CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND TO THE STUDY

Family planning refers to the planning of when to have children, and the use of birth control. It
allows individuals and couples to anticipate and have their desired number of children, and to
achieve healthy spacing and timing of their births (Bongaarts & John 2017). Family planning is
achieved through use of contraceptive methods and the treatment of involuntary infertility. Other
techniques commonly used include sexuality education, prevention and management of sexually
transmitted infections, pre-conception counselling and management, and infertility management
(Cleland, Kelly, & Jeffrey 2016).

Family planning (FP) is an essential strategy in promoting maternal and child health through
adequate spacing of birth, avoiding pregnancy at high-risk maternal age and high parity (Handady,
Naseralla, Sakin & Alawad 2015). The family planning use in developing countries has reduced the
number of maternal mortality by forty-four percent 44% which is about 270,000 deaths prevented
in 2008 but could prevent 73% if the full demand for birth control were met (Handady, Naseralla,
Sakin & Alawad 2015).

In the family planning component, actions are recommended to help couples and individuals meet
their reproductive goals and to increase the participation and sharing of the responsibility of men in
the actual practice of family planning. In understanding the process of family planning use, is not
appropriate to focus on women alone since the program is designed to evaluate family planning and
reproductive health, men must be involved. It is important to involve men in reproductive health
since several of these reproductive health components (especially sexuality, STD/AIDS prevention,
and infertility) require the active participation of both men and women. Men’s involvement is
defined by the International Planned Parenthood Federation (IPPF) as male acceptance of family
planning and the importance of men’s increasing practice of contraception measured by the
popularity and prevalence of vasectomy and condoms (Ramesh, Gulati, & Retherford 2016).

Unavailability or poor access to contraceptives is associated with many interrelated factors ranging
from personal to governmental setbacks (Esere, 2018). This eventually contributes to high
unplanned pregnancy rates which are estimated to have contributed to about 8 to 30 million annual
pregnancies worldwide. Global estimates have also shown that about 210 million pregnancies occur
annually across the world. 75 million (or about 36%) of the 210 are unplanned or unwanted
pregnancies (Singh, Sedgh, & Hussain, 2020).
A lot of Studies in Africa have generally documented low knowledge and awareness levels of
effective contraceptive use amongst women of reproductive age. Several factors including age,
culture, ethnicity, and religion, poor access to contraceptive services, and lack of partner support
were identified as contributing to the non-utilization of contraceptives in Nigeria today (Golbasi,
Tugut & Erenel, 2022). In a study amongst South African women, it was estimated that only 52.2%
of reproductive age are using contraceptives. Because 80% of women in their reproductive age are
sexually active, it is important that they have access to safe, accessible and adequate contraceptive
services (Tilahun, Assefa, & Belachew, 2019).

1.2 STATEMENT OF THE PROBLEM

The world population is increasing in geometric rate; government can no longer meet up with the
demand of their citizens. This has resulted to global food shortage. Having many children is really a
great burden that tends to drain the financial resources of standard of living and bring about
economic hardship. Most parents with large families find it difficult to provide the basic need of
their children such as food, shelter health and education for the family. This tends to bring
psychological and emotional stress on most families.

Family planning is considered a first line of defense against unwanted pregnancy, sexually
transmitted infections (STIs) and human immune deficiency virus (HIV). The access and correct
use of family planning methods reduce greatly unwanted pregnancies, STIs and HIV among women
of reproductive age in any nation thus enhancing their health. However, it appears that knowledge
of family planning commodities among women of reproductive age in Nigeria is low and it varies
by demographic and socio-economic characteristics.

Studies have been conducted on knowledge of family planning commodities among women of
reproductive age in many parts of the World including Nigeria. However, very little studies about
knowledge of family planning commodities have been conducted in Lagos, to the best knowledge
of the researcher. Following from this, the need arose to study the knowledge of family planning
commodities available for prevention of pregnancy among women of reproductive age attending
Rauf Aregbesola health center in Egbeda, Lagos state.
1.3 PURPOSE OF THE STUDY

The purpose of the study is to assess the knowledge of family planning commodities available for
prevention of pregnancy among women of reproductive age attending Rauf Aregbesola health
center in Egbeda, Lagos state. This study will specifically explore the knowledge of various family
planning methods available or accessible to women.

1.4 RESEARCH OBJECTIVES

The study will currently review the following specific objectives;

1. To assess the knowledge family planning among the women of reproductive age attending
the facility.

2. To identify the various family planning commodities available or accessible to the women.

3. To determine the level practice or utilization of family planning among the women of
reproductive age attending the facility.

1.5 RESEARCH QUESTIONS

This current study hopes to answer the following research questions;

1. What is the level of knowledge of family planning among these women?

2. What are the various family planning commodities available or accessible to these women?

3. Do these women utilize the family planning commodities that are available?
1.6 SIGNIFICANCE OF THE STUDY
This study which investigates the knowledge of family planning commodities available is
immensely relevant to the parents, government, non-governmental organization and health workers
(nurses and midwives). The benefit of family planning cannot be over-emphasized because they go
a long way in helping parents, their children, and education of the children and also enhanced the
socio-economic and political development of the society. For these reasons, government, non-
governmental organization have found it necessary to introduce family planning at both Federal,
State and Local Government levels to maintain good health, socio-economic and political
endeavours.

However, midwives will benefit from this study since it beholds on them to inform the public,
parents as well as society on the importance of family planning. Midwives are in better position to
provide accurate information on to family planning, child spacing and likewise encourage on the
number of children one can carter for.

The study will therefore help parents and health workers (nurses and midwives) to know the right
steps to take in creating awareness on the appropriate method of family planning that is good for
different individual and society at large. Theoretically, the study will add to the body of knowledge
in the step that had been taken so far in the implementation of family planning. This body of
knowledge will be disseminated through publication in journals, workshop, conferences and
seminars.

1.7 SCOPE OF THE STUDY

The study is delimited to women of reproductive age attending Rauf Aregbesola health center in
Egbeda, Lagos state. Rauf Aregbesola is a state-owned medical facility located in Egbeda, a sub-
urban area in the mainland of Lagos state. The study is concerned with the knowledge of family
planning commodities available for prevention of pregnancy among women of reproductive age.
The study involved only women of reproductive age and not post-menopausal women.
1.8 OPERATIONAL DEFINITION OF TERMS

1. Availability of family planning commodities: access to various modern family planning

methods or contraceptives.
2. Contraceptives: these are various means, methods and devices that can be used by women to
prevent pregnancies.
3. Knowledge of family planning: the awareness of family planning and child-spacing within
limits through means such as contraceptives and other medical aids among the
women of reproductive age attending Rauf Aregbesola health center.
4. Reproductive age: This is the period between menarche and menopause in women.

5. Unwanted Pregnancy: this refers to unplanned, unintended or undesired pregnancy that may
occur in women of Reproductive age in relation to time and factors.
6. Women of Reproductive age: these are women with the ability to conceive technically from
the period of menarche to the period of menopause.
 CHAPTER TWO

LITERATURE REVIEW

2.1 CONCEPTUAL REVIEW

2.1.1 Concept of Family Planning

Different opinions have been postulated about the concept of family planning. Multifarious
definition have been offered for the concept for instance, Hoberaft (2020), sees it as the practice of
exercising choice about the arrival of the child into the family, taking into consideration, the
mother’s health, welfare of the children, family happiness and all other prevailing economic
circumstances. He explained further that such plans encourage couples to have only those children
that they can properly and adequately cater for especially as at such a time when family is ready for
them, implying that every child should be wanted by choice and not chance.

Nwangoro (2015) sees family planning as involving child-spacing. He goes further that well-spaced
child-rearing practice helps women to maintain good health in them and in their children. The
overall essence of family planning therefore seems to be the control of family population and
invariable too, the population of the nation so as to avoid unwanted children.

According to the economic postulation of Malthus (2018), many countries are today experiencing
population explosion that makes the available social infrastructures very much deficient for the
people. Food supplies to such population have become bug and unsolvable problems to the
indigenous government who mostly have resort to sealing foreign aids from international
organization such as UNICEF, UNO, etc. nation like china, India and many more with the third
world grapple with endemic problem. It is true that some other countries share their food shortage
experience not because of their own self-styled over-population problem, but because of famine,
draught, flooding and refugee influx from war-torn neighbouring countries such as Rwanda,
Uganda, Liberia and Ethiopia.

The Nigeria situation however, seems as varied since it bothers solely on the economic down-turn
of the nation which relies mainly on proceeds from oil sales that presently face drastic price-cuts at
the international market. The lack of money to face capital projects also undermines the generation
of employment opportunities for people. It also affects all other facets of the Nigerian nation’s life
in the area of commence, health, agriculture, education and others. On the face of this reality where
the means of livelihood of the citizens continue to dwell (dwindle) on daily basis, it is therefore no
gain saying that caring for the living should be paramount and upper-most in the mind of parents
rather than a further venturing into the baby-making engineering which will end the family in a one
square mean per-day type of survival. Well-planned families therefore appear to be very plausible
solution to the ugly development.

2.1.2 Methods of Family Planning

There are two well-known method of family planning. These include:

(i) The traditional methods

(ii) The new modern methods

Traditional Methods of Family Planning

According to Ayeni (2019), the traditional methods of controlling family size were practiced as far
back as history could tell. This has been confirmed by the display of these methods side by side
with newly introduced modern methods. These traditional methods include prolonged breast
feeding, post-partum abstinence, the use of ring, waist band, “blue” (a chemical substance dissolved
in water for drinking immediately after sex to prevent pregnancy and for abortion), hair pin (for
women) feather (attached to hair during sex), salt ( to be dissolved and taken immediately after
sex), padlock (which is opened and attached to the body during sex), broom (a small gourd with
medicine inside, to be taken after sex) and the use of black soap. The uses of various objects are
sometimes accompanied by incantation and divination. These methods are also associated with
some taboos. Any violation of the taboo associated to these methods will render them ineffective.
Civilization and modernization have however helped in putting behind many of the traditional
methods replace with modern methods particularly in African cities.

New Modern Methods

According to National Research Council (2016) and Mandani (1019), they highlighted that the new
modern methods of family planning is categorized into three types. These include;

i. Temporary family planning methods

ii. Permanent family planning methods
iii. Natural family planning methods
Temporary family planning methods: These are methods that couples can use to delay pregnancy
and space their children as they wish. They can stop using them when they want to have a child.
Examples are:
(A). IUCD (Intrauterine Contraceptive Device): This device is chosen by some women who
want to avoid pregnancy. It is placed inside the uterus.

(b). Pills: These are oral contraceptive which helps to reduce the fertility rate in women with ease
and little upset. A women taking oral contraceptives is unlikely to have dysmenorrheal, her
menstrual flow will reduce (which in turn helps to prevent anemia) and she is likely to have a
reduce amount of premenstrual tension.

(c). Injectable: The injectable is an injection of a hormone give to a women to prevent her ovaries
from releasing an egg for some months. This prevents pregnancy. There are two commonly used
injectable: DEPO-PROVERA (DOPA) given every three months and Noristerart (NE-EN) given
every two months.

(d). Implants: Implant system is a set of 6 small, plastic capsules. Each capsule is about the size of
a small match stick. The capsules are placed under the skin of a woman’s upper arm. A set of
implant capsules can prevent pregnancy for at least 5 years. It may prove to be effective longer.

(e). Condom: A condom is a close-fitting thin rubber that a man wears over his erect penis during
sexual intercourse to hold sperm. Condoms help prevent both pregnancy and sexually transmitted
disease (STD’s) used correctly, they keep sperm and any disease organisms in semen out of the
vagina. Condoms also stop any disease organisms in the vagina from entering the penis.

(ii). Permanent Family Planning Methods: These are methods that are used by men and women
who do not want to have any more children but want to enjoy sex without fear of pregnancy.
Examples vasectomy and tubectomy.

(A). Vasectomy: It is a permanent birth control methods for men who do not want to have any
more children. It is a simple operation in which the doctor cuts and seals the vas deferens in the
scrotum. This prevents the sperm from traveling from testis to the penis when a man ejaculates
(releases).
(b). Tubectomy: it is a permanent birth control method for women who do not want to have more
children. It is simply operation consists of cutting out a portion of the oviducts. These are the tubes
which stretch from the upper corner of the uterus towards the ovaries.

(iii). Natural Family Planning Methods: These are methods that do not rely on any medication or
device. Natural family planning requires that a woman should be aware of her fertile days so that
she and her partner can plan sex to avoid or achieve pregnancy. Examples of such methods are
withdrawal and Rhythm methods.

(A). Withdrawal Methods: This is the methods that a man withdraws his penis from the vagina
and ejaculates out. This requires great self-control, as the man will often want to keep his penis in
the woman’s vagina for as long as possible to obtain the greatest amount of pleasure.

(b). Rhythm: Contraception is based on the menstrual cycle of woman. Intercourse is avoided
during period when fertilization might easily take place. No effect on sexual pleasure and no need
for intervention by health personnel.

2.1.3 Benefit of Family Planning

Upadhyay and Robey (2019) highlighted the following as some of the benefit derived from family
planning:

Saving Women’s Lives and Avoiding Unsafe Abortion

Family planning could avoid most of the estimated 78,000 maternal deaths that result from unsafe
aborting, about 13% of the 588,000 maternal deaths each year. Worldwide, if all couples who do
not currently want to have a child used effective contraception, most of the estimated 46 million
induced abortions each year would not occur. As many as 20 million of the 46 million abortions
annually, over 40% are unsafe. They take place outside health care system, often because abortion
is limited by law, and are performed by unskilled providers and under unsanitary conditions. Most,
but not all, unsafe aborting take place in developing countries where abortion is limited by law.

Expanding and improving family planning programs can increase use of effective contraceptive and
this helps to reduce the number of unintended pregnancies and abortions. As studies have shown in
many countries and at different times, abortion rates have fallen, often substantially, as use of
modern contraceptive has become more widespread. For national health systems, providing family
planning widely is a sound investment. Preventing unintended pregnancies save health care
resources that would be required for treating complication of unsafe abortion.
Limiting Risks of Pregnancy and Child Birth
Every pregnancy poses risks. When a woman wants to avoid pregnancy, using contraceptive
consisting and correctly helps protect her from exposure to the risk of pregnancy and childbirth. In
developing countries complications of pregnancy and childbirth cause at least 25% of deaths among
women of reproductive age compared with less than 1% in developed countries. In some
developing regions, a woman’s life time risk dying due to maternal causes is 150 time greater than
in developed regions. For some women, pre-existing medical conductions make pregnancy
especially risky. Such conditions include high blood pressure, valvular heart disease; heart disease
with blocked arteries, diabetes with vascular disease, a history of or current breast cancer, malaria,
sickle cell disease, anemia, tuberculosis, hepatitis, and sexually transmitted infection Law.

Among women who do not want to have children, contraception can save lives by avoiding the
possible complications of childbirth, which can be especially risky where access to emergency
obstetric care is limited. An estimated 67% of maternal deaths are due to complications of
childbirth. About 40% of pregnant women have some complication of childbirth many for reasons
that are not predicable or preventable. Almost all maternal deaths occur in developing countries
where many women lack access to emergency obstetric care. Until all women have access to
adequate obstetric care, family planning remains essential to saving women’s lives. Recognizing its
importance, countries at the 1994 International Conference on population and development (ICPD)
organized by United Nations Organization (UNO) agreed that family planning should be a
component of maternal health and safe motherhood program.

Saving Children’s Lives

Spacing birth helps protect children’s health. A baby conceived more than two year after an older
sibling is born is more likely to survive than a baby conceived sooner. Spacing pregnancies at least
two years apart is particularly important in developing countries, where infant mortality rate are
over 10 times higher than in developed countries 65 infant deaths per 1,000 live birth compared
with 6 per 1,000. It helps ensure her infant’s health when a woman avoid pregnancy for 24 months
after previous birth. A baby born too soon is vulnerable because the mother has not yet recovered
from vitamin depletion, blood loss, and reproductive system damage from the previous birth. The
fetus may not get the nourishment it needs, and the baby’s birth weight may be low, and the
immune system, underdeveloped. (Winikoff, 2015).

United Nation Population Fund (UNFPA), suggested that if women used family planning to space
all pregnancies at least two years apart, one of every four infant death would be avoided. Family
planning saves children’s lives, by enabling women to space pregnancies at least tow years apart
and to limit births to the healthiest reproductive years, contraceptive use has important benefits for
children as well as for women themselves.

Limiting childbearing to the healthiest ages

Practicing family planning can help ensure healthy children by enabling women to give birth only
during their healthiest reproductive years, ages 20 to 40. Children born to teenagers are more likely
than those born to mothers in their 20s to die before their first birthday. Younger women are less
likely to receive prenatal care and more likely to have premature babies and to suffer from obstetric
complication. Children born to mothers over age 40 are more likely to die before age 5. Older
women and women-with many previous births are more likely to have still births or to have
children congenital abnormalities and who may not survive childhood. Pregnancies that occur
before age 20 or after age 40 increase the risk of a wide variety of health problems for the child.
When woman limit births to their healthiest reproductive year, they have healthier babies.

Having Fewer Births

Family planning helps women avoid giving birth more time than is good for their health. The risk
of maternal complications rises dramatically after a woman’s third or fourth birth. Regardless of a
women’s age, her risk of dying when giving birth the fourth time or more is an estimated 1.5 to 3
times higher than when having a second or third birth. Women who have had at least four births
often develop complication during delivery (Presser 2018).

Offering women Choice

In a social environment that allows women to take roles other than motherhood, family
planning empowers women by enabling them choose the number and timing of their births. For
some women control over their own childbearing can open the door to more education,
employment, and community involvement. At the ICPD in Cairo, countries agreed that assuring a
woman’s right to control her own fertility is important to resolving the gender inequality that exists
at almost every level of society.

In virtually every society women derive status from their role as mothers. Much needs to be done,
however, to ensure that women get an equal share to other life choice and opportunities. Family
planning can help, for instance with effective contraceptive women choose to be employed without
the interruption of unintended childbearing inhibit women’s educational and occupational
decisions. Other things being equal, women facing such uncertainty tend to invest less in education
and to have lower paying jobs than women who can control their fertility. Obviously, contraceptive
choice itself seldom is enough to change a woman’s situation in life. Nevertheless, it is a powerful
influence. Women who can choose contraceptive gain more control over their own bodies.
Moreover, women who use contraceptive report that they make more decision for themselves and
that their quality of life has improved. Merki and Merki (2017) reported that the benefits of
contraceptive use included less stress, fewer worries over family matters husbands, and more time
for work and community activities.

Delaying Motherhood enables women to obtain Schooling

Family planning helps many young women remain in school, thus improving their futures each
year, 14 million children are born to women ages 15 to 19. Women who begin child bearing before
age 20 complete less schools than women who delay having children until they are in their 20s. The
two most common reasons that young women do not complete secondary education are marriage
and pregnancy. In some countries pregnancies is the main reason that the school drop-out rate is
higher for boys. Although school policies are changing in some places, others female students who
become pregnant are routinely expelled from school, while such action is rarely taken against male
students who cause pregnancy. Most women do not return to school after they become mother.
Women who do not finish school have fewer job opportunities and less income than others and
more likely to live in poverty.

Helping women remain in school by avoiding unintended pregnancies could substantially improve
child survival health. Family planning helps women delay motherhood in order to complete school.
Unless sexually active young women use contraceptive, they face a risk that young men do not
face: that they will become pregnant and have to leave or forego school.

Family With Fewer Children are More Likely to Educate Their Daughters as well as
Their Sons
Family planning benefits for girl children, long before they reach reproductive age. Families with
fewer children are more likely to send their daughters to school. Small families have more
resources per person and thus have more money to spend on school fees, books, transportation and
other education costs. In contrast, as family size grows, especially over five children, the likelihood
of the children in school drops dramatically for girls, coming from large family typically means
even less schooling than their brother receive, When there are many children in a family, girls may
complete with boys for the chance to attend and remain in school. When parent must make a
choice, they often think that it is better to educate sons rather than their daughters. While girl’s
school enrollment has been rising, it still lags behind than of boys. A disproportionate two-thirds of
the 300 million children in the world who do not attend school are girls. When families are smaller,
their resources tend to be distributed more equally among sons and daughters.
Helping People Avoid STDs
Family planning programs, along with other reproductive health programs, can play an
important role in preventing STDs, including the human immunodeficiency virus (HIV), which
causes Acquired Immune Deficiency Syndrome (AIDS). As HIV/AIDS spreads with devastating
consequences, family planning programs and STDs prevention programs need more support for
condom supplies and promotion, health education and community outreach (UNAIDS, 2019).
Family planning programs encourages young people to delay sexual initiation, advice couples to
remain monogamous and promote condom more among unmarried men. At the same time,
condoms are also a method that an estimated 44 million married couples rely on for family
planning. Today family planning communication and social marketing campaigns often promote
the dual role of condom in pregnancy and avoiding STDs.

Encouraging Healthier Sexual Behavior

Most men, and particularly sexual active unmarried men, have a lot to learn to become responsible
sex partners. Most need to know more about preventing pregnancy and about avoiding and
preventing HIV/AIDS and other STDs. Other unmarried men are less able than married men to
obtain information about safer sexual behavior. Embarrassment and reluctant providers may stand
in the way of obtaining condoms.

Family planning programs can address many of the obstacles that men face when learning about
and adopting safer sexual behavior. For example, programs have organized community activity and
meetings where men can discuss their concerns about sexual behavior comfortably and openly.
Family planning can help young people make responsible sexual decisions. For youths, these
programs also can provide better access top reproductive health services, including contraception.

Slowing Population Growth

In any country population size helps determine demand for resources and level of pollution. Rapid
increases in population, along with rising per capital demand for natural resources, can put
tremendous pressures on the environment. Family planning program have played an important role
in slowing population growth. Without access to modern contraception, most people are unable to
space or limit their birth effectively. By providing good quality family planning information and
services, program have helped people have the smaller families they prefer, fertility has fallen and
population growth has slowed (Ernest, 2020).
2.2 THEORETICAL FRAMEWORK

The Health Belief Model

The Health Belief Model (HBM) is a psychological model that attempts to explain and predict
health behaviour. This is done by focusing on the attitudes and beliefs of individuals. The Health
Belief Model was first developed in the 1950s by social psychologist Hochbaum, Rosen Stock and
Kegels working in the U.S. public Health Services. The model was developed in response to the
failure of a free tuberculosis (TB) health screening program. Since then, the Health Belief Model
has been adapted to explore a variety of long-and short-term health behaviours, including sexual
risk behaviours and reproductive health behaviour.

The Health Belief Model on the understanding that a person will take a health-related action (i.e use
contraceptive) if that person:

1. Feels that a negative health condition (i.e material mortality and other
reproductive related problem) can be avoided.
2. Has a positive expectation that by taking a recommended health action couples
will avoid negative health condition (i.e using contraceptive and other family planning method that
will prevent unwanted pregnancy and risk associated with child bearing.
3. Believes that couples can successfully take a recommended health action (i.e
any recommended family method comfortably and with confidence).

The Health Belief Model was spelled out in term of four constructs representing the perceived
threat and net benefits: perceived susceptibility, perceived severity, perceived benefits and
perceived barriers. These concepts were proposed as accounting for people’s “readiness to act”. An
added concept, cues to action, would activate that readiness and stimulate overt behaviour. A recent
addition to the Health Belief Model is the concept of self-efficiency, or one’s confidence in the
ability to successfully perform an action. This concept was added by Rosen stock and others in
1998 to help the Health Belief Model better fit the challenges of changing habitual unhealthy
behaviours, such as reproductive health behaviour that involves risk. The prediction of the model is
the likelihood of the individual concerned to undertake recommended health action (such as
preventive and curative health action).
2.2.1 Application of Health Belief Model to the study

The Health Belief Model (HBM) has been successfully applied to understanding and improving
knowledge of family planning among women of reproductive age. This model focuses on the
individual’s beliefs and attitudes towards the perceived risk of a health condition, the perceived
benefits of engaging in preventive behaviors, and the perceived barriers to engaging in these
behaviors. By examining the social, cultural, and economic context in which a woman of
reproductive age lives, the HBM can be used to identify gaps in knowledge and develop effective
strategies for increasing knowledge and utilization of family planning. Additionally, the HBM
can be employed to evaluate the effectiveness of existing family planning programs and make
recommendations for improvement. Through its application, the health belief model can be used
to improve knowledge and access to family planning services for women of reproductive age.
2.3 REVIEW OF EMPIRICAL LITERATURE

The awareness drive should be for both couples as they are the ones to jointly take the decision
of accepting the need for family planning and what method(s) to adapt from available options.
According to Gage and Zomahoun (2021) information given to clients refers to information
imparted during provider-client interactions that enables clients make informed choice and
derive satisfaction. Modern methods of contraception include pill, injection, implants, female
sterilization, male sterilization, female condom, male condom, intrauterine device, diaphragm,
foam/jelly, and emergency contraception. Choice of methods refers to both the number of
contraceptive methods offered regularly and the extent to which methods offered meet the needs
of significant subgroups (Gage and Zomahoun (2021). In their study (Alege, Matovu, Ssensalire
and Nabiwemba, 2016) reported that Knowledge of FP methods was nearly universal with
(98.1%) and that method-specific knowledge was highest for short-term methods (e.g. male
condoms (98.3%), pills (97.9%) and injectables (97.6%) while Knowledge of long-term FP
methods (implants (91.7%); intra-uterine devices (89.1) was equally high as was knowledge of
permanent methods (female (79.3%); male sterilization (77.6%)). with knowledge of lactational
amenorrhea and emergency contraceptives being the lowest at 71.9% and 40.1% respectively. In
a case study conducted in Ghana by Eliason, Awoonor-Williams, Eliason, Novignon,
Nonvignon, and Aikins, (2014), it was reported that a little over 90% of both cases (93.8%) and
controls (91.5%) knew at least a method of modern contraceptive of which Injectable was the
most known modern method of family planning amongst both cases (93.1%) and controls
(82.6%), followed by the pill (cases-86.9%; controls-65.9%). The diaphragm was the least
known method amongst the cases (3.1%), while vasectomy or male sterilization was the least
known amongst the controls (0.4%).
Sources of information on family planning include television, radio, posters, hospitals,
friend/relatives, communities, religious organizations, seminars, talk show, and even social
media platforms among others. Msovela, Tengia–Kessy and Mubyazi (2016) in their study
reported that overall - close to half of their respondents (45.7%) reported to have obtained FP
information from their spouses. The other half received such information through other sources
including mass media (27.6%); health facilities where they attended for care seeking (18.1%);
community health meetings (12.6%), and others from neighbours, friends, campaigns, and
billboards. While on actual access by mediums Msovela, Tengia–Kessy and Mubyazi (2016)
discovered that Majority of respondents were exposed to at least one type of mass media with
82.7% of them reported to have listened to radios at least once per week. One third (38.4%) of
those that listened to radios also watched television while a slightly lower proportion (28.1 %)
claimed to have received FP information by additionally reading newspapers. Out of those who
listened to the radio, 78.1% confirmed to have heard FP messages as compared to more than half
(65.7%) of respondents who got such messages by watching TVs. Moreover, about half of
respondents (48.4%) reported to have had access to newspapers through which they could get FP
messages. For those reporting to have had seen or heard of FP messages through the mass media,
they specified that the contents of the messages were related to such issues as child spacing,
types of recommended FP methods, importance of using the methods, their safety and male
involvement in FP services. However, the above study is for male and there is much likelihood
that male tend to be more media friendly than women.
According to Obinna (2017) only 15 percent of Nigeria women are utilizing any form of family
planning which is at variance with the 2012 London Summit targets. FGN (2016) National CPR
figures mask the significant range in contraception use patterns across Nigeria. State-level
modern contraceptive prevalence rates (mCPRs) range from <1 percent to 27 percent, with usage
concentrated largely in the southern States. Usage patterns also follow traditional education and
wealth lines, with higher levels of each equating to higher usage. According to National
Population Commission (2017) urban women are more than twice as likely as rural women to
use a method of contraception (20 percent versus 9 percent) and contraceptive use varies
significantly by region. For example, one-third of married women in the South West use a
method of contraception compared with just 4 percent of women in the North East and 5 percent
of women in the North West. FGN (2016) reported that among women of reproductive age in
developing countries, of which Nigeria is part of, 867 million (57%) are in need of contraception
because they are sexually active but do not want a child in the next two years. Of these, about
222 million (26%) do not have access to modern methods of contraception, resulting in
significant unmet need. In 2006, unmet need for family planning was added to the fifth
Millennium Development Goal as an indicator for tracking progress on improving maternal
health. In Nigeria, according to the population census of 2006, there were, at that time,
44,152,637 women of reproductive age. The Nigerian Demographic and Health Survey (NDHS)
2013 reported that only 15.1 percent of married women of reproductive age were using any
contraceptive. Ten percent of currently married women reported using a modern method, and 5
percent use other methods of contraception. In addition, there is a significant unmet need for
family planning in Nigeria; 16 percent of married women have an unmet need for family
planning (NDHS 2013). Ghulam, et al (2015) reveal that majority knew about some modern
contraceptive methods, but the overall contraceptive use was very low. Knowledge and use of
any contraceptive method were particularly low. In their study in Pakistan, Ghulam, Syed,
Azmat, Hameed, Ali, Ishaque, Hussain, Ahmed and Erik, (2015) reported that the majority of
men and women across all regions were not using any family planning method mainly because
they wanted more children, had negative perceptions about family planning, or had concerns
about side-effects and due to lack of access to information and services. Gage and Zomahoun
(2021) argued that in contrast, there were only few who used modern methods as these ensured
better health of the mother and child. A female from KPK said, “We did plan and tried that we
should not have another child because our first child was too young; therefore we wanted to have
another child once our first child was grown enough; so we used condoms.” Method-wise,
condoms were mostly preferred by men. Quoting another woman respondent from Punjab, “The
idea of using a condom was my husband’s; he had asked the Doctor and decided.” (Gage and
Zomahoun, 2021). Alege, Matovu, Ssensalire and Nabiwemba, (2016) revealed that in the
overall, 62.2% of the women reported that they were currently using a family planning method;
76.3% of these were using a modern method. This was highest for injectables (33%), lactational
amenorrhea (16.7%), female sterilization (12.3%) and male condoms (11%). Current use of IUD
(7.2%) was low just like pills (6.7%). Low demand for FP services and commodities remains a
significant barrier to increasing CPR. Many women are not aware of the various methods of
contraception or the relative benefits and side effects of each of them. In addition to lack of
awareness, common misconceptions about side effects and efficacy persist among many men and
women.
Furthermore, the overall health and economic benefits of birth “spacing” and “limiting” are not
well understood among families or even providers. This seems to translate into a low motivation
to use family planning and low usage patterns. To address this situation, all stakeholders and
influential leaders should be encouraged to provide correct and appropriate information on birth
spacing. There is a low knowledge of contraceptives, especially LARCs, across Nigeria. The
NDHS (2016) reported that 84.6 percent of married women of reproductive age have heard of at
least one method. However, this average masks critical differences related to method type, age,
wealth, and other factors. For example, only 25.9 percent of women have heard of implants in
Nigeria—a much lower rate of knowledge than in other countries. From a geographical
perspective, knowledge is significantly lower in the North, as is contraceptive prevalence.
Reasons for not using family planning and modern contraception included incomplete family
size, negative perceptions, in-laws’ disapproval, religious concerns, side-effects, and lack of
access to quality services Ghulam, et al (2015).
 CHAPTER THREE

RESEARCH METHODOLOGY

3.1 INTRODUCTION

This chapter describes all activities involved in the collection of all necessary and vital
information required for the execution of this research work. The chapter is set to describe the
following: research design, area of study, population of the study, sample size, research
instruction, sampling techniques and method of data collection, method of data analysis and
ethical consideration.

3.2 RESEARCH DESIGN

The study adopts a descriptive cross-sectional study carried out to assess the knowledge of
family planning commodities available for prevention of pregnancy among women of
reproductive age attending Rauf Aregbesola health center in Egbeda, Lagos state.

3.3 AREA OF STUDY

Rauf Aregbesola health center is a primary health center located in Egbeda in Alimosho local
government area of Lagos state. In view of the objectives of primary health care, Rauf
Aregbesola health center seeks to deliver standard quality care to individuals and families in the
society through community participation, intersectoral collaboration, utilization of appropriate
technology and development of human resources for health integrated service, provision, and
supply of essential drugs and comprehensive monitoring and evaluation.

3.4 TARGET POPULATION AND SAMPLE SIZE

The target population for this study are women of reproductive age attending Rauf Aregbesola
health center for medical care services. However, these women easily access medical care at the
Rauf Aregbesola health center and from the statistical records of the community health center,
there have been a total of 670 women of reproductive age that have been to the health center for
health care services within the last six (6) months.

The sample size for this study is to be determined using Taro Yamane’s Formula (1964).
According to Yamani, sample size can be determined with the formula below;

n = ____N

1 + (Ne2)

Where n = sample size

N = total population of the study area

e = error limit

N = 670

e = 0.05

Sample size (n) = 670

1 + (670 x 0.05 x 0.05)

670

2.7

= 248

Therefore, the sample size is 248.

3.5 SAMPLE SIZE/SAMPLING TECHNIQUE

Two hundred and forty eight (248) women will be selected as sample size for this research study.
The simple random sampling will be employed to select the participants who will meet the
eligibility criteria. The simple random sampling technique gives the target population an equal
chance of being selected in the sample.

3.5.1 Inclusion criteria

Must be a woman in her reproductive age

Must be willing to participate

Must be above 18 years

Must be emotionally and physically stable at the time of the study

3.5.2 Exclusion criteria

Men are excluded from the study

Women in their menopause are excluded from the study

Any women not willing to participate is excluded

Any women not emotionally and physically stable at the time of the study is excluded

3.6 INSTRUMENT OF DATA COLLECTION

The major instrument suitable for this research is a self-structured questionnaire. The
questionnaire will comprise of four sections:

Section A: Socio-demographics of the women in Kurikyo community

 Section B: knowledge of family planning among the women of reproductive age
attending Rauf Aregbesola health center.

Section C: the various family planning commodities available or accessible to the

women.

Section D: the practice or utilization of family planning commodities among the women
of reproductive age attending Rauf Aregbesola health center.

The questionnaires would be administered by the researcher and four trained research assistants.

3.7 VALIDATION OF THE INSTRUMENT

The instrument will be cross checked and validated by the supervisor. The supervisor would be
given the initial draft of the instrument to check the structural adequacy of the items. After which
modifications would be made on the instrument before its approval.

3.8 RELIABILITY OF INSTRUMENT

In order to ensure the reliability of the questionnaire, the split-half method will be employed as
an indicator of the instrument stability and consistency. This will be done by administering the
questionnaire to 50 women in a different primary health center within Alimosho local
government area. If a correlational score of 0.9 is obtained, this will imply that the instrument is
reliable for the main study.

3.9 METHOD OF DATA COLLECTION

The method of data collection would be through the administration of questionnaire. Prior to the
administration of the questionnaires to the respondents, verbal informed consent was obtained
from all the respondents that met inclusion criteria. The consenting participants would each be
given a copy of the questionnaire to fill within the duration of 20 minutes.
3.10 METHOD OF DATA ANALYSIS

Analyzing of data is an ongoing process that occurs throughout a research. The data obtained
from the field will be analyzed quantitatively, with more emphasis on the quantitative method
using Microsoft Excel software and descriptive statistical tools which include frequency counts,
percentages and tables.

3.11 ETHICAL CONSIDERATIONS

An application was sent to the ethical review committee (Lagos state ministry of health research
ethical committee and Health Service Commission) for notification of the study and to give an
approval to carry out the study. All respondents in the study were informed about the study, its
purpose and a choice to participate in the study or not. Consent of the respondents was obtained
verbally and in written form. Confidentiality of the respondents was maintained throughout the
study. The research also ensured no physical or emotional harm is caused to the participant and
the integrity of the research is maintained. All the information collected during the survey is
treated as confidential and used for the study purpose only.