have not been revealed and still worsens the
situation of these vulnerable groups with regard to decision and choices to make in controlling
child birth. In order to give answers to the pronounced questions, the study has laid a platform to
provide knowledge to parents, government and health care workers to enable them decide
independently what choice to make as regards the use of contraceptive.
1.7 Scope of the Study
The scope of this study covered Ushongo Local Government Area of Benue State. With a
focus on investigating the number of children and contraceptive use to enable us examine the
effects and outline the strategies to instill the use of contraceptive among married women in
Ushongo Local Government Area of Benue State. The population of the study will cover the
entire married women in the study area. The study will last for the period of one academic
session that is nine (9) months
1.8 Definition of Terms
Family Planning: This may be defined as “educational, comprehensive medical or social
activities which enable individuals, including minors, to determine
freely the number and spacing of their children and to select the means
by which this may be achieved.
Contraceptive: May be defined as a measure or measures an individual may use or
apply to prevent pregnancy by interfering with the normal process of
ovu3lation, fertilization, and implantation.
Maternal Mortality or Death: is defined by the World Health Organization (WHO,2002) as
“the death of a woman while pregnant or within 42 days of termination

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 of pregnancy, irrespective of the duration and site of the pregnancy,
from any cause related to or aggravated by the pregnancy or its
management but not from accidental or incidental causes.
Child Birth Control: Birth control, also known as contraception and fertility control, is a
method or device used to prevent pregnancy.
Population: A population is the number of living people that live together in the
same place.

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 CHAPTER TWO
REVIEW OF RELEVANT LITERATURE AND THEORETICAL FRAMEWORK

This chapter covers a review of relevant concepts and theories. Some of the concepts that
will be considered in the study include: the concept of contraceptive, family planning, and the
theoretical framework will based on the planned behavior Theory
2.1 Conceptual Clarification
Contraception
Obstet (2011) defined contraception as the intentional prevention of conception through
the use of various devices, sexual practices, chemicals, drugs, or surgical procedures. Thus, any
device or act whose purpose is to prevent a woman from becoming pregnant can be considered
as a contraceptive.
Methods of Contraception
Adults, who are sexually active, regardless of age and race should be aware of family
planning options. The World Health Organization, for one, does not confine family planning
as a pregnancy prevention method alone. According WHO, (2012), it is about planned
conception and making sure that each newborn is wanted. Family planning makes use of
birth control techniques to primarily decide the number of offspring a family will have and
the best time to have each one. The decision of which birth control method to use is often
based on health concerns, habits, and vital personal preferences like religion. While only
abstinence assures complete pregnancy prevention, most contraceptive methods are highly
effective especially when correctly practiced. There are two major procedures for
contraceptives practice known as the natural (traditional) and artificial (modern) methods
(Jennie, 2020).
Natural Contraceptive:
a. Abstinence
Refraining from penetrative sex provides 100% protection from pregnancy, and offers
effective prevention of transmission of sexually transmitted infections as well. While this
may be an impractical long-term family planning method for married couples, there are
examples of periods of prolonged abstinence in certain cultural settings. Programs aimed at
unmarried adults and adolescents to delay first sex can have a positive impact in pregnancy
prevention and can have other health, education and economic benefits too (Aldo, 2017).

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b. Withdrawal or Coitus Interruptus
The withdrawal method of family planning is unlike other natural methods in that it is
male-controlled. Withdrawal has been used for centuries, following the discovery that
ejaculation into the vagina leads to pregnancy; this method prevents pregnancy by preventing
contact between the sperm and the egg. This method is practiced by significant percentages
of contracepting couples in Rumania, Turkey, the Czech Republic, and Mauritius. Most
couples in those countries cite concerns about health and side effects of modern methods as a
major reason for using withdrawal, along with partner preference, lack of knowledge of and
access to modern methods, and the cost of modern methods (Aldo, 2017).
An analysis of the literature on withdrawal revealed a lack of rigorous data on current
prevalence, acceptability, use-effectiveness, service delivery issues and safety of this method.
Although it has been criticized as an ineffective method, withdrawal probably offers a level
of contraceptive protection similar to that of barrier methods. Effectiveness depends largely
on the man’s ability to withdraw prior to ejaculation. The best estimates of effectiveness
indicate that about 4% of couples who use the method perfectly would experience a
pregnancy in the first year; among typical users, the probability of pregnancy would be about
19% in the first year of use. While this probably is not an ideal method of family planning, it
should remain an option for those who are using it effectively (Ryder, 2010).
c. Calendar Methods (based on calculations of cycle length)
In calendar rhythm method, a woman makes an estimate of the days she is fertile
based on past menstrual cycle length. She does this with the expectation that the length of her
current cycle, and thus the time of her fertile phase, will not vary greatly from previous
menstrual cycles.
Various versions of the calendar method exist, with each using a specific rule to
determine when the fertile phase is most likely to occur. All of the variations involve setting
the days of avoidance of unprotected intercourse by subtracting the upper limit of the rule
from the number of days in the shortest of the previous 6 menstrual cycles and subtracting
the lower limit of the rule from the number of days of the longest of the previous 6 menstrual
cycles. The calendar method is reportedly the most common of the natural methods;
however, the great majority of couples who report relying on this method do not follow such

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a methodological approach. In addition, women with irregular or unpredictable cycles are not
good candidates for this method (Kambic & Lamprecht, 2000).
d. Methods Based on Symptoms and Signs
Ovulation Method, Billings Method, Cervical Mucus Method
This method is based on the changes in cervical secretions due to the effects of
circulating levels of estrogen and progesterone, as described above. Introduced in the 1960s,
this method relies on daily self-examination for the detection of the quantity and evaluation
of the quality of cervical secretions. Women are taught to feel for secretions throughout their
cycles. Couples either abstain from sex or use a barrier method during menstruation and on
alternating days prior to the appearance of cervical mucus. They abstain from unprotected
intercourse from the time that the first sticky mucus appears until four days after the last
clear, stretchy, slippery mucus is observed.
Data collected during a World Health Organization (WHO) study in five countries –
New Zealand, India, Ireland, the Philippines and El Salvador – showed that, when this
method was used correctly, the first year probability of pregnancy was 3.4%, but that the
method was unforgiving of incorrect use; imperfect, or typical, use resulted in a 22.5%
failure rate in the first year.
e. Basal Body Temperature (BBT) Method
Due to the actions of progesterone on the hypothalamus, a woman’s body temperature
rises slightly after she ovulates (0.2 to 0.50 C) and remains elevated until the end of the cycle,
until menstruation. Women who use this method must chart their temperature every day,
immediately after waking up and before getting out of bed or drinking any liquids. Couples
relying on this method must abstain from unprotected intercourse between the first days of
menstruation until after the third consecutive day of elevated body temperature, so
unprotected sex is limited to the postovulatory infertile time. This method is quite demanding
for the couple as it imposes the longest duration of abstinence from unprotected sex, typically
between 14 and 21 days. The effectiveness is high, if couples can adhere to this schedule.
Among perfect users, the first year probability of pregnancy is only about 2%; during typical
use, the probability of pregnancy is closer to 20% (Arevalo, Sinai & Jennings, 2001).

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f. Sympto-Thermal Method
This method combines several techniques to predict ovulation. It typically includes
monitoring and charting cervical mucus and position and temperature changes on a daily
basis and may include other signs of ovulation, such as breast tenderness, back pain,
abdominal pain or "heaviness," or light intermenstrual bleeding. To use this method
correctly, couples must abstain from unprotected sex from the first sign or sensation of wet
cervical mucus until the woman’s body temperature has remained elevated for three days
after peak day is observed. Effectively, the method uses the guidelines of the ovulation
method to determine the onset of the fertile period and the guidelines of the BBT method to
determine its end. This method reduces the number of days of abstinence required by the
BBT method alone. However, the daily measurement and charting is more demanding than
any of the above methods. As with other natural methods, the pregnancy rate for perfect
users is about 2-3% in the first year; users who do not consistently follow the rules of the
method can expect a 13-20% chance of pregnancy in the first year (Delano, 2016).
g. Lactational Amenorrhea Method (LAM)
Research has confirmed that a form of breastfeeding to achieve contraception, called the
lactational amenorrhea method, or LAM, is more than 98% effective during the first 6
months following delivery. Based on years of data from thousands of women in more than a
dozen countries, the research also suggests that LAM may be dependable for longer –
perhaps up to a year after giving birth.
During breastfeeding, ovulation is inhibited by a series of physiological responses to
nipple stimulation. More frequent or intense suckling sends nerve impulses to the mother’s
hypothalamus that disrupt normal signals to the pituitary controlling hormone secretion; the
resulting abnormal pattern of LH secretion is inhibitory to ovarian activity. When
breastfeeding diminishes with less frequent breastfeeding and or more frequent supplemental
feeding, the chance of ovulation and subsequent pregnancy rises.
To use LAM correctly, a woman must remain amenorrheic (no menstrual bleeding)
since delivery, fully or nearly fully breastfeed, and be within six months of delivery. When
any of these criteria changes, the woman should immediately begin to use another form of
contraception if she wishes to prevent another pregnancy (Knoema, 2017).

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Modern (Artificial Method) of Contraception
Modern contraceptive use remains an important public health intervention and a cost-
effective strategy to reduce maternal mortality, avert unintended pregnancies and to control
population explosion, especially in developing countries. Despite these benefits, there are
reports of low usage among reproductive-aged women in most developing countries. Modern
contraceptive methods were invented so couples could act on natural impulses and desires
with diminished risks of pregnancy. Modern contraceptive methods are technological
advances designed to overcome biology. In this regard, modern methods must enable couples
to have sexual intercourse at any mutually-desired time. There are different methods of
modern contraception, including:
1. Birth Control Pills
Birth control pills are oral contraceptives that must be taken daily. The method is often
recommended for both women who are religious in remembering daily doses and those who
desire to restore fertility quickly (Super, 2020).
Birth control pills aside from its birth control properties, the pill also has health benefits. Both
progestin-only and combination pills lighten periods, reduce the intensity of menstrual cramps,
and lessen the possibility of ectopic pregnancies
The combination pill specifically helps prevent bone thinning, acne, ovarian cysts and cancers,
breast cysts, endometrial cancers, infections in the uterus, fallopian tubes, and ovaries, anemia,
PMS, and iron deficiency (Super, 2020).
Women on the pill can get pregnant immediately after stopping it- one of the reasons why
most women prefer the method. Also, taking the pill is made easier to remember with easy to
bring small pill packs (Super, 2020).
The most popular thing that women don’t like about birth control pills is the daily routine of
taking it. The use of alarms and reminder apps or pill pack just next to you may help in
remembering, but not a complete assurance. Also, like other medications, pills have their own set
of side effects (Super, 2020).
While they usually go away after a couple of months, most women on pills experience changes
in sexual desire, bleeding between periods, nausea, and sore breasts.

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2. Barrier Methods
Diaphragms, female and male condoms, as well as cervical caps all belong to the barrier
family planning methods. Basically, they work in preventing the sperm from getting close or in
contact to the egg. (Super, 2020).
For the methods to be effective, these must be anchored before the actual copulation takes place.
While thousands do not like the methods because somehow it inhibits spontaneity, barriers
prevent the spread of diseases as well as promote sharing of birth control responsibilities (Super,
2020).
The advantage of barrier methods are that is simple to use, widely available and must be
used before intercourse only. They protect both parties from possible spread of sexually
transmitted diseases and, often, are not contraindicated against most allergies.
Female condoms, specifically, are unlikely to tear even during the roughest sexual techniques
and can be inserted many hours before the sexual intercourse. (Super, 2020).
 However, it is extremely rare to use the male condoms perfectly as they are easily torn apart.
Also, frequent users report reduced arousal during sexual intercourse with the use of it.
Female condoms, on the other hand, easily dislodged and may result to the penis inserting
between the vaginal wall and the condom instead. There were circumstances where women
report a “noisy” method experience during the intercourse. (Super, 2020).
 3. Long-Term Contraceptive Methods
For individuals who would want to get pregnant in the future, but are not into regularly
prepping up against contraception, long-term methods are the best tools to use.
The methods include vaginal ring, contraceptive shots, intrauterine device or IUD, and
implantable rod. All these are not easily reversible and non-hormonal. However, fertility
immediately returns when the woman decides to discontinue its use (Super, 2020).
The long-term effect of not having to remember daily routines is the biggest advantage of
using these methods. It is extremely effective in preventing pregnancy although a few methods
halt menstrual periods.
The long-term contraceptive methods do not protect either of the parties from contacting
sexually transmitted infections. Also, most of these methods require surgeries for both the
insertion procedure and the removal of it. (Super, 2020).

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While there are rare instances of infections in areas of tool implantation, the most common side
effects include weight gain, nervousness, irregular menstrual periods, hair loss, and episodes of
depression. (Super, 2020).
Most importantly, it is not for use of all women. Those with maintenance medications are
discouraged from using any of the long-term contraceptive methods (Super, 2020).
4. Vaginal Ring
The vaginal ring (Nuva Ring) is a newer form of birth control. The actual design of
vaginal rings for contraception was first developed in the 1970s. Vaginal rings deliver a
combination of estrogen and progesterone. The hormones are released slowly and are absorbed
directly through the walls of the vagina. Preliminary studies have shown that they work to
prevent pregnancy, similar to birth control pills, with fewer side effects (Super, 2020).
Vaginal rings are used in the same manner as birth control pills, with the ring being left in
the vagina for three consecutive weeks, followed by removal for a week during which time a
menstrual flow is anticipated. (Super, 2020).
If the ring is expelled spontaneously and remains out for more than 3 hours, another form
of birth control should be used until the next period begins, at which time a new ring may be
reinserted. The vaginal ring is only available by prescription (Super, 2020).
5. Injections
An injection of a synthetic hormone depomedroxy-progesterone acetate (DMPA, brand
name: Depo-Provera) can be given every 3 months to stop ovulation. You receive it by injection
in the doctor's office. After injection, the medication is active within 24 hours and lasts for at
least 3 months. It prevents your ovaries from releasing eggs. DMPA is an extremely effective
contraceptive option. Other medications or patient weight do not diminish its efficacy. The
failure rate is approximately 0.3% during the first year of use (Super, 2020)..
DMPA does not produce the serious adverse effects seen with estrogen, such as a
tendency to increase blood formation. It lowers risk for certain types of endometrial cancers.
Problematic irregular periods may normalize with Depo-Provera usage.
Some women may cease menstruating within the first year of usage. Irregular bleeding
can be treated by giving the next dose earlier or by adding a low-dose estrogen temporarily.
Because DMPA lasts in the body for several months in women who have used it on a long-term
basis, it can significantly delay a return to normal fertility. About 70% of former users desiring

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pregnancy conceive within 12 months, and 90% will conceive within 24 months. Other adverse
effects, such as weight gain, depression, and menstrual irregularities may continue for as long as
1 year following the last injection. Recent studies suggest a possible link between DMPA and
bone density loss. Results are conflicting and limited.
2.1.2 Family Planning
According to the World Health Organization (WHO, 2008) family planning is 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. The importance of family planning is clear from its benefits
to individuals, as well as to families, communities, and societies (Agi, 2003). Family planning
serves three critical needs: (1) it helps couples avoid unintended pregnancies; (2) it reduces the
spread of sexually transmitted diseases (STDs); and (3) by addressing the problem of STDs, it
helps reduce rates of infertility. These benefits are reflected in the federal government’s
continued recognition of the contribution of family planning and reproductive health to the well-
being of people.
According to the Center for Disease Control and Prevention CDC, (2002), family
planning is one of the ten great public health achievements of the twentieth century, on a par
with such accomplishments as vaccination and advances in motor vehicle safety. The ability of
individuals to determine their family size and the timing and spacing of their children has
resulted in significant improvements in health and in social and economic well-being (IOM,
2000). Smaller families and increased child spacing have helped decrease rates of infant and
child mortality, improve the social and economic conditions of women and their families, and
improve maternal health.
The ability to time and space children reduces maternal mortality and morbidity by
preventing unintended and high-risk pregnancies (World Bank, 2000). Unintended pregnancy is
associated with an increased risk of morbidity for the mother and with health-related behaviors
during pregnancy, such as delayed prenatal care, tobacco use, and alcohol consumption that are
linked to adverse effects for the child. According to the Institute of Medicine (IOM) report: the
child of an unwanted conception especially (as distinct from a mistimed one) is at greater risk of
being born at low birth weight, of dying in its first year of life, of being abused, and of not
receiving sufficient resources for healthy development. The mother may be at greater risk of

14
depression and of physical abuse herself, and her relationship with her partner is at greater risk of
dissolution. Both mother and father may suffer economic hardship and may fail to achieve their
educational and career goals. Such consequences undoubtedly impede the formation and
maintenance of strong families. (IOM, 2001)
In 2000, approximately half of unintended pregnancies resulted in abortion (Finer and
Henshaw, 2006); thus the availability and appropriate use of contraception can also reduce
abortion rates (AGI, 2003). When children are adequately spaced (with conception taking place
no sooner than 18 months after a live birth, or about 2.5 years between births), they are less
likely to suffer complications. Such complications include low birth weight, which is associated
with a host of health and developmental problems (Conde-Agudelo et al., 2006).
2.2 The Number of Children and Contraceptive Use among Married Women
Contraceptive use helps couples and individuals realize their basic rights to decide
freely and responsibly if, when and how many children to have. The growing use of
contraceptive methods has resulted in not only improvements in health-related outcomes
such as reduced maternal mortality and infant mortalitys, but also improvements in schooling
and economic outcomes, especially for girls and women (Maharjan, 2012).
Family planning is the major component of reproductive health. It can save human
life, controlling unwanted pregnancy, limiting the number of birth, avoiding unsafe abortion,
preventing transmission of sexual transmitted disease (STDs). Consequently reducing infant
and child mortality is on one hand and on the other hand, it directly controls fertility and
population growth. Therefore, the utilization of the family planning method has been
increasing day by day as a means of birth controls recognized early in the development
process (Maharjan, 2012). Family planning is also the systematized process through which
medical science is applied to control and plan the number of children and their spacing as
desired by the couple. WHO (2010) defines family planning as a way of thinking and living
which is adopted voluntary, upon the basis of knowledge, attitude and responsible decision
by individuals and couples to promote the health and welfare of the family. Family planning
is very important aspect to maintain the reproductive health of male and female. The main
aims of family planning program should be spacing of the children and to have the
information and means to do so and to ensure informed choices and make available a full
range of safe and effective method (Sharma,2009).

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 In Nigeria, only 15% of women who are aged 15-49 use contraception for limiting
and spacing of birth. It is estimated that a Nigerian woman gives birth to an average of 5.5
children in her lifetime (Funke , 2017).
2.3 Global use of contraceptives
The World Health Organizations (2009), view reproductive rights as “Reproductive
rights rest on the recognition of the basic right of all couples and individuals to decide freely
and responsibly the number, spacing and timing of their children and to have the information
and means to do so, and the right to attain the highest standard of sexual and reproductive
health also include the right of reproduction free of discrimination, coercion and violence”
can serve as guidelines in reviewing married women contraceptive use. As at 2011, the
prevalence rate off contraceptives was estimated at 63% worldwide (World contraceptive use
2013). The use of contraceptives is increasingly becoming one of the essential basic element
to married women reproductive health’ as it gives them a sense of freedom to exercise their
sexuality and a sense of power in view that they will be able to manage their lives in dignity
(Khan & Mishra, 2008).
Attainment of easy access to the reproductive health need globally is still quite far
from being achieved; it is estimated that about 143 million women in sexual relationships
globally, face an unmet need for contraceptives; this number has a probability of rising up to
215 million when traditional methods of contraceptives are included (Westoff,
2006).According to the WHO (2013), sexual education within the married women
community is still a challenging issue and of great concern globally, this is due to its
sensitive nature and bias acquired from the ways and values that are personal, regional or
associated with local traditions.
2.4 Contraceptive use in Africa
Data available indicates that Sub – Saharan Africa has a prevalence rate of
contraceptive use being below 30% (Cates, 2010). Again, Africa has 53% of its female
population in their reproductive age, having an unmet need for modern contraceptive
methods, with the number of females between the ages of 15 -45 who reported to using
contraceptives in Africa rising from 24% to 27% between 2008 to 2012 (Darroch & Singh,
2013).

16
 The percentage of married women who give birth is quite high in Sub-Saharan Africa,
this predisposes them to illness and death amongst both the young mothers and their babies;
Chad and Mozambique for instance have more than 50% of their married women aged 19
already having at least one child (Clifton, et al., 2008).
2.5 Contraceptive Use among Married women
According to WHO; the World Health Statistics shows that, worldwide the typical
birth rate among married women between age 15-45 years is 491000 for girls. The country
margin is between 1 to 299 delivery per 1000 females, with the top margin found in sub –
Saharan Africa; with an estimate of about 3 million married women girls undergoing unsafe
termination of pregnancies resulting from non-contraceptive use annually (WHO, 2014).
In most rural African settings, conceiving of babies is seen as something that occurs naturally
and thus must not be subjected to any form of interference artificially or deliberately, thus the
use of contraceptives is not encouraged, no matter the consequences of non-usage to the
parties involved (Akyeah, 2007).
Sub-Saharan Africa generally has low literacy rate, poor access to materials, and
information on health care as well as well as the needed infrastructure which has negative
effect on their contraceptive use (Palamuleni, 2013).
In recent years, the use of contraceptives among married women between the ages of 15 -45
in Kenya for instance, shows that the prevalence rate for the use of contraceptives rose
between 2003 -2009 (Obare, et al., 2009). In Sudan, the prevalence of contraceptive use
(24%) is a bit low as compared to that of other African countries and globally (Frini, et al.,
2013).
In Ethiopia for instance, more than 60% of pregnancies recorded among married
women are mainly unwanted, leading to unsafe abortion practices that most often end up
being the cause of maternal mortality and morbidity (Tessama, et al., 2015).
Ghana has a strong policy on sexual reproductive health. Its objectives mainly is to “promote
programs that will improve the knowledge of married women on sexual reproductive health
which will in turn guide them to develop socially acceptable and responsible attitudes
towards sex and sexuality” .It also gives support to programmes and researches to help
decrease the rates of Unplanned pregnancies and transmission of sexually transmitted

17
infection and all undesirable conditions associated with unhealthy reproductive health (NPC,
2004).
Findings from studies among married women found in Kintampo in the Brong Ahafo
region of Ghana has revealed that there was high level of inconsistent use of contraceptives
among married women; this was evident in the fact that some of the respondents were
already teen parents and were being confronted with harsh social consequences, other
married women had also undergone unsafe abortion procedures and might be faced with
challenging issues with regards to their fertility in future, whiles others on the other hand
were still carrying their pregnancies; this might mean the end of education for such young
mothers and bring about immerse hardship to both mother and child socially and
economically (Boamah, et al., 2014).
2.6 Knowledge of Contraceptive Use
Married women generally have little knowledge of contraceptives and their effective
use. According to a 2004 Youth Reproductive Health Survey using 12 – 19 year olds,
Awusabo– Asare, et al (2006) observed that at least 90% of the married women studied, at
most knew of one form of modern contraceptives. Quite worrisome was the fact that, the
male condom was mostly the only known form of contraceptives; their knowledge of other
contraceptive methods was not quite assuring. With regards to the pills, 55.7% males and
52.7 % of the females had some knowledge of its usage. Regarding to the Intra Uterine
Device 23.1% of males and 235 of females were aware of it. Also there was 55.5% and
56.5% familiarity with the use of injectable among the males and females respectively.
Regarding the use of implants, 17.6% of the males and 18.7% of the females had knowledge
of it. Males had 20.1% and females 18.4% knowledge with regards to emergency
contraceptives. The highest knowledge level was with the male condom; of the total
population, 90.6% and 87.9% of the males and females were recorded as being familiar with
this method. The Foam or Jelly recorded the least known among the married women with
15% of the males and 11.8% of the females having knowledge of its usage (Biddlecom,
2009). In a study of four sub Saharan countries namely Ghana, Malawi Uganda and Burkina
Faso; it was observed that education on sex is very essential in married women men using
contraceptives regularly.

18
 Male married men who had received some form on sex talk in school showed that
they were considerably more susceptible to using condom consistently, as related to their
peers who had not received any sex talk or education (Bankole, et al., 2007).
Demonstrating how to use condom appropriately tended to have a positive outcome in
the sense that, male married women who had been taught how to use the condom through
demonstrations, were more likely to engage in condom use during sexual encounters, as they
had been given a form of education on how it is supposed to be used (Bankole, et al.,
2007).During a research conducted in a rural based South African University, the teenage
participants stated the lack of knowledge on the use of contraceptives as one of the leading
causes of teenage pregnancy (Lebese, et al., 2015).
Having knowledge and a good understanding off contraceptives and their uses tended
to be an essential step towards the overall acceptance towards initiating or using
contraceptives during sex (Khan & Mishra, 2008). Knowledge of contraceptives is generally
poor, married women are misinformed; thus making usage low even though they have
positive attitudes regarding the use of contraceptives, they have the believe that it is
especially not safe for female users though contraceptives are available making the us e of
contraceptives underutilized in Nagpur (Relwani, et al., 2012).
In Kenya for instance, though there was knowledge on contraceptive use during a
study to ascertain the knowledge, perception and information that the married women in
Kenya had concerning contraceptives; it showed that the knowledge was deemed to be
shallow, since some of the participants could not distinguish the fact that condom was the
same as contraceptives (Miano & Mashereni, 2014).
A gap exist between the knowledge married women have on contraceptive use and the
actual use, of the contraceptives, conducting a research among married women in selected
senior High 14 Communities in the Central Region of Ghana, Hagan & Buxton, (2012) found
out that though 18.7% of the married women were knowledgeable about contraceptives, as
high as 48% were engaged in sexual activities where they admitted contraceptives was not
used always. Males usually have low levels of knowledge concerning the different
contraceptive methods as compared with females (Tilahum, et al., 2013).
Also, with married women in Ghana for instance, there are no exact courses in the
educational curriculum labeled as sex education tools; both the teachers and married women

19
alike make do with subjects that have relevant education on sex they are able to get from
Reproductive health topics in Reproductive system in biology as well as a couple of Family
Life subjects in Social Studies (Asiedu, et al., 2014). The appropriate use of contraceptives,
prevention of sexually transmitted diseases and infections, coping with secondary sexual
characteristics and relationships needs severe attention in the lives of married women
(Tenkorang & Adjei, 2014).
2.7 Perception of Contraceptive Use
Nigeria has a prevalence rate of contraceptive use which is less than 13%. Some of the
reasons why contraception use is quite little, largely stems from the perception that use of
contraceptives might result in infertility especially among the females later on in life (Omo-
Aghoja, et al., 2009)
Most of the female In a study conducted by Manena – Netshikweta (2007) among secondary
school married women in the Limpopo Province, 88% answered “no” when asked if they
engage their partners in whether to use contraceptives during sexual intercourse. This they
claimed was so due to the fact that they felt uncomfortable and had the fear of passing
themselves of as immature, and thus losing their partners in the process should they insist on
taking protective measures.
Bangi, (2011) conducted a study among married women aged 15 – 45 in Lagos, Nigeria; out
of 35 of the respondents, only 4 responded to having used contraceptives in their sexual
encounters, whiles the rest of the 31 admitted to never resorting to any form of contraceptive
use. This they claimed was because they had the perception that contraceptives were only
meant for married people and not teenagers. Again, family planning and contraceptive use is
viewed as a tool for promoting promiscuity among the female population (Nettey, et al.,
2015).
In her research work “They will wonder what kind of a girl I am”: Married women
perceptions towards contraceptive use in Nairobi, by Kinaro, (2012), the results showed that
generally there was poor perception towards contraceptive use by the parents and guardians
of the married women. What they did mostly, was to dissuade their wards from engaging in
contraceptive use, because to them it is only meant for married adults. Misperceptions
towards the use contraceptives made married women belief that, the use of contraceptives
(condom) for example could be harmful to the female during sex (Biddlecom, 2007).

20
Parental views and values played a crucial part in influencing the married women’s views
toward contraceptives, with most of the females more than their male counterparts perceiving
their parents would raise objections if they should find out they are using or would like to use
contraceptives (Kinaro, 2012).
In Nigeria, a married male residing in the Onu refugee camp shared his view on why
he was not on contraceptives and also discouraged his partners from using it despite being an
married women father. In his own words, he explains his perceptions as “my girlfriend likes
to use contraceptive to prevent pregnancies, but I have advised her not to use it again because
it is not good for unmarried people like us. I told her it can affect her womb and prevent her
from giving birth in the future when she gets married and when she is ready to have children;
Contraceptives like pills and injections are only good for married people who already have
children” (Okanlawon, et al., 2010).
Most married women are of the view that sex before marriage should not be practiced,
however, it is quite intriguing to know they practice the contrary; in a study conducted by
Awusabo-Asare, et al., (2006) the outcome was that 87% and 84% of females and males
respectively who held this notion that females should remain virgins prior to marriage, were
themselves sexually active. Religious beliefs also make it quite difficult for the married
women to boldly request for the use of contraceptives or seek education from health care
provider (Biddlecom, 2009; Okereke, 2010). This is thought to be so because there is a
shared perception that, once the married women is given education on sexual and
reproductive health issues , the education might in turn lead to the married women becoming
more sexually aware of themselves (Awusabo –Asare, et al., 2008).
Once there is an acceptance as to why a particular contraceptive method should be practice, it
will have an impact on the use of that particular method; this is so because, different
contraceptive methods have different efficiencies, effectiveness and side effects (Alkema,
2013). As high as 80% of married women who were engaged in a focused group discussion
using married women within the Buffalo City Municipality of Eastern Cape, found in South
Africa, viewed contraceptives as being harmful to their health and fertility as well as it not
being an acceptable practice (Mnyanda, 2013).
Some married women also have the perception that, they are insusceptible from the
dangers resulting from not using contraceptives, which includes getting pregnant and they

21
also perceive contraceptive use will lead to them gaining weight, so avoid using it (Hagan &
Buxton, 2012).
Married women in recent times perceive that engaging themselves in sexual activities
is the “In thing”, meaning it is in trend with modernization and also perceive that having a
relationship devoid of sex was not possible (Okereke, 2010).
Peer group seems to have the most influential outcome on married women sexual behaviors;
married women with most of their friends being the opposite sex have been seen to have
higher possibility of becoming sexually active where as those with most friends who are of
the same sax have less possibility of being sexually active (Bingenheimer, et al., 2015).
Family values and ideals can be altered my married women just to get peer acceptance; thus
married women who perceive their friends to be in sexual relationships are more likely to
initiate sex and have multiple sexual partners as in contrast to those who believe their friends
are abstaining (Nikken & deGraaf, 2013).
2.8 Attitude towards Contraceptive Use
Married women are very vulnerable to contracting sexually transmitted diseases and illnesses
such as HIV and AIDS, as well as pregnancies not planned for due to their negative sexual
behavior towards contraceptive use (Gupta, et al., 2008).
Within the United States alone, there are about 61 million females who fall within
childbearing age (Daniels, 2013). Generally, 43 million of them are at risk of unplanned
pregnancies, but may however have to deal with the threat of unplanned pregnancy if they
avoid using contraceptives regularly or using it in the correct way (Jones, 2012).
The age at which married women begin having sex or practice sexual activities differs a lot;
it normally depends on the kind of mingling experiences and opportunities at their disposal
which enables them engage in such sexual activities (Atere, et al., 2010).
Studies in Malawi have shown that the use of contraceptives increased with age of the
participants; older married women between ages 18-24 were more likely to use protection
during sex, also conversations relating to sexuality and reproductive health issues between
married women, their parents and family at large tend to increase contraceptive awareness
among married women (Melaku, et al., 2014). In recent years, the male population is
beginning to approve and embrace the use of contraceptives; however they are more
comfortable with the female methods of contraceptives (Iribhogbe, 2013).

22
 A study to examine the attitude married women exhibited towards contraceptive use,
by Florence Ugoji found out that there was actually a significant difference in the knowledge
of contraceptives and the attitude married women tend to exhibit towards the actual use of
contraceptives; in fact, results showed that it was rather their attitude that influence the
knowledge they acquire towards the use of contraceptives (Ugoji, 2013).
Sexual activities among married women starts quite early, this is because married
women as low as age 14, were found to be sexually active in studies conducted within
Ghana, Burkina Faso, Malawi, and Uganda which are all within sub- Saharan Africa
(Biddlecom, et al., 2007). This was quite similar to findings among North Eastern Brazilian
married women whom studies show had a high rising percentage of married women who
became sexually active before the age of 15 (Costa, et al., 2014).
Even though a considerable large number of married women Kenyans were living with their
parents, they were quite fast with the attitude to list their parents as the least person they will
seek information concerning sex and contraceptives (Kinaro, 2012).
A study of contraceptive use among married women randomly selected among seven
second cycle institutions in the greater Accra region showed that the main reason attributed
to the low use contraceptives among themselves was due to the fact that, most of them were
ignorant and felt shy purchasing contraceptives. Also, just 23.3% and 11% of the males and
females who admitted using contraceptives, actually did so consistently (Baku, 2012). A
2005 study by Youth reproductive health survey, among married women aged 12 to 19 years,
58.5% and 60% of the females responded positively when asked if they had had discussions
relating to contraceptive use with their partners (Awusabo- Asare & Biddlecom, 2006).
Having sex prior to marriage is not an issue with married women in Ghana only; Bankole, et
al., (2004) revealed in their work “the knowledge of correct condom use and consistency of
use among married women in four countries in sub Saharan Africa” that married women
between the ages of 12 to 19 in these countries were sexually active. Ghanaian married
women had 15% and29 % of male and female being involved in sexual activities. Malawi
had 60% for males and 37% for females , Burkina Faso reported 34% for males and 45% for
females , whiles Uganda had 49% and 48%;showing that Ghana seems to have less compared
with the other three countries (Bankole, et al., 2007).

23
 Parents of married women normally avoid discussing issues relating to sex and
contraceptives with their wards, they believe their children are too naïve and not matured
enough to be able to have sexual thoughts or be involved in any form of sexual activity
(Elliot, 2014). Married women who had prior communication with their parents before the
onset of sex are three times likely to engage in the use of condoms or contraceptives during
their first sexual encounter, with a high probability of having their first sex at an older age
(Winskell, et al., 2011).
A number of married women are discouraged by their parents not to enter into sexual
relationships, while others on the other hand are influenced to do so mainly due to the
financial rewards such relationships bring to them, here Nyovani, et al., (2007) identified that
married women from low economic background were 2.7 times likely to engage in sexual
activities as against those who were well do. Most women in the Kwabre District in a study
was realized had high knowledge of contraceptive us, but its usage was rather low due to the
fact that, they claimed that though there was family planning services available, the quality of
services given is on the low side in terms of the different contraceptives available (Baidoo,
2013).
The choice to utilize contraceptives when having sex involves dynamic thought
procedures and maturity of the mind; initially, the decision to use contraceptives has a direct
link to one’s personal and socio cultural factors. Later, the economic and health related issues
then determines the use of contraceptives (Clottey, 2012).
In Ghana, Awusabo- Asare, et al., (2008) found out from studies that one of the main
challenges impeding contraceptive use, as well as modern health care facilities among
married women was the attitude of health care service providers; and this was seen in
responses given by the health service providers themselves; some were sympathetic and
created welcoming environments for the young in their facilities, whiles those who were less
sympathetic to the married women reproductive health needs often turned them away, most
especially those who went in seeking for services related to abortion or sexually transmitted
infections. A third group of health providers also stereotyped young people either by
imposing their own values on them or by projecting the behaviour of their parents or society
on them, thus building barriers in the way of married women’s access to contraceptives and
sexual reproductive health services.

24
 The value placed on education by married women tends to influence their use of
contraceptives; those who desire to attain higher education before having babies are very
likely to use protection (Kapito, et al., 2012). Among secondary married women in plateau of
state in Ningeria, the married women responded that poverty and high rate of school dropout
as well as poor school attendance, tended to impart negatively on contraceptive use, making
it problematic with as high as 74.7% of the females and 82.1% of the males responding that
they do not use any form of contraceptives despite being sexually active (Rondini & Krugu,
2009).
2.9 The Effects of Contraceptive Usage on the Number of Children
Family planning allows people to attain their desired number of children and
determine the spacing of pregnancies. It is achieved through use of contraceptive methods
and the treatment of infertility. By preventing unintended pregnancy, family planning
/contraception prevents deaths of mothers and children. Family planning reinforces people’s
rights to determine the number and spacing of their children. Family planning / contraception
reduce the need for abortion, especially unsafe abortion.
Until the 1960gs rhythm and barrier contraceptives were the only methods of birth
control widely available to couples desiring to plan the number and spacing of their children.
In the 1960s oral contraceptives (OCs) were introduced and new efficacious intrauterine
devices (IUDs) became widely available, so that the choice of effective methods of
contraception increased substantially. Later, in the 1970s, female and male sterilization
techniques became much more widely accepted and used. Couples were then able to choose
from several different temporary and permanent methods of contraception and to switch from
one to another. Worldwide, family planning programs expanded, and the prevalence of
contraceptive use increased.
As these methods of contraception became more widely used, anecdotal reports of
adverse health effects associated with their use began to appear. Since the late 1960s and
early 1970s, epidemiologic studies have more rigorously evaluated the health effects
associated with the use of different contraceptive methods. Most of these studies have been
conducted in the United States and Europe. In the process researchers have recognized that
different contraceptive methods have important beneficial health effects, in addition to the
desired effect of preventing pregnancy. Although much research is still needed, especially

25
targeted to the developing world, a large body of information is now available to assess the
health effects of the various contraceptive methods.
2.10 Benefits of Contraception as a Method of Family Planning
The promotion of family planning and ensuring access to preferred contraceptive
methods for women and couples is essential to securing the well-being and autonomy of
women, while supporting the health and development of communities. Some of these
benefits are as follows:
1. Preventing pregnancy-related health risks in women
A woman’s ability to choose if and when to become pregnant has a direct impact on her
health and well-being. Family planning allows spacing of pregnancies and can delay
pregnancies in young women at increased risk of health problems and death from early
childbearing. It prevents unintended pregnancies, including those of older women who face
increased risks related to pregnancy. Family planning enables women who wish to limit the
size of their families to do so. Evidence suggests that women who have more than 4 children
are at increased risk of maternal mortality. By reducing rates of unintended pregnancies,
family planning also reduces the need for unsafe abortion. (WHO 2018).
2. Reducing Infant Mortality
Family planning can prevent closely spaced and ill-timed pregnancies and births, which
contribute to some of the world’s highest infant mortality rates. Infants of mothers who die as
a result of giving birth also have a greater risk of death and poor health.
3. Helping to Prevent HIV/AIDS
Family planning reduces the risk of unintended pregnancies among women living with
HIV, resulting in fewer infected babies and orphans. In addition, male and female condoms
provide dual protection against unintended pregnancies and against STIs including HIV.
4. Empowering People and Enhancing Education
Family planning enables people to make informed choices about their sexual and
reproductive health. Family planning represents an opportunity for women to pursue
additional education and participate in public life, including paid employment in non-family
organizations. Additionally, having smaller families allows parents to invest more in each
child. Children with fewer siblings tend to stay in school longer than those with many
siblings (WHO 2018).

26
5. Reducing Adolescent Pregnancies
Pregnant adolescents are more likely to have preterm or low birth-weight babies. Babies
born to adolescents have higher rates of neonatal mortality. Many adolescent girls who
become pregnant have to leave school. This has long-term implications for them as
individuals, their families and communities.
6. Slowing Population Growth
Family planning is key to slowing unsustainable population growth and the resulting negative
impacts on the economy, environment, and national and regional development efforts
(WHO, 2018).
2.11 Health Workers Attitude and Contraceptive Acceptance by Women
There is scanty literature on health workers attitudes on prospective users of
contraceptives. Available documentation of staff attitudes has to do with the general
provider-clients relations in respect of total quality assurance in services delivery.
Contraceptive provision in many settings continues to be based on outdated medical
information, unproven theoretical concerns, and provider biases. Studies have found that in
some developing countries 25-50% of women seeking contraceptives are refused services
until they are menstruating.( Stanback et al., 1999). Coupled with effective training,
checklists can be important tools for health care workers at various levels to apply the latest
WHO medical eligibility criteria and guidelines for contraceptive use. The pregnancy,
combined oral contraceptive (COC), depot -medroxyprogesterone acetate (DMPA), and
intrauterine device ( IUD) checklists allow health care workers to avoid medical barriers and
better provide methods of contraception(WHO, 2018).
There has been evidence that service providers usually private providers, especially,
pharmaceutical and chemical shop owners easily perceived that persons who patronize
condoms may be leading immoral sexual lives (Osemwenkha, 2004). Health workers attitude
is also informed by societal perspective of contraception. In Nigeria, health workers are
reluctant to provide adolescent with contraceptives yet are willing to counsel them on
contraception (Arowojolu, 2000). The ability to divulge our professional responsibility from
societal perspective on who is eligible to use contraceptives is the expected of the ideal
health worker.

27
2.11 Birth Control
Birth control, also known as contraception and fertility control, is a method or device
used to prevent pregnancy. Birth control has been used since ancient times, but effective and
safe methods of birth control only became available in the 20th century. Planning, making
available and using birth control is called family planning. Some cultures limit or discourage
access to birth control because they consider it to be morally, religiously, or politically
undesirable. (Hanson, Burke & Anne, 2010).
The most effective methods of birth control are sterilization by means of vasectomy in
males and tubal ligation in females, intrauterine devices (IUDs), and implantable birth
control. This is followed by a number of hormone-based methods including oral pills,
patches, vaginal rings, and injections. Less effective methods include physical barriers such
as condoms, diaphragms and birth control sponges and fertility awareness methods. The least
effective methods are spermicides and withdrawal by the male before ejaculation.
Sterilization, while highly effective, is not usually reversible; all other methods are
reversible, most immediately upon stopping them WHO (2011). Safe sex practices, such as
with the use of male or female condoms, can also help prevent sexually transmitted
infections. Other methods of birth control do not protect against sexually transmitted
diseases. Emergency birth control can prevent pregnancy if taken within the 72 to 120 hours
after unprotected sex. Some argue not having sex is a form of birth control, but abstinence-
only sex education may increase teenage pregnancies if offered without birth control
education, due to non-compliance (DiCenso,et al., (2008).
In teenagers, pregnancies are at greater risk of poor outcomes. Comprehensive sex
education and access to birth control decreases the rate of unwanted pregnancies in this age
group. While all forms of birth control can generally be used by young people, long-acting
reversible birth control such as implants, IUDs, or vaginal rings are more successful in
reducing rates of teenage pregnancy. After the delivery of a child, a woman who is not
exclusively breastfeeding may become pregnant again after as few as four to six weeks.
Some methods of birth control can be started immediately following the birth, while others
require a delay of up to six months. In women who are breastfeeding, progestin-only methods
are preferred over combined oral birth control pills. In women who have reached menopause,

28
it is recommended that birth control be continued for one year after the last period (WHO,
2011).
About 222 million women who want to avoid pregnancy in developing countries are
not using a modern birth control method. Birth control use in developing countries has
decreased the number of deaths during or around the time of pregnancy by 40% (about
270,000 deaths prevented in 2008) and could prevent 70% if the full demand for birth control
were met. By lengthening the time between pregnancies, birth control can improve adult
women's delivery outcomes and the survival of their children. In the developing world
women's earnings, assets, weight, and their children's schooling and health all improve with
greater access to birth control. Birth control increases economic growth because of fewer
dependent children, more women participating in the workforce, and less use of scarce
resources (Canning, Schultz, et al., (2012).
2.12 Theoretical Framework
Theories are formulated to explain, predict, and understand phenomena and, in many
cases, to challenge and extend existing knowledge within the limits of critical bounding
assumptions. The theoretical framework is the structure that can hold or support a theory of a
research study. The theoretical framework introduces and describes the theory that explains
why the research problem under study exists. In this research, the theory that best explain
contraceptive is The Theory of Planned Behaviour.
The Theory of Planned Behaviour
The theory of planned behaviour was proposed by Icek (1985), through his article
"From intentions to actions: Theory of Planned Behavior (TPB), an extension of the Theory
of Reasoned Action In this theory, behavior is explained by behavioral intention, which is
influenced by attitudes toward a specific behavior, subjective norms (SNs), i.e. perceived
social pressure to perform the behavior and perceived behavioral control (PBC). That is, both
internal and external factors can facilitate or hinder behavior (Montan et al., 2000).
The theory of Planned Behaviour is one of the models most frequently used in the
literature to explore pro-environmental behaviour including recycling, travel mode choice,
energy consumption, water conservation, food choice, and ethical investment (Stern, 2000;
Staats, 2003). Armitage and Conner (2001) identified its application in 154 different
contexts. The Theory of Planned Behaviour (Ajzen, 1988) assumes that the best prediction of

29
behaviour is given by asking people if they are intending to behave in a certain way. Here we
note that the intention will not express itself in behaviour if it is physically impossible to
perform the behaviour or if unexpected barriers stand in the way. Assuming intention can
explain behaviour, how can intention be explained?. According to Azjen, three determinants
explain behavioural intention: 1. The attitude (opinions of oneself about the behaviour); 2.
The subjective norm (opinions of others about the behaviour); 3. The perceived behavioural
control (self-efficacy towards the behaviour).
Attitudes toward the object of the behavior and beliefs about the consequences of
doing or not doing the behaviors also affect behavior. This can be applied in this study to
evaluate the behavior of women toward use of contraceptive and believes that the
consequences of use are important to them, perceives social pressure to use contraceptive and
feels control over contraceptive use, they will be more likely to intend to use contraceptive
and then be effective in their actual contraceptive use.
In general, the theory has proven ‘successful’ in its predictive ability because
alternative social science models typically explain even less of the variance. Thus, the TPB
has become one of the most influential and popular theories for studying human behavior.
The TPB was used to predict women’s contraceptive use because (i) the TPB
instruments include the context and perspectives of women’s experiences; (ii) it has been
successfully used to predict OC use in a similar population (Kridli & Libbus, 2002).

30
 CHAPTER THREE
RESEARCH METHODS

This chapter presents the methodology employed for the research work. Main issues
discussed under this chapter include: the area of study, population of the study, sample and
sampling technique, methods of data collection, techniques and data analysis
3.1 Research Design
The study adopted survey research design. A survey research design focuses on the
assessment of public opinions, attitudes, motivation and behaviours (Osuala, 2004). According to
Nworgu (1991), survesy research design is any study in which questionnaire is employed as the
main instrument in terms of ensuring the validity and reliability of the research work. This design
was chosen because the researcher intends to find out or survey the opinions of married women
on the use of contraceptives and number of children in Ushongo Local Government area
3.2 Area of the Study
The study will be carried out in Ushongo Local Government area of Benue State which
was created in May 1989 by the Babangida administration. The local government derives its
name from Ushongo Hills located at Ushongo town in Mbayegh District. Its headquarters is
situated in Lessel and is located between latitude Longitude: 7° 2' 39" N / 9° 5' 19" E. The local
government is bounded to the North Region with Gboko and Buruku Local Government Areas,
Vandeikya to the South, Kwande to the East and Konshisha Local Government Area to the West.
It has a population projection of about 259,100 people (National Bureau of Statistics,
2016) the local government has eleven (11) council wards namely; Atirkyese, Ikov, Lessel
Township, Mbaawe, Mbaaka, Mbagba, Mbaagir, Mbakuha, Mbagwaza, Mbayegh and Utange.
Agriculture is the mainstay of the people’s economy. Agricultural products are produced in
varying degrees across the local government area. The area is also naturally blessed with mineral
resources: barites, marble and clay are available in large quantities.
The study will be conducted in Ushongo Local Government because of lack of
knowledge about contraceptive use which result to high level of birth rate especially on married
women with little or no proper measures to control and which is seriously affecting the area. The
study is therefore conducted to determine the amount of contraceptive use among married
women in the area.

31
3.3 Population of the Study
The population of this study is married women from the ages of 18 – 45 years that cut
across the 11 council wards that make up the Ushongo locals government area and their main
Population is estimated to 38,865 (National Bureau of Statistics, 2016)
3.4 Sample Size Determination
The sample size of 400 respondents was determined from the study population using
Taro Yamane’s (1964) formula. According to Wimmer and Dominic (2011), we can determine
size from heterogeneous population using Taro Yamane’s formula given as:
n = N
1 + N(e)2
n = The sample size required
N = The population size
e = Level of significance (0.05)
Using this formula, our sample size for the study is determined thus:
n = 259,100
1 + 259,100 (0.05)2

n = 259,100
1 + 259,100 (0.05)2

n = 259,100
648.75

n = 399.99
Approximately; = 400

3.5 Sample and Sample Technique

To minimize bias and enhance a reasonable level of objectivity, the sampling technique
adopted to cover the entire study population is a combination of stratified and simple random
sampling techniques.

32
In stratified sampling, the population is first categorized into strata according to some unifying
characteristics. Once this is done, the sample is apportioned for each stratum. For this system to
work, membership of strata should be mutually exclusive. This means that an item cannot be in
strata A and B. In rural studies, it is often useful to zone the local government according to
council wards from and examine variations within and between the zones. This explains why the
researcher choose Mbayegh, Atirkyese, Mbakuha, Mbagba, Utange, which contain the major
core areas of Ushongo Local Government and can best be a representative of the entire Local
government to be the points of investigation. Having identified these five major areas of
Ushongo which serve as the strata in stratified sampling, the sample of 80 respondents was now
apportioned to each stratum. In selecting the respondents within each stratum, a simple random
procedure will be applied.
Simple random sampling technique is considered the purest form of probability sampling (Gyuse
2005). Each candidate has an equal chance of being chosen from the pool of those selected.
Random selection is accomplished using a number of strategies. The strategies are based on
gaming or gambling technique and other games of chance, such as the roll of an honest die,
spinners and so on. Statisticians use a table of random numbers which are machine generated
numbers that ensure randomness or absence of bias in random sampling. The selection of each
item from the population must be controlled by some probabilities, and successive selections
must be independent of each other (Gyuse 2005). Thus, in selecting a sample of 80 from each
stratum for this research work, the researcher will number these council wards in each of the
stratum. There was a written number of each council ward on a piece of paper, rolled each paper
up, placed them in an empty bucket, shook up the bucket and blind folded, selected one slip at a
time. After each selection, the bucket was shaken again, until 80 respondents will be drawn from
the 5 council wards. In each of the selected ward, the researcher administered 80 questionnaires
to married who were 18-45 years old.
3.6 Methods of Data Collection
A well-structured questionnaire was used to collect data from the respondents by the researcher.
The questionnaire was developed from validated questionnaires that have been used in previous
studies and considered valid and reliable for use in the current study by experts. The
questionnaire was designed to cover three sections. The first section captured information on the
socio-demographics of the respondents; the second section was designed to consider information

33
on the number of children, utilization of contraception and its effects on married women in the
study area; the third section seeks to exploit the views of the respondents on the
recommendation.
Due to the sensitivity of the issue, the researcher selected only female data collectors (three) who
were trained for three days on how to collect data and were supervised by the researcher during
data collection. Interviews will also be conducted in private locations with each participant at a
time and maintaining interviewee privacy.
3.7 Techniques of Data Analysis
The questionnaires that were collected for the study will be manually checked for errors before
they will be analyzed both quantitatively and qualitatively. The research question will be
answered using descriptive statistics such as frequency and mean, where the Hypotheses were
tested using gamma statistics. The P-value is significant at <0.05.

34
 CHAPTER FOUR
DATA PRESENTATION AND INTERPRETATION
Introduction

The chapter the deals with data presentation and interpretation of the result, the result were
presented in tables where the mean and percentages were worked out, the data presented were
gathered from the 400 questionnaire distributed and retrieved from the respondent. Each table
was followed by an interpretation of the result, also the hypothesis were tested using Gamma
P<0.05

4.1 Data Presentation

Table 4.1 Demographic Characteristic of the Respondents

ITEMS No of respondents Percentage of Respondents

18-27 70 17.5
28-37 184 46
38-above 146 36.5
Total 400 100
Highest Educational qualification
Non formal 49 12.25
Primary education 87 21.75
Secondary Education 191 47.75
Tertiary education 73 18.25
Total 400 100
What is your Occupation
Farming 30 7.5
Civil servant 120 30
Business 250 62.5
Total 400 100

Source filed study 2020

The result in table 4.1 shows the demographic characteristic of the respondents. The result
revealed that majority of the respondent 46% of the respondent were 28-37 years of age
followed by those within the age range of 38 above (36.5%) while 17.5% were in the age range
of 18-27.

35
On the education qualification the result show that 47.75% of the respondent were obtained
secondary education, followed by 21.75% who obtained primary education certificate, 18.25% of
the respondents completed their tertiary education while 12.25% have no former education.

The result in the table further shows that majority of the respondents 62.5 percent were business
women, 30% were civil servant while 7.5% were engaged in farming as their occupation

Research Question1: What is the number of children by married women in Ushongo Local
Government Area?

Table 4.2 The number of children by married women in Ushongo Local Government
Area
Number of children alive No of respondents percentages
0-2 80 20
3-4 230 57.5
5 above 90 22.5
Total 400 100
Number of children lost
0-2 369 92.25
3-4 28 7.0
5 above 3 0.75
Total 400 100
Total number of children gave birth to
0-2 158 39.5
3-4 169 42.25
5 above 73 18.25
Total 400 100
Source field Study 2020

The result in table shows the number of children by married women in Ushongo Local
Government Area. The result revealed that 57% of the women have 3-4 children alive, 92.25%
of the respondents have lost 0-2 children, while 57.5 % of the respondents. This implies that a
significant number of women in Ushongo may have lost their children through unsafe abortion
due to unwanted pregnancy which most times is as a result of non use of contraceptive. This
result is in line with the statistic by National Population Commission, (2018) who revealed that
Nigeria currently has a high rate of maternal mortality, and more than 40% of these maternal
deaths are due to complications of unsafe abortions as a response to unwanted pregnancy. The
fertility rate in Nigeria is 5.7 children per woman.

36
 Research question 2: Do married women in Ushongo Local Government Area utilize
contraceptive methods?
Table 4.3 Utilization of contraceptive among married women in Ushongo LGA
Items Responses Total Mean Decision
SA A D SD
Do you know anything about contraceptive 260 108 16 16 400 3.53 Agreed

Have you use anything before to prevent

pregnancy? 280 117 3 0 400 3.69 Agreed

Are you currently using any contraceptive

method to prevent conception? 300 76 23 1 400 3.69 Agreed

Do you consider abstinence a way of

preventing pregnancy 169 191 30 10 400 3.30 Agreed

Do you consider withdrawal a way of

preventing pregnancy 78 290 30 2 400 3.11 Agreed

Do you use injections to prevent pregnancy 247 128 23 2 400 3.55 Agreed

Do you use Barrier (male and female

condom) to prevent pregnancy 303 76 12 9 400 3.68 Agreed

Do you use Pills to prevent pregnancy 290 67 28 15 400 3.58 Agreed

Do you us Calendar method to prevent

pregnancy 309 77 12 2 400 3.73 Agreed
Cluster Mean 3.54 Agreed
Source: field survey 2020

The result in shows the use of contraceptive among married women in Ushongo local
government area, the view of the respondent were determine based on the mean respondent on
each item in the table and the decision to agree with a particular item in the table was made
where the mean was above 2.49 otherwise disagree, thus the result as indicated by the view of
the respondent indicate that, they are ware and have utilized contraceptive method which include
withdrawal, injections, condom Pills, Calendar method as contraceptive and way of preventing
unwanted pregnancy . This implies that there is high level of awareness and utilization of the
contraceptive among married women in Ushongo Local Government Area this study agree with
this study finding are supported by that of Adeyemi A, et al., (2008) who summated that

37
Nigerians are using any form of contraceptives and contraceptive knowledge is almost universal
among women. As such, previous estimates of contraceptive use may not reflect the current level
of contraceptive use. This at least provides a basis for further studies.

Research Question 3: What is the effect of number of children on contraceptive use among
married women in Ushongo Local Government?
Table 4.4. The effect of contraceptive use among the women in Ushongo local government
Response Mea
ITEMS s Total n Decision
SA A D SD
Do you consider contraceptive as good
method of child spacing 260 108 16 16 400 3.53 Agreed

Contraceptive negatively affect child 15 Disagree

bearing 3 109 130 8 400 1.89 d

Is contraceptive practice harmful to your

health 169 191 30 10 400 3.30 Agreed

Contraceptive have more positive effects

than negative effects 290 78 30 2 400 3.64 Agreed
Cluster Mean 3.09 Agreed
Source field study, 2020
The result in table 4.3 shows the effect of contraceptive use among married women in Ushongo
local government .The study revealed that contraceptive is a good method of child spacing
among married women in Ushongo Local Government the mean response was 3.53 also the
respondent agreed that contraceptive may be harmful to some women, though it have more
positive effects than negative effects, however the respondent disagree that contraceptive
negatively affect child bearing the mean responses were found to 3.30, 3.64 and 1.89
respectively this implies that contraceptive more of positive effect than negative once. This result
is in line with the study by Stover and Sonneveldt (2017). Who revealed that Contraceptive
utilization has multiple benefits to women who are using and the community in large .
Contraceptives prevent unintended pregnancies, reduce the number of abortions, and lower the
incidence of death and disability related to complications of pregnancy and childbirth. The long-
term benefits range from increased education for women and better child health to greater family
savings and stronger national economies. Increased contraceptive use and reduced unmet need

38
for contraception are central to improving maternal health, reducing child mortality and
combating HIV/AIDS

Research question 4: What can be done to inculcate the knowledge of contraceptive use among
married women in Ushongo Local Government Area?

Table 4.5 Recommendations For An Increased Contraceptive Use Among Women In

Ushongo Local Government Area
ITEMS Responses Total Mean Decision
SA A D SD
Government should increase awareness
for the use of contraceptive 233 127 24 16 400 3.44 Agreed

Government should subsidize the cost of

contraceptives 158 109 130 3 400 3.06 Agreed

Non-governmental organizations should

support government in awareness creation 169 191 30 10 400 3.30 Agreed

Stake holders should make contraceptives

more accessible 199 180 19 2 400 3.44 Agreed
Cluster Mean 3.31 Agreed
Source field survey 2020

The result in table shows the view of the respondent on what can be done to inculcate the
knowledge of contraceptive use among married women in Ushongo Local Government Area, the
study revealed that the five items as indicated in the table were agreed by the respondent as the
way to inculcate the knowledge of contraceptive use among married women in Ushongo Local
Government Area. Some of the ways include Government should increase awareness for the use
of contraceptive, Government should subsidize the cost of contraceptives, Non-governmental
organizations should support government in awareness creation and Stake holders should make
contraceptives more accessible the mean responses were found to be 3.44, 3.06,3.30, and 344
respectively.

4.2 Hypotheses Testing

39
4.2.1 Hypothesis 1

This hypothesis states that there is no significant relationship between the use of contraceptive
and the number of children among married women in Ushongo Local Government.
This hypothesis was tested using gamma to determine the association between contraceptive use
and number of children

Table 4.6.1 use of contraceptive * number of children Crosstabulation

Count
number of children
Use of Contraceptive 0-2 3-4 5 above Total
Always 28 3 2 33
Most a times 104 22 16 142
Sometimes 25 139 22 186
Never 1 5 33 39
Total 158 169 73 400
The result in table 4.6.1 shows that 28 respondent who always uses contraceptive give birth to 0-
2 children, 104 of the respondents who uses contraceptives most times give birth to 0-2 children,
the responses further shows that 139 respondent who uses contraceptive sometimes give birth to
3-4 children, also 33 of the respondent who never uses contraceptive give birth to 5 children
above.
Table 4.6.2: Gamma statistic analysis summary table showing relationship between the use
of contraceptive and the number of children among married women in Ushongo Local
Government

Asymp. Std. Approx. Approx.

Value Errora Tb Sig.
Ordinal by Gamma
.766 .043 14.558 .000
Ordinal
N of Valid Cases 400
a. Not assuming the null hypothesis.
b. Using the asymptotic standard error assuming the null hypothesis.

Gamma was run to determine the association between Number of Children and use of
contraceptive married women in Ushongo local government. There was a strong, positive
correlation between number of children and use of contraceptive, which was statistically

40
significant (G = .766, p < .0005). Therefore hypothesis one is rejected and concludes that there is
significant relationship between use of contraceptive and the number of children among married
women in Ushongo local government area. This result is in line with the statistic by National
Population Commission, (2018) who revealed that Nigeria currently has a high rate of maternal
mortality, and more than 40% of these maternal deaths are due to complications of unsafe
abortions as a response to unwanted pregnancy. The fertility rate in Nigeria is 5.7 children per
woman.

CHAPTER FIVE
SUMMARY CONCLUSION AND RECOMMENDATIONS
5.1 Summary
The study examine the relationship between number of children and contraceptive use among
married women in Ushongo Local Government of Benue state, the study objectives include to:

41
Examine the number of children among married women in Ushongo Local Government;
Examine the use of contraceptive among married women in Ushongo Local Government Area;
Examine the effect of contraceptive use among women in Ushongo local government and Make
recommendations to improve the use of contraceptive among women in Ushongo Local
Government Area. A descriptive research Design was adopted for the study, and the population
comprised of 38,865 married women whose were drawn from the 11 council ward that make up
Ushongo Local Government. A sample size of 400 respondents was drawn from the study
population using Taro Yamane’s (1967) formula of sample size determination. The data for the
study were collected using closed ended Questionnaire and were analysed using descriptive
statistic to answer the research question and the hypothesis was tested using gamma statistic. The
study finding revealed that there is significant positive relationship between use of contraceptive
and the number of children among married women in Ushongo local government area of Benue
state.
5.2 Conclusions
Based on the findings the study conclude that there is significant positive relationship
between use of contraceptive and the number of children among married women in Ushongo
local government area of Benue State.
5.3 Recommendations
The following Recommendations were made based on the finding.
1. Stakeholder in the reproductive health system should intensify awareness on the use
of contraceptive among married women
2. Nongovernmental organization and government agency should make available the
various contraceptive devices for easy accessibility by married women.
3. Married women should avail themselves of little opportunities created by government
to get more enlighten on modern contraceptive techniques to improve their
reproductive health.
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APPENDIX I
Department of Sociology.
Benue State University,
Makurdi.

47
Dear Respondents,

A QUESTIONNAIRE FOR RESEARCH PROJECT

I am a student of the above mentioned institution undertaking a study on the number of

children and contraceptive use among married women in Ushongo Local Area of Benue State
pursuance of a B. Sc in Sociology. I hereby seek your response to the questions below.

Your anticipated co-operation will be highly appreciated and treated confidentially and for the
purpose for which it is meant.

Yours Faithfully,

Iorpuu Doowuese Grace

APPENDIX II

48
 QUESTIONNAIRE ON NUMBER OF CHILDREN AND CONTRACEPTIVE USE
AMONG MARRIED WOMEN IN USHONGO LOCAL GOVERNMENT AREA OF
BENUE STATE

SECTION A: DEMOGRAPHIC DATA

Instruction: Please tick ( √ ) appropriate answer

1. What is your Sex: (a) Male [ ] (b) Female [ ]

2. What is your Age: (a) 18-27 [ ] (b) 28-37 [ ] (c) 38-49 [ ]
3. What is your Marital status: (a) Single [ ] (b)Married [ ] (c) Divorce [ ]
4. What is your highest Educational qualification: (a) Non formal Education [ ] (b) Primary
education [ ] (c) Secondary Education [ ] (d)Tertiary education [ ]
5. What is your Occupation: (a) Farming [ ] (b) Civil servant [ ] (c) Public servant [ ] (d)
Business [ ]

SECTION B

THE NUMBER OF CHILDREN AND CONTRACEPTIVE USE AMONG MARRIED

WOMEN IN USHONGO LOCAL GOVERNMENT

The number of children by married women in Ushongo Local Government Area

Number of children alive:

0-2 ( ) , 3-4( ), 5 above ( )

Number of children lost:

0-2 ( ), 3-4 ( ) , 5 above ( )

Total number of children gave birth to:

0-2 ( ), 3-4 ( ), 5 above

49
UTILIZATION OF CONTRACEPTIVE METHODS AMONG MARRIED WOMEN IN
USHONGO LOCAL GOVERNMENT AREA

Items SA A D SD
Do you know anything about contraceptive

Have you use anything before to prevent pregnancy?

Are you currently using any contraceptive method to

prevent conception?

Do you consider abstinence a way of preventing pregnancy

Do you consider withdrawal a way of preventing

pregnancy

Do you use injections to prevent pregnancy

Do you use Barrier (male and female condom) to prevent

pregnancy

Do you use Pills to prevent pregnancy

Do you us Calendar method to prevent pregnancy

WHAT IS THE EFFECT OF NUMBER OF CHILDREN ON CONTRACEPTIVE USE

AMONG MARRIED WOMEN IN USHONGO LOCAL GOVERNMENT?

Items SA A D SD
Do you consider contraceptive as good method of child spacing

Contraceptive negatively affect child bearing

50
 Is contraceptive practice harmful to your health

Contraceptive have more positive effects than negative effects

RECOMMENDATIONS FOR AN INCREASED CONTRACEPTIVE USE AMONG

WOMEN IN USHONGO LOCAL GOVERNMENT AREA
Items SA A D SD
Government should increase awareness for the use of contraceptive

Government should subsidize the cost of contraceptives

Non-governmental organizations should

support government in awareness creation

Stake holders should make contraceptives more accessible

51