Barow Thesis

Accord University
Knowledge & Vision
_____________________________________________________________________
This dissertation is submitted as partial fulfillment of the requirements for the award of the
Master of from Accord university-Somalia.
Department of Public Health
Department of Master of Public Health
Supervisor:
Submitted By:
MOGADISHU – SOMALIA
December 2023
FACTORS ASSOCIATED WITH UTILISATION OF FAMILY PLANNING
METHODS AMONG WOMEN OF REPRODUCTIVE AGE (18-45 YEARS) IN
WADAJIR DISTRICT, MOGADISHU- SOMALIA
FARHAN MOHAMUD IBRAHIM
MASTER OF PUBLIC HEALTH
OCTOBER, 2021
FACTORS ASSOCIATED WITH UTILISATION OF FAMILY PLANNING
WADAJIR DISTRICT, MOGADISHU- SOMALIA
Farhan Mohamud Ibrahim
19/MPH/BU/G/1008
A Thesis Submitted to the School of Graduate Studies, Bugema
University, in Partial Fulfilment of the Requirement for Award of
the Degree of Master of
Public Health
OCTOBER, 2021
DECLARATION
I, Farhan Mohamud Ibrahim, declare that this thesis proposal on “Factors
associated with utilization of family planning methods among women of
reproductive age (18-45 years) in Wadajir district, Mogadishu, Somalia ” is my
original work and has never been submitted to Bugema University or any other Institution
of higher learning for any award.
Signature………………………………
Farhan Mohamud Ibrahim
Date………………………………………
i
APPROVAL
This is to confirm that this thesis proposal on “Factors Associated with
Utilization of Family Planning Methods among Women of Reproductive Age (18-
45 Years) In Wadajir District, Mogadishu, Somalia” is under my supervision and
is now ready for submission to the faculty of post graduate studies of Bugema
University.
…………………………… …………………………….
Signature Date
………………………………… …………………………….
Signature Date
ii
ACKNOWLEDGEMENT
First and foremost, I must thank my research supervisors, Dr. Christopher
Ddamulira, and Dr. Stephen S. Kizza. Without their assistance and dedicated
involvement in every step throughout the process, this paper would have never been
accomplished. I would like to thank you very much for your support and
understanding over these past four years.
Most importantly, none of this could have happened without my family who
offered his encouragement, both emotional and financial support. This dissertation
stands as a testament to your unconditional love and encouragement.
Lastly, I am so indebted to the friends with whom I have studied; they have
been a resource for deeper learning and encouragement to continue to completion of
the research project.
iii
TABLE OF CONTENTS
DECLARATION............................................................................................................i
APPROVAL...................................................................................................................ii
ACKNOWLEDGEMENT............................................................................................iii
TABLE OF CONTENTS..............................................................................................iv
LIST OF FIGURES................................................................................................viii
LIST OF APPENDICES...............................................................................................ix
LIST OF ACRONYMS..................................................................................................x
ABSTRACT.................................................................................................................xi
CHAPTER ONE..........................................................................................................1
INTRODUCTION........................................................................................................1
1.1. Background to the Study.................................................................................1
1.2. Problem statement...................................................................................................3
1.3. Research questions..................................................................................................4
1.4. Objectives of the Study......................................................................................5
1.4.1. General Objective............................................................................................5
1.4.2. Specific objectives..............................................................................................5
1.5. Hypothesis of the Study.....................................................................................5
1.6. Significance of the study....................................................................................6
1.7. Study scope........................................................................................................7
1.9. Operational definition of key terms...................................................................8
CHAPTER TWO.........................................................................................................12
2.0. LITERATURE REVIEW......................................................................................12
2.1. Personal factors Influencing Family Planning Methods among Women of

Reproductive Age.........................................................................................................12
iv
2.2. Family factors Influencing Family Planning Methods among Married Women of
Reproductive Age.........................................................................................................15
2.3. Health Facility Related Factors Influencing Family Planning Methods among
Married Women of Reproductive Age.........................................................................17
METHODOLOGY......................................................................................................20
3.0. Introduction...........................................................................................................20
3.1. Research Design....................................................................................................20
3.3. Study Area............................................................................................................20
3.4. Sample Size determination...................................................................................21
3.5. Sampling Procedure..............................................................................................21
3.6. Data Collection Instruments.................................................................................22
3.7. Data Collection Procedure....................................................................................22
3.8. Data Analysis........................................................................................................23
3.9. Inclusion and exclusion criteria.......................................................................23
3.11. Ethical consideration......................................................................................24
CHAPTER FOUR........................................................................................................25
RESULTS AND DISCUSSION...................................................................................25
4.1. Demographic Characteristics (Personal related Factors) of Women of

Reproductive Age (18-45 years) in Wadajir District, Mogadishu, Somalia................25
Table 2: Demographic/ Personal characteristics of Women of Reproductive Age (18-

45 years) in Wadajir District, Mogadishu, Somalia.....................................................25
4.2. Prevalence of Modern Family Planning Utilization among Women of

Reproductive Age (18-45 years) in Wadajir District, Mogadishu – Somalia..............28
Figure 2: Prevalence of modern family planning utilization among women of
reproductive age (18-45 years) in Wadajir District, Mogadishu – Somalia........29
4.3. Factors Affecting Utilization of Modern Family Planning Methods Among

Women of Reproductive Age (18-45 Years) in the Study............................................30
v
Table 3: Factors Affecting Utilization of Modern Family Planning Methods among
Women of Reproductive Age (18-45 Years) in the Study.......................................30
4.4. Health Facility Related Factors Affecting Utilization of Modern Family Planning
Methods among Women of Reproductive Age (18-45 years) in the Study.................32
Table 4: Health Facility Related Factors Affecting Utilization of Modern Family

Planning Methods among Women of Reproductive Age (18-45 Years) in the Study
33
4.5. Factors Associated Factors with Utilization of Modern Family Planning Methods
among Women of Reproductive Age (18-45 Years) In Study......................................36
Table 5: Chi-Square Analysis of Personal Factors Associated with Utilization of

Modern Family Planning Methods among Women of Reproductive Age (18-45
Years) in the Study...................................................................................................37
Table 6: Chi-Square Analysis of Family Specific Factors Associated With

Utilization of Modern Family Planning Methods among Women of Reproductive
Age (18-45 Years) in the Study...............................................................................38
Table 7: Chi-Square Analysis of Health System Factors Associated With

Age (18-45 Years) in the Study...............................................................................39
Table 8: Logistic Linear Regression Analysis of the Factors Associated with

Age (18-45 Years) the Study...................................................................................40
CHAPTER FIVE.........................................................................................................44
5.0. SUMMARY, CONCLUSIONS AND RECOMMENDATIONS..........................44
5.1. Summary of the Study Findings...........................................................................44
5.2. Conclusions...........................................................................................................44
5.3. Recommendations.................................................................................................45
APPENDICES.............................................................................................................50
Appendix 1: Informed Consent Form..........................................................................50
Appendix II: Questionnaire..........................................................................................52
Appendix III: Map showing the location of the study.................................................56
vi
LIST OF TABLES
Table 2: Demographic/ Personal characteristics of Women of Reproductive Age (18-
45 years) in Wadajir District, Mogadishu, Somalia.....................................................25

Reproductive Age (18-45 years) in Wadajir District, Mogadishu – Somalia..............28
reproductive age (18-45 years) in Wadajir District, Mogadishu – Somalia...........Error:
Reference source not found

Women of Reproductive Age (18-45 Years) in the Study............................................30

Women of Reproductive Age (18-45 Years) in the Study...........................................30
4.4. Health Facility Related Factors Affecting Utilization of Modern Family Planning
Methods among Women of Reproductive Age (18-45 years) in the Study.................32

Planning Methods among Women of Reproductive Age (18-45 Years) in the Study.33
4.5. Factors Associated Factors with Utilization of Modern Family Planning Methods
among Women of Reproductive Age (18-45 Years) In Study......................................36

Years) in the Study.......................................................................................................37
Table 6: Chi-Square Analysis of Family Specific Factors Associated With Utilization

of Modern Family Planning Methods among Women of Reproductive Age (18-45
Table 7: Chi-Square Analysis of Health System Factors Associated With Utilization

vii
Utilization of Modern Family Planning Methods among Women of Reproductive Age
(18-45 Years) the Study 40
LIST OF FIGURES
Figure 1: The Conceptual Framework of the Study.......................................................9
reproductive age (18-45 years) in Wadajir District, Mogadishu – Somalia................35
viii
LIST OF APPENDICES
Appendix 1: Informed Consent Form..........................................................................56
Appendix II: Questionnaire..........................................................................................58
Appendix III: Map showing the location of the study.................................................62
ix
LIST OF ACRONYMS
CPR contraceptive prevalence rates
FP Family Planning
FTR Fertility Rate
IUD Intra Uterine Device
mCPR modern Contraceptive Prevalence Rate
MDGs Millennium development goals
SDGs sustainable development goals
SDHS Somali Demographic Health survey
SEM Social Ecological Model
SRH sexual and reproductive health
UN United Nations
UNHCR United Nations High Commissioner for Refugees
UNPF United Nations Population Fund
WHO World Health Organization
x
ABSTRACT
Mohamed Hassan Barow, School of Graduate Studies, Accord University,

December, 2023-2024. Thesis title: “FACTORS ASSOCIATED WITH
UTILISATION OF FAMILY PLANNING METHODS AMONG WOMEN OF
REPRODUCTIVE AGE (18-45 YEARS) IN WADAJIR DISTRICT,
MOGADISHU- SOMALIA.”
This study was set to examine the factors associated with utilization of modern family
planning methods among women of reproductive age (18-45years) in Wadajir
District, Mogadishu – Somalia. The study adopted a cross-sectional analytical design
with a quantitative approach. Data was collected from 388 participants out of the
planned 420, thus the response rate was 92.4%.
The results indicate that most (62.1%) of the women of reproductive age (18-45
years) in Wadajir District are currently using some form of modern family planning
methods. Results of multivariate binary logistic for the relationship between
associated factors affecting utilization of modern family planning methods among
women of reproductive age (18-45 years) in Wadajir District showed that education
level (AOR = 0.36; 95%CI= 0.16-0.83; p= 0.017 and capacity of health workers to
offer FP services (AOR = 87.04; 95%CI= 17.17-441.02; p= 0.000) were significantly
associated with utilization of modern family planning methods among women.
The study concludes that there is still a high burden of non-optimal utilization levels
of modern family planning methods among women of reproductive age 18-45 years)
in Wadajir District with 37.9% reported to be non-users of modern FP methods that
requires interventions that can promote use of modern family planning methods so as
to revert unplanned pregnancies, increased maternal and infant mortality rates among
health problems. The study also concludes that level of formal education and capacity
of health workers to offer FP services are crucial in increasing FP utilization among
women of reproductive age in Wadajir District. The study recommends that in order
to further increase utilization of modern FP methods, health should come up with
programs (Outreach community programs) that inspire and advocate use of modern
family planning methods. It also recommends that the government needs to come with
a policy that supports girl child education through girl child education support
programs among others.
xi
CHAPTER ONE
INTRODUCTION
1.1. Background to the Study
At the end of 2015, the sustainable development goals (SDGs) replaced the
Millennium development goals (MDGs) that aim at promoting universal access to
sexual and reproductive health (SRH) services (United Nations, 2015). One of the
main targets to reach the SDGs (3.7 and 5.6) is to promote family planning (Starbird,
Norton, and Marcus, 2016). However, implementation of family planning
interventions is context dependent and the countries with stable sociopolitical
infrastructure may be better suited to successfully implement the interventions and
achieve the goals than their counterparts in conflict afflicted settings. The conflict
afflicted settings such as Somalia often have fragile health systems that can hardly
support provision of comprehensive SRH. In a bid to improve the implementation of
family planning methods in conflict afflicted like Somalia, studies that address the
utilization and associated factors of family planning services are urgently needed.
This study is therefore intended to serve the same purpose. This first chapter of the
proposal provides the background to the study, problem statement, purpose of the
study, study objectives, research questions, study hypotheses, significance of the
study, study scope, limitations of the study, theoretical framework, conceptual
framework, and operational definitions.
Globally, women of reproductive age between 18-49 years married or in union using
modern family planning has increased in the recent past from 58% in 2017, to 61% in
2019 (United Nations, Department of Economic and Social Affairs, Population
Division, 2020).
1
Although the number of women using modern family planning is increasing globally,
those that have unmet need is still very high as 222 million women want to space or
limit their pregnancies are not currently using modern family planning (Singh and
Darsh, 2013). More than one in ten women married or in union have unmet need of
modern family planning (WHO, 2017). As a result, more than 41% of the 208 million
pregnancies that occur each year worldwide, are unplanned which also result in
women seeking unsafe abortions, especially in countries where access to safe legal
abortion is highly restricted (Cleland et al., 2014). Approximately 13% of all maternal
deaths are due to abortion complications (Cleland et al, 2014) and about 0.3million
women die as a result of pregnancy related causes (WHO, 2017).
In sub-Saharan Africa, the contraceptive prevalence rate is estimated at 21.8%, of this
only 17% married women of reproductive age use a modern contraceptive. CPRs for
modern methods ranged from 1.2 percent in Somalia to 60.3 percent in South Africa
(World Bank, 2018) A recent review of demographic health survey for countries in
sub-Saharan Africa showed the relationship between the low contraceptive prevalence
rates with high unmet need has both led to increased unintended pregnancies and
increased maternal, infant and child morbidity and mortality (Foots et al, 2009). This has
been attributed among other factors; to shortfalls in health infrastructure and transport
to health facilities and inadequate information (UNFPA, 2012). In addition, studies
show that women tend to seek long lasting family planning methods such as
intrauterine devices, Injectable and implants which are often not readily available.
Besides that, 214 million women (NFPSBCCS, 2018) want to avoid pregnancy are
not using safe and effective family planning methods, for reasons ranging from lack
of access to information or services to lack of support from their partners or
2
communities (Aviisah et al, 2017). This threatens their ability to build a better future
for themselves, their families and their communities.
In Somalia, it has been revealed that despite the benefits of using modern family
planning, the modern contraceptive prevalence rate (mCPR) is still among the lowest
in Africa at 1.2% percent. Some s tudies demonstrate that Somali women have negative
attitudes and believe towards the use of contraceptives to space the birth of their children.
More often, the family planning is perceived to be prohibited by the Islam and large
families are favored (UNHCR, 2011). While many Islam scholars have explained in
details with reference to Quran about the family planning, many Somalis men and women
still misconstrued the Quran and misinterpret it to a larger extent. However, use of
modern family planning remains unclear whether especially in regard to the
associated factors. Hence, this study tries to understand examine the factors associated
with utilization of family planning methods among women of reproductive age (18-
45years) in Mogadishu-Somalia.
1.2. Problem statement
Consistent with the UN (2020), the worldwide fertility price has decreased from
3.2 births according to female in 1990 to 2.5 in 2019. The finest fertility price
vicinity inside the international, sub-Saharan Africa, noticed a decline in TF
from 6.three births according to female in 1990 to 4.6 in 2019.
The SHDS reports that fertility rates for Somalia remain very high at 6.9 children per
woman (SDHS, 2020) compared to National Demographic wish of 2.5 to harness the
demographic dividend. In the Somali region the overall demand and application of
family planning services have been found to be low. The prevalence of contraceptive
use by method based on the World Contraceptive Use 2019 estimated that about
14.9% of women in Somalia currently use contraceptive methods (United Nations -
3
Department of Economic and Social Affairs, 2019). The estimates are presented for
female and male sterilization, intrauterine device (IUD), implant, injectable, pill, male
condom, withdrawal, rhythm and other methods combined (United Nations -
Department of Economic and Social Affairs, 2019).
Consequently, low CPR and high FTR among the Somali women translates to close
child spacing which is related to increase in maternal and childhood morbidity and
mortality.(L, 2016) Coupled with the consequences of political instabilities, Somalia
is a developing country with limited resources to sustain the ever-growing population.
However, if women use modern family planning there are chances of getting positive
economic, environmental and social benefits for families and communities like
improving maternal and child survival. Since it is not clear why women in Somalia
are not using modern family planning, it creates a knowledge gap that warrant studies
that focus on the factors associated with utilization family planning methods among
women of reproductive age (18-45years) in Mogadishu-Somalia.
1.3. Research questions
1. What is the prevalence of family planning utilization among women of
reproductive age (18-45 years) in Wadajir District, Mogadishu – Somalia?
2. What are the personal related factors affecting utilization of family planning
methods among women of reproductive age (18-45 years) in Wadajir District,
Mogadishu – Somalia?
3. What are the family specific factors affecting utilization of family planning
Mogadishu - Somalia?
4
4. What are the health facility related factors affecting utilization of family planning
Mogadishu – Somalia?
1.4. Objectives of the Study
1.4.1. General Objective
The purpose of the study is to examine the factors associated with utilization of family
District, Mogadishu – Somalia.
1.4.2. Specific objectives
1. To determine the prevalence of family planning utilization among women of
reproductive age (18-45 years) in Wadajir District, Mogadishu – Somalia?
2. To investigate the personal related factors affecting utilization of family planning
Mogadishu - Somalia
3. To examine the family specific factors affecting utilization of family planning
Mogadishu - Somalia
4. To establish the health facility related factors affecting utilization of family
planning methods among women of reproductive age (18-45 years) in Wadajir
District, Mogadishu - Somalia
Hypothesis of the Study
H01: Personal, family, and health facility factors are not associated with the utilization
of family planning methods among women of reproductive age (18-45 years) in
Wadajir District, Mogadishu in Somalia
5
Ha1: Personal, family, and health facility factors are associated with the utilization of
family planning methods among women of reproductive age (18-45 years) in Wadajir
District, Mogadishu in Somalia.
Significance of the study
Women of reproductive age
This study is hoped to provide relevant information for the FP program that will support
increased FP uptake among the priority groups and thus harness the benefits associated
with women’s and girls’ use of FP.
Health practitioners
The study will help health practitioners to understand the inherent factors which
significantly influence family planning use among women of reproductive age in
Somalia. Building a deep understanding of these factors, will help to isolate and
classify those factors which may have been misconstrued due to religious assertions
and Quran interpretations by different Muslim scholars.
Policy makers
This study will be useful in that both the local people and the policy makers will be
able to identify the pressing issues pertaining to low FP use among young women
and, consequently, find ways to address the existing problems.
Ministry of health
The findings will also be handy in tailoring family planning intervention programs
that will be used to guide the ministry of health and other relevant health bodies in
setting up plans and strategies relevant to Islamic religion that will enable Somali
women to seek and access FP services.
6
Researchers
This study will be helpful to other researchers in Somalia as it will act as a reference
for information in a related field. Further research is necessary to inform priorities and
national strategies and provide evidence to support program implementation.
Study scope
Research is going to be conducted in Wadajir District, Mogadishu in Somalia.
Wadajir is one of highly populated districts of Mogadishu in Somalia and has the
highest number of health facilities offering family planning methods. This offers an
opportunity to examine why women of reproductive age are using or not using family
planning methods.
The study will focus on examining utilization of family planning methods as the
dependent variable and the associated factors (personal, family, and health).
The study will be focused on a period of 2 years, that is from 2023 to 2024.
7
Conceptual Framework of the Study
Personal factors
 Age
 Level of education
 Personal level of income Utilization of Family planning
 Occupation methods
 Number of children  Pills
 Attitudes  IUD
 Injections
Family factors
 Decision making powers  Implants/Norplant
 Spousal communication  Female condom
 Family support
 Nature of family  Female sterilization
 Lactational amenorrhea
Health system factors
 Attitudes of FP service (LAM)
providers
 Privacy of service
provision
 Affordability of services
 Counseling
 Waiting time
 Capacity of health
workers to offer FP
services
Operational definition of key terms
Demographic Factors: In this study, demographic factors will include age, marital
status, education level, income levels, number of living children, and experience of
child loss and will be operationalized as below.
Age: In this study refers to the respondent’s years since time of birth to the time of the
study. It will be measured in complete years for instance; 18, 19, 20, 21
8
Education level: Refers to the respondent’s highest level of educational attainment. It
will be measured using an ordinal scale; 1 = No formal education, 2 = Primary, 3 =
Secondary, 4 = Diploma, 5 = Certificate/vocational training, and 6 = Degree.
Income levels: In this study refers to the respondent’s monthly income. It will be
measured nominally as 1 = high, 2 = Medium, and 3 = Low
Number of living children: Refers to the number of biological children respondent
has. It will be measured basing on the exact number of children in the household for
example; 1, 2, 3, 4.
Occupation: In this study will refer to whether the respondent is engaged in any
economic activity that earns her income. It will be measured on a nominal scale as 1 =
Yes, and 2 = No
Attitudes: In this study will refer to how the respondent perceives family planning as
either positively or negatively. It will measure nominally as 1 = Positive and 2 =
Negative.
Family factors: In This study will refer to decision making powers, spousal
communication, family support, and nature of family and will be operationalized as
below:
Decision making powers: In this study refers to the ability of the respondent to
choose a method of limiting child birth without consulting her partner. It will be
measured nominally as; 1 = Woman alone, 2 = both man and woman, 3 = Husband
alone, and 4 = someone else.
Spousal communication: In this study refers to whether the respondent
communicates with her partner on issues related to family planning. It will be
measured nominally as; 1 = Yes, and 2 = No
9
Family support: refers whether the respondent is support by any of the family
members to use the family planning. It will be measured nominally as; 1 = Yes and 2
= No.
Nature of family: Will refer as to the family is nuclear or extended, It will be
measured nominally as; 1 = nuclear, and 2 = extended
Service provider factors: In this study will include; attitudes of FP service providers,
design of service provision which includes; privacy of service provision, affordability
of service, counseling, waiting time, capacity of health workers to offer FP services.
These will be operationalized as below.
Attitudes of FP service providers: In this study refers to the positive or negative
perception clients have towards service provider’s interest in providing FP services
for instance; service providers refusing to provide FP services to women of
reproductive age under 18 years, harassing and abusing clients, refusing to offer a FP
service because the provider religion is against the service and others. It will be
measured on self-constructed attitude index score indicating the personal feeling the
respondent has about the service provider as; 1 = Welcoming, 2 = Listening, 3 =
Friendly, 4 = Rude, 5 = Respectful.
Privacy of service provision: In this study refers to a reserved or private room where
women of reproductive age receive birth control methods in the presence of only
medical personnel. It will be measured nominally as; 1 = Available, 2 = Not available
Affordability of services: In this study refers to the respondent’s ability to meet the
costs which are involved in acquiring and using methods that limit child birth such as
transport costs, consultation fees and medical bills. It will be measured nominally as 1
= Yes, 2 = No
10
Counseling: In this study refers to the respondent’s awareness of facts about all
available methods for limiting, space children, their related effects and which one is
most effective for them. It will be measured nominally as; 1 = Yes, 2 = Never given,
and 3 = sometimes among others.
Waiting time: Refers to how long a respondent takes in the health facility while
receiving FP services. It will be measured on an ordinal scale as; 1= <1 your (short
waiting time), and 2 = >1 hour (Long waiting time)
Capacity of health workers to offer FP services: Refers to whether the health
services providers are knowledgeable enough to offers FP services. It will be
measured nominally as; 1 = Knowledgeable, 2 = Not knowledgeable
Uptake of family planning services: In this study refers to whether a respondent is
currently using any family planning services or not during the time of the study. It
will be measured on a nominal scale as; 1 = Inject able, 2 = Pills (Oral
contraceptives), 3 = IUD, 4 = Male condoms, 5 = Implants, 6 = Female condoms, 7 =
Female sterilization, 8 = Rhythm method, 9 = Withdraw, 10 = Emergency
contraceptives, 11 = Male sterilization, 12 = Lactation amenorrhea, and 13 =
Spermicides
11
CHAPTER TWO
2.0. LITERATURE REVIEW
This chapter provides the related literature on the factors influencing family planning
methods among women of reproductive age.
2.1. Personal factors Influencing Family Planning Methods among Women of

Reproductive Age
2.1.1. Age and family planning service
In one study, Ethiopia's FP use decreased as the age of women increased above 30
years. In addition, there was a variation in the use of FP in different age groups.
Women aged 25-29 were the group's highest users (Takele et al., 2012). In this study,
the reason for decreasing FP use as the age of women increases was not mentioned. In
reality, by the time women age 30, they will have the desired number of children, and
FP use is expected to increase. In addition, Morrison (2013) points out that age has
been known to be one of the barriers to contraceptive use as many reproductive health
providers decline to serve young women (less than 18 years) or on the other hand,
young women are afraid or ashamed of going to seek these services from hospitals or
clinics. Lakew et al. (2013), in an analysis of 10,204 women from Ethiopia's 2011
demographic and health survey data, indicated that younger women were more likely
to use modern contraception than older women. The current study will thus examine if
a similar scenario occurs among women of reproductive age in Somalia.
2.1.2. Women’s level of education and family planning service
A study in Ethiopia showed that Women's literacy is associated with an increased use
of FP (Tilahun et al., 2013). In another study exploring women's education and
modern contraceptive Use in Ethiopia, Family planning use differs in those who did
and did not attend school. Study results revealed that 80% of women who have
12
attended and 56% of women who have not attended school have used family planning
(Gordon et al., 2011).
When the level of women's education increases, FP use also increases. Fifty percent
of women who have attended primary and 65.3% of women who have attended
secondary school used FP, and the association was significant (Beekle & McCabe,
2015). All study results showed that girls and women's enrolment in formal school is
an essential factor for FP use.
In addition, Mona (2013) mentioned that female education had been seen as a critical
determinant of contraceptive use in that better-educated women have more knowledge
of contraceptive methods on how to acquire them than less-educated women because
of their literacy, greater familiarity with modern institutions, and greater likelihood of
rejecting a fatalistic attitude towards life.
2.1.3. Religion and family planning service
In a study from Kenya, religion was found to be the second most crucial determinant
which affects FP use negatively. Women from the catholic faith were less likely to
use FP as compared to other religions. This is because of the discouragement of FP
use in the catholic religion (Okech et al., 2011a). However, a study from Tanzania
showed that Catholics are more likely to use contraceptives, and the association was
statistically significant (Tengia-Kessy & Rwabudongo, 2006). Though people are
from the same religion, they have different thoughts about FP use.
In a study that analyzed the Perceptions and behavior related to family planning in a
rural area in the Oromia region, both Orthodox Christian and Muslim participants
believed that the timing to give birth is determined by God. So, FP use is breaking the
laws of God (Ieda, 2012). These results show that the issue of religion is more
contextual. In addition, as it is the most sensitive area for intervention, it needs an in-
depth analysis.
2.1.4. Occupation and family planning service
13
Belay et al. (2016). V reports that factors such as women's educational and
employment status and occupation are associated with women's empowerment for
FP's decision-making power. The authors note that employed womens and those with
a higher educational status are more likely to have higher decision-making power
concerning their fertility, individually or with their partners, than the unemployed and
those with less education.
2.1.5. Women’s level of income
Higher income for women enables them to control resources, access health care and
information, and participate in decision-making (OECD, 2012). A study from Kenya
that analyzed contraceptive Use among Women of reproductive age revealed that
women’s income was significantly associated with FP use. Women with an income
are more likely to use FP than those without (Okech et al., 2011a).
2.1.6. Number of children
In a study that analyzed influencing factors of Women's Intention to Limit
Childbearing in Ethiopia, in older women, as the number of surviving children
increases, women's desire to have more children will decline (Dibaba, 2014;
Bhargava, 2012). In another study, when the number of living children increases, the
women's chance of using FP will increase. Based on their analysis, Women with 3 to
4 children and five or more were 3.7 times and 7.4 times more likely to use family
planning than those without children (Gizaw & Regassa, 2011).
Women with more living children used family planning services more than those with
fewer children. Of the women using family planning services, the majority 36 percent
had exactly 4 – 6 children, followed by those with between 1 to 3 living children at 30
percent. few families , 17 percent of those respondents using family planning services
had 7 – 9 living children, while 15 percent had no living child. Women in Zimbabwe
14
who already had several children wished to delay having further children (Feldman &
Maposhere, 2012). These findings demonstrate that the willingness to use family
planning services increases with the number of living children. This is due to the
possibility that people who have more children no longer want for more as their needs
have already been met. Numerous reasons were given for the desire for more children,
including the cultural belief that having more children was a symbol of affluence
(Teresa.c. 2018). In comparison to women who had no surviving children, 26.2% of
those who had three or more children who survived used contraception (Agyei &
Migadde,2019).
2.1.7. Perceptions and attitudes and family planning service
In a study analyzing reproductive Health Knowledge and attitudes among Adolescents
in Ethiopia, participants were asked six questions to assess their attitude toward
adolescent service use. Their responses ranged from completely agree to disagree, and
the result revealed that individuals' attitude influences health service use (Tegegn et
al., 2016). We can see that an individual's attitude towards service use affects either
positively or negatively. Those with positive attitudes towards FP can utilize the
service more than those with negative attitudes.
2.2. Family factors Influencing Family Planning Methods among Married

Women of Reproductive Age
2.2.1. Partner discussion and approval and family planning service
One study of FP practice and related factors of married women in Ethiopia
demonstrated that partner/husband discussion had an association with FP use. Those
women who had more frequent discussions about FP with their husbands were 11
times more likely to use FP than those who had no discussion (Ko et al., 2010).
15
Similarly, another study in Ethiopia also found an association between FP use and
partner discussion (Stephenson et al., 2014).
In another study that analyzes the role of mens in contraceptive use and fertility
preference in southern Ethiopia, the result showed that 90% of respondents approved
of FP use by their spouse (Tuloro et al., 2006). According to Okech et al. (2011), the
use of FP is much higher in those whose husbands have consented than those who are
not. The probability of using FP in those women who gets their husband’s consent is
83% when it is compared to those who do not get consent. This shows how men play
a significant role in family planning use. Their involvement will significantly
contribute to a country like Ethiopia, where the family system is patriarchal and is
dominated by them (MOH, 2011).
2.2.2. Spousal communication on FP and family planning service
The ability of the couple to absorb and communicate information, thoughts, and
feelings as well as come to decisions regarding vital matters, such as family planning,
that ensure the stability of the family, is essential for the functioning of the family
(Noller & Fitzpatrick, 2015; Peterson, 2017). In fertility plans, rational decision-
making includes discussing family planning with the spouse, which is one of the
aspects that influences whether the plan is approved (DeRose et al., 2004; Islam,
Padmadas, & Smith, 2015). Additionally, a family benefits from agreement on goals
for reproduction, desired family size, family planning, and the attainment of these
goals (Meekers & Oladosu, 1996; Salway, 2013). Female autonomy and seclusion,
equality between spouses, and spousal communication all have an impact on the use
of contraceptives (Narzary, 2012).
In a study conducted in Nepal, Shrestha (2014) discovered that spousal
communication about family planning was a significant predictor of contraceptive use
16
there. Sometimes wives believe their husbands are against using contraception when
in reality they are in favor. The internal conversation of family planning between
spouses has a considerable good effect on lowering spacing and minimizing
requirements, according to Korra (2013). The results suggest that couples that don't
talk about family planning suffer from unmet needs, but more research is needed to
see whether this is also true of married women in Somalia.
2.2.2. Nature of a family and family planning service
In a society where extended kinship links and lineage systems play a decisive role in
social interactions, research has demonstrated that extended family influences the
decisions of both individuals and couples (Char, Saavla & Kulmala, 2010; Darwish &
Huber, 2014). Due to the dynamics of families, decisions about family planning are
also influenced by extended family (Char, Saavla, & Kulmala, 2010). Due to the
various responsibilities played by the person, the couple, and others outside the
family, reaching a consensus on family planning is particularly difficult (Bankole,
2013).
2.3. Health Facility Related Factors Influencing Family Planning Methods

among Married Women of Reproductive Age
2.3.1. Quality of services and family planning services
A study by Khanal et al. (2014) found that limited capacity in healthcare delivery can
affect healthcare utilization. They found that lowly trained village health workers with
only a few months of training and no high school level qualification may have
affected the quality of health care delivered, preventing women from attending FP
services. Similarly, Tesfahun et al. (2014) found that most mothers who did not attend
FP complained of limited availability of health services, including drugs and
equipment.
17
2.3.2. Distance to health facility and family planning service
Distance of health facility has a negative implication on the use of FP; when the
facility is located far away from the place where women are living, the likelihood of
using the FP service is 3.3 lower than those who are living near the health facility
(Okech et al., 2011b). Similarly, in another study, those living closer to the facility
showed higher use of contraceptives. However, the association was not statistically
significant (Tengia-Kessy & Rwabudongo, 2006).
Access to health facilities offering family planning services influences modern
contraceptive family planning methods. Katende et al. (2003) found that most women
(eighty-nine percent) who access family planning services live in a community with at
least one government-run source of family planning, while sixty-two percent live in a
community with at least one private-sector source. Twenty-one percent have access to
an NGO-operated source. They further affirm that short distances to the nearest
family planning facility enable women to seek family planning services. Their study
concluded that Ugandan women with access to family planning facilities use long-
term contraceptives (implant, sterilization), with one woman in two accessing the
facility.
2.3.3. Affordability of services and family planning services
Cost is also one of factors according to Chacko (2015), some forms of contraception,
such as minor surgery (like vasectomy), carry a fairly significant amount of one’s
time and is very cost as compared to other options, such as condom or the calendar
cycle methods which are less expensive; hence, couples engage in them.
2.3.4. Health providers’ attitude and family planning service
In one study that analyzed, health workers' attitudes toward sexual and reproductive
health services for unmarried adolescents in Ethiopia, health workers were asked
18
about their attitude toward FP provision to unmarried adolescents. The result showed
that almost half (46.5%) of participants had a negative attitude towards FP provision
to unmarried adolescents (Tilahun et al., 2012). Healthcare worker attitude either
positively or negatively affects the use of FP. When they show a positive attitude,
women are more likely to use the service, but it is unlikely that adolescents will go for
FP when they show a negative attitude. As demonstrated in another study, the
approach of HCWs working in the FP directly affects the use of FP services. The
likelihood of women using the service was 19% higher in those HCWs who showed
good attitude/friendliness than those HCWs who were not friendly (Okech et al.,
2011b). So, the negative attitude of HCWs discourages the use of FP, and as a result,
unwanted pregnancy and unsafe abortion will follow.
2.3.5. Availability of health supplies, health providers and equipment and family
planning service
Shortages of drugs, health providers, and equipment can have profound effects relating to
health services utilization. Kinungu (2012), in his study conducted in Jinja health units in
Eastern Uganda, found an association between delays in mothers’ turn-up for deliveryand
a shortage of trained staff, essential drugs, supplies, and equipment. A similar study
in South Africa- Kwazulu Natal, observed heavy workload, long hours, inadequate
equipment or facilities, and personal danger, causing demoralization and traumatizing of
staff and leading them to take their frustration out on patients, hence compromising the
quality of healthcare (Ruminjo & Hiza, 2014).and as a result, unwanted pregnancy and
unsafeabortionwillfollow.
19
CHAPTER THREE
METHODOLOGY
3.0. Introduction
This chapter highlights the methodological features and procedure for conducting the
study. These include the research design, location of the study, population of the
study, sample size, sampling techniques, data collection methods, Validity of the
study tools, and reliability of the study, data processing and analysis and ethical
considerations. The operational structures are to be placed of high interest in this
section.
3.1. Research Design
This will be a population-based study that will employ a cross-sectional study design
with a quantitative approach. The quantitative approach will collect data from the
participants in a numerical form to investigate the factors associated with family
planning utilization in Wadajir district, in Mogadishu, Somalia. The study design
selection of a cross-sectional to be used is based on its cost effectiveness in terms of
time and finance.
3.2. Population of the Study
The study population will consist of women of reproductive age in Wadajir District.
The study will include women aged 18 – 45 years. Women of reproductive age that
will happen to have hearing and talking problems will not be included in the study, as
this leads to poor communication that might affect the data quality.
3.3. Study Area
This study will be carried out in Wadajir district of Banadir region in Somalia.
Wadajir district is 1of 17 districts in Banadir region Mogadishu Somalia is the 2 nd
20
largest district in Banadir region. Geographically it lies in South-Eastern Somalia,
situated on the Indian Ocean Coast of the Horn of Africa. Wadajir is one of highly
populated districts of Mogadishu in Somalia and has the highest number of health
facilities offering family planning methods. This offers an opportunity to examine
why women of reproductive age are using or not using family planning methods
3.4. Sample Size determination
Sample size is calculated using Kish Leslie (1965). Assuming the degree of precision
of 5% and using a sample determination formula by Kish Leslie (1965), a sample is
determined as follows:
The formula n = Zα ² * p*(1-p)

e²
Where: Z = 1.96 at 95% confidence level
P = Prevalence of women in reproductive age using family planning = 0.291
n = 1.96 ² * 0.291*(1-0.291)
0.05²
n = 317.038
n ≈ 317
The final sample size will be 317 women of reproductive age.
3.5. Sampling Procedure
The participants will be selected at house hold level from whereby simple random
sampling will be used to women aged 18 – 45 years from the four divisions of
Wadajir district which include Madina, Bulahubey, Zobe and Bandir in each division
a list of names of women aged between 18 – 45 years will be obtained from the
division registry. The names will be assigned numbers which will be written on
papers. The papers will be rolled and put in one basin where they will be mixed and a
rotary method.
21
3.6. Data Collection Instruments
Being a quantitative study, the survey method will be used to collect data. The data
collection instrument will be a self-administered questionnaire which will contain
closed-ended questions.
3.6.1. Questionnaire
Data will collect using a researcher administered standard self-administered
questionnaire design for this study. Included in the questionnaire will Section A
which will capture data on personal factors Age, level of education personal, level of
income, occupation number of children and perceptions
Section B will capture data on family factors like Decision making powers, spousal
communication, family support, and nature of family
Section C will capture data on health system factors like attitudes of FP service
providers, privacy of service provision, affordability of services, counseling, waiting
time and capacity of health workers to offer FP services.
3.7. Data Collection Procedure
The researcher will get approval by the Accord University, after which a letter from
the Dean of Accord University will be issued to the researcher that will be presented
to the administration of Wadajir district.
The training of two research assistants will be conducted one week before the main
data collection exercise. The training will be done in a single day, with some breaks
between sessions, and it will cover issues to do with the objectives of the study, data
collection tool and the data abstraction process, the data collection methods and how
to execute them, and ethics that will be considered. The research assistants will be
22
ones who are well conversant with the local language. Unless the research assistants
are well trained about the protocol, the study implementation will not start.
The researcher will ensure voluntary participation and confidentiality of the
participants. The researcher will follow all the ethical guidelines that include getting
informed consent from the respondent before any study procedure and ensuring that
the respondents are aware of their voluntary participation and can withdraw from
participation at any time. Deliberate participation and privacy of the respondents will
be warranted by the investigator.
3.8. Data Analysis
Simple proportions will be used to describe categorical data at univariate level and
presented in frequency, percentage distributions, Means (M), and Standard Deviation
(SD). At bivariate level, Pearson’s Chi-Square will be used to determine the
associations between the independent and dependent variables. The computed Chi-
Square test will be compared to the critical value 0.05 level of significance at a 95%
confidence interval. A relationship between the independent and dependent variable
that resulted in a critical p value of less than 0.05 will be interpreted as being
significant. All the variables that will be found to be significant at the bivariate level
will be included in a logistic regression model to determine the relationship between
the variables and the dependent variable.
3.9. Inclusion and exclusion criteria

Women included in this study are women aged 18 years and above up to 49 and who
consented to take part in the study
Women less than 15 years and more than 49 years. And who had not consented to
take part are excluded in this study.
23
3.10. Quality control
The data quality control will be achieved by ensuring the validity and reliability of the
data collection instruments.
3.10.1. Reliability
Reliability refers to the consistency of the instrument in measuring whatever it is
intended to measure. Sekaran, (2000) argues that reliability of an instrument indicates
the stability and consistency with which the instrument measures the concept and
helps to assess the goodness of a measure. The method of internal consistency will be
adopted by the researcher; a pilot study will be carried out to check the consistency
and logical flow of the questions before data collection..
3.10.2. Validity
Validity is the appropriateness of the instrument. Content validity will be used since it
focuses on the extent to which the content of an instrument corresponds to the content
of the theoretical concept it is designed to measure (Amin, 2014). He further states
that for an instrument to be accepted as valid, the average index should be 0.7 or
above. The researcher will consult colleagues, supervisors and other researchers, who
will review the instruments before sending them out for a pilot study. A total of 08
questionnaires will be administered during the pilot study; this will help to test the
content validity of the questionnaire and interview guide
3.11. Ethical consideration

The researcher will obtain approval from Accord University and The researcher will
ensure that all target respondents will be consented before administering the survey
data collection tools. While administering the data collection tools, the respondents
will be assured of both confidentiality and privacy by keeping their identities
anonymous at all stages of the exercise.
24
CHAPTER FOUR
RESULTS AND DISCUSSION
4.0. Introduction
The study was set to examine the factors associated with utilization of modern family
District, Somalia. This chapter provides the results and discusses them in line with the
objectives. First are the results in relation to the demographic characteristics of the
respondents.
4.1. Demographic Characteristics (Personal related Factors) of Women of

Reproductive Age (18-45 years) in Wadajir District, Mogadishu, Somalia
The study examined the demographic characteristics of the women of reproductive
age (18-45 years) in Wadajir District, Mogadishu, Somalia. These characteristics are
also in line with the personal factors examined under objective 2 of the study. The
data was collected from 388 participants out of the planned 420, thus the response rate
was 92.4%. The results on the demographic characteristics (personal factors) of
respondents are presented in Table 2.
Table 2: Demographic/ Personal characteristics of Women of Reproductive Age

(18-45 years) in Wadajir District, Mogadishu, Somalia
Demographic characteristics Frequency Percentage

(N=388) (%)
Age in full years 15-24 96 24.7
25-34 205 52.8
35+ 87 22.4
Highest level of No formal education
45 11.6
education
Primary 213 54.9
Secondary 84 21.6
Diploma 34 8.8
Certificate/vocational
10 2.6
training
Degree 2 .5
Monthly income 1 - less than 100 $ 108 27.8
150-300$ 260 67.0
25
More than 300$ 20 5.2
Employment status Not employed 263 67.8
Employed 125 32.2
Number of children 1–2 128 33.0
3–4 194 50.0
5 and above 66 17.0
Attitudes towards FP Positive 231 59.5
Negative 157 40.5
4.1.1. Age
Findings in Table 2 show that most 205(52.8%) of the women were aged between 25-
34 years as compared to those aged between 15-24 and 35 and above with 24.7% and
22.4% respectively. Different age categories at times have different requirements and
are affected different by similar situations. The age group between 25-34 years is one
of the most active and productive years that need to be at the forefront of using
services. This result is similar to an earlier finding of the study by Lakew et al.,
(2013) in which it was indicated that the highest number of women were aged
between 25-34 years. Similarly, Takele, Degu and Yitayal (2012) in one study
Ethiopia use indicated that FP decreases as the age of women increases above from 30
years. It was found in the study by Takele and colleagues that women of age group
25-29 years were the highest user among the group (Takele, Degu and Yitayal 2012).
4.1.2. Highest Educational Qualification
In regard to formal education, the study findings revealed that most 213(54.9%) of
women had attained up to primary level of education, while the least (0.5%) had
attained degrees. Formal education empowers women with the necessary knowledge
to make informed decisions while seeking for health services. This finding is
comparable to finding in a study by Gordon et al. (2011) who explored women’s
education and modern contraceptive Use in Ethiopia and revealed that most (80%) of
women had attained secondary school. The finding is also in agreement with that of
Mona, (2013) who indicated that most of the women studied were of secondary
school level ate that female education was a key determinant of contraceptive use.
26
4.1.3. Household Monthly Income
The findings reveal that most (67.0%) of women were earning between 150-300$
monthly, and the least (5.2%) indicated earning more than 300$. Low-income levels
have negative effects on health service utilization especially where costs are incurred
to seek for a given health service such as family planning. This finding is similar to
the finding of an earlier study by Okech, Wawire and Mburu (2011a) while studying
'Contraceptive Use among Women of reproductive age in Kenya’s City Slums’
revealed that most of women were low-income earners. The study finding is also
comparable to that contained in OECD (2012) where it was indicated that much as
higher income of women enables them to have control over resources, to access health
care, information and to participate in decision making, most women are low-income
earners.
4.1.4. Employment Status
The study findings in Table 2 indicate that most 263(67.8%) of the women
respondents were not employed as compared to 32.2% who were employed. The high
rate of general unemployment in Somalia resulting from the civil unrest in the country
could be the reason for most of the women of reproductive age being unemployed.
Being employed comes along with certain responsibilities which can either negatively
or positively influence utilization of health services among women or reproductive
age. This result is comparable to that of Belay et al. (2016) who indicated that most
women were not employed as they were fulltime housewives.
4.1.5. Number of Children
Results in Table 2 show that most (50.0%) women indicated having 3 - 4 children, as
compared to those with less than 3 people (33.0%). A high number of children born
by one woman may have implications on family planning utilization among because
27
as the number of children increases, the mother may opt for family planning to control
on her birth rates. This finding is comparable with that in a study by Feldman and
Maposphere (2012) on Safer Sex and Reproductive Choice in Zimbabwe revealed that
most mothers had children between 3 and 4. Still in agreement with the current study
finding, an earlier study by Dibaba (2014) also showed that most women of child
bearing age had more than 3 children.
4.1.6. Attitude towards Family Planning
The results on attitude of women towards family planning show in Table 2 that most
(59.5%) of them had positive attitude, while 40.5% depicted negative attitude. The
high level of positive attitudes could be as a result of the continued awareness
campaigns about the usefulness of FP. Positive attitude towards a given health
services is good in promoting good health seeking and utilization of that particular
service in this case family planning and thus need to be encouraged. This finding is
similar to that found in a study by Tegegn, Yazachew, and Gelaw (2016) on
'Reproductive health knowledge and attitude among adolescents in Jimma Town,
Southwest Ethiopia' where it was revealed that most adolescents had positive attitudes
towards family planning use.

Reproductive Age (18-45 years) in Wadajir District, Mogadishu – Somalia
Objective 1 of the study was to determine the prevalence of modern family planning
utilization among women of reproductive age (18-45 years) in Wadajir District,
Mogadishu – Somalia. The results as per the above objective are presented in figure 1
below.
28
reproductive age (18-45 years) in Wadajir District, Mogadishu – Somalia
Source: Primary Data (2021)
The study findings in Figure 2 indicate that most (62.1%) of the women of
reproductive age (18-45 years) in Wadajir District are currently using some form of
modern family planning methods compared to those who reported not be using. Much
as the prevalence of FP appears to be high, the 37.9% of non-users is still a big burden
that need to be narrowed down. Low utilization of modern contraceptives among
women of reproductive age in Wadajir District, Mogadishu could lead to the
continued increase in unwanted pregnancies which are associated with an increase in
maternal morbidity and mortality.
Among the modern family planning methods used, injectable method, pills (oral
contraceptives), emergency contraceptives, and IUDs, were the most used in a
descending order. However, it was found that implants, female condoms, female
sterilization were rarely used. Analysis of the study findings indicate that a majority
of the respondents were using short acting contraceptive methods. Nonetheless, the
findings of the current study indicate that the prevalence of FP use in Wadajir District
29
is higher than that of national FP prevalence rate of Somalia which was estimated to
be at 14.9 based on the World Contraceptive Use 2019 (United Nations - Department
of Economic and Social Affairs, 2019). High family planning use among women in
Wadajir District needs to be upheld as it translates to appropriate child spacing which
is related to decrease in maternal and childhood morbidity and mortality.

Women of Reproductive Age (18-45 Years) in the Study
Objective 3 of the study was to examine the family specific factors affecting
utilization of modern family planning methods among women of reproductive age
(18-45 years) in Wadajir District, Mogadishu – Somalia. The descriptive results as per
this objective are presented in Table 3.

Women of Reproductive Age (18-45 Years) in the Study
Factors Frequency Percent
(N=388) (%)
Decision making powers I make the decisions 28 7.2
My partner makes the decisions 126 32.5
We make the decision together 234 60.3
Spousal communication We discuss 346 89.2
We never discuss 42 10.8
Family support Yes 42 10.8
No 346 89.2
Nature of family Nuclear 213 54.9
Extended 175 45.1
Source: Primary data (2021)
4.3.1. Decision making power
Study findings in Table 3 show that most (60.3%) of the women of reproductive age
(18-45 Years) in Wadajir District, Mogadishu, Somalia reported that they make
decisions with their partners in regard to family planning as compared to the least who
reported to be in control of their FP decisions. This could be attributed to the fact that
most women were married and thus needed consent from their partners. Both men’s
30
and women’s participation in household decision-making is assumed to be reflective
of couple’s ideologies regarding gender roles in the family affairs. Decision making
with communications with partners on family planning use has a substantial
contribution to the improvement of maternal health. This result is comparable with the
findings in another study by Tuloro et al. (2006) which showed that 90% of women made
family planning decisions with their partners.
4.3.2. Spousal Communication
The study findings in Table 3 indicate the majority (89.2%) of women discuss with
their spouses/part on issues regarding family planning. This high level of spousal
communication could be as a result of joint responsibilities between couples.
Communication about family planning may be associated with reducing
misperceptions about a spouse's views on family planning, which, in turn, may
promote mutual decision-making. Interventions are needed to improve women's
autonomy and strengthen their negotiating capacity for family planning use through
spousal communication. This finding is similar to an earlier finding in an earlier study
by Korra (2013) who reported that majority (79%) of women discuss with their
spouses on issues of family planning in areas of agreement on fertility intentions,
desired family size, family planning, and the achievement of reproductive goals is
beneficial to the family.
4.3.3. Family Support
Table 3 results show that most (89.2%) of the women respondents reported not be
getting family support in regard to family planning. This implies that family planning
is in most cases an affair between the woman and her spouse with minimal or no
support from other family members. To promote contraceptive use, family planning
programs should focus on increasing family members’ approval of contraception,
31
improving partner communication around family planning and bolstering women's
confidence in their reproductive decision making. This finding is comparable with
that of Behrman, Kohler & Watkins (2013) who reported that a woman's decisions
about contraception may be influenced by the number and types of relationships
within her social network and mostly the family perceptions of prevailing social
norms.
4.3.4. Nature of Family
In regard to the nature of families, majority (54.9%) of the women reported to be
belonging to nuclear families. The high level of nuclear families could be attributed to
the prevailing hard economic conditions in the country that do not enable families to
have external members apart from children and their parents. The family structure that
has been held up as the cultural ideal for the past half century has been a catastrophe
for many and such most people have opted for nuclear families. A nuclear family
headed by two loving married parents remains the most stable and safest environment
for raising children in Somalia. Similar findings were reported by Char, Saavla and
Kulmala (2010) who indicated that it is rare to find extended families as most of the
families are nuclear.
4.4. Health Facility Related Factors Affecting Utilization of Modern Family

Planning Methods among Women of Reproductive Age (18-45 years) in the Study
Objective 4 of the study was to establish the health facility related factors affecting
(18-45 years) in Wadajir District, Mogadishu, Somalia. The descriptive results of the
health facility related factors are presented in Table 4.
32
Planning Methods among Women of Reproductive Age (18-45 Years) in the Study
Health Facility Factors Frequency Percent

(N=388) (%)
Attitudes of FP service providers Positive 271 69.8
Negative 117 30.2
Privacy of service provision Available 153 39.4
Not available 235 60.6
Affordability of services Yes 83 21.4
No 305 78.6
Counseling Yes 200 51.5
No 188 48.5
Waiting time 30 minutes 86 22.2
1 hour 103 26.5
>1 hours 199 51.3
Capacity of health workers to offer Knowledgeable
215 55.4
FP services
Not knowledgeable 173 44.6
4.4.1. Attitudes of FP Service Providers
The findings in Table 4 show that most (69.8%) of the respondents reported positive
attitudes of health workers. The positive could be due to fact that they are at the
forefront of promoting FP among mothers as mandated by the ministry of health in
Somalia. A nuclear family headed by two loving married parents remains the most
stable and safest environment for raising children. Health workers attitudes affect the
utilization of health services such as family planning either positively or negatively
depending on the nature of the attitude. Similar findings were reported in s a study by
Okech, Wawire& Mburu (2011b) who reported that most of the health workers were
friendly to their clients who were seeking for family planning services in health
facilities in Kenya’s City Slums.
4.4.2. Privacy of Service Provision
Findings in Table 4 indicate that most (60.6%) of the study participants reported the
lack of privacy at the health centre. Given that ensuring privacy of clients among
33
health workers is one of the ethical considerations they have to ensure. As a result,
health facilities try as much as possible to ensure the clients’ privacy. Lack of clients’
privacy at the health facility discourages many potential services users from visiting
the health facility. In comparison, Tsegaye and Sena (2015) reported high level of
privacy in FP clinics and those clients whose privacy was maintained during family
planning counseling and procedures, were more likely to be satisfied using the
services more than those whose privacy was not maintained. The possible reason
might be family planning is a very personal subject and people do not like to openly
discuss their problems. Therefore, privacy is very much important in providing family
planning services clients feel more comfortable if providers respect their privacy
during counseling sessions, examinations.
4.4.3. Affordability of Services
Findings in Table 4 also showed that most (78.6%) of the respondents are in not in
position afford costs for family planning services. The prevailing economic conditions
characterized by high rates poverty could be the major reason why most women are
not in position to afford FP services. Affordability of the services in way or another
likely to affect the use reproductive health services, in this case family planning. In
comparison, Ciszewski and Harvey (2014) reported interrupted time series study
found that the increase in the price of pills by about 60 percent in 2013 in Bangladesh
led to a decline in sales of pills by 15 percent during the same period. This suggests
that the price elasticity is far less than minus one, all other things being equal.
However, the authors reported that the observed change was due not only to a
reduction in demand, but also to the refusal of many retailers to buy products after the
increase.
34
4.4.4. Counseling about Family Planning
The study findings in Table 4 show that most (51.5%) of the women respondents
reported to have been counselled about family planning issues. Family planning
counseling is part of the health services provided by the health workers and this could
be reason as to why most women reported to have been counselled about FP. Family
planning counselling helps women to make informed and voluntary choices about the
number of children and the spacing of the children within their family. Similar
findings were reported in a study by Holt, Dehlendorf and Langer (2017) who
indicated high levels of family planning counselling in health facilities. This finding is
also comparable to the finding contained in a study by Huda, Chowdhuri & Sirajuddin
(2014) where it was reported that majority of women had received receiving family
planning counselling and that any counseling during the 2 years after the first round of
the survey was associated with an increased the odds of using any modern method of
contraceptive during the second round of the survey. This finding is comparable with
the findings of Zaky et al. (2018) who slightly more than a half of the women reported
that long waiting time. Waiting time is a very important contributing factor to client
satisfaction regarding healthcare services. Waiting time not only has a negative
impact on users but also on healthcare providers. In this study it was reported that
most of women spent an hour on average travelling to FP services.
4.4.5. Capacity of Health Workers to offer FP Services
The study finding indicate that health workers are knowledgeable enough to provide
family planning services as reported by most (55.4%) of the women respondents.
Given that all heath workers are trained in their respective capacities, it was not
surprising that most of the health workers were knowledgeable about FP services.
Health workers' knowledge of family planning is crucial in increasing the confidence
35
of the users of FP services. In comparison, a study by Simbar et al. (2016) revealed
adequate knowledge of interns and nurses regarding female contraceptives which was
significantly associated with their use among women of reproductive age in Iran.
This finding is however, quite different from the finding of Hight-Laukaranet al.
(2017) who reported that health workers’ knowledge about lactational amenorrhoea
was minimal.
4.5. Factors Associated Factors with Utilization of Modern Family Planning

Methods among Women of Reproductive Age (18-45 Years) In Study
Study objectives 2, 3, and 4 were to establish factors associated with utilization of
modern family planning methods among women of reproductive age (18-45 years) in
the study. Data was analyzed using both chi-square and logistic linear regression
analysis. Factors significant factors in the chi-square analysis were reanalyzed in the
logistic regression to generate both crude and adjusted odds. Chi-square results are
summarized in Tables 5, 6 and 7 and logistic linear regression results are summarized
in Table 8.
36
Years) in the Study
Utilization of Family
Planning Methods
Yes No
Factors N (%) N (%) χ2 df p-Value
Age in Years
15-24 58(60.4) 38(39.6) 1.550a 2 .461
25-34 124(60.5) 81(39.5)
35+ 59(67.8) 28(32.2)
Level of formal education
No formal
3475.6) 11(24.4) 8.208 2 0.042
education
Primary 58(69.0) 26 (43.7)
Secondary 29(63.0) 17(37.0)
Tertiary 241((62.1) 14737.9)
Personal level of income
1 - less than 100 $ 6762.0) 41(38.0) 1.35 2 0.509
150-300$ 164(63.1) 96(36.9)
More than 300$ 10(50.0) 10(50.0)
Employment status
Not employed 158(60.1) 105(39.9) 1.440 1 .138
Employed 83(66.4) 42(33.6)
Number of children
1–2 82(64.1) 46(35.9) 3.052 2 .217
3–4 81(41.8) 113(58.2)
5 and above 46(69.7) 20(30.3)
**significant at p< 0.01, 0.05
The chi-square results in Table 5 above show that among the personal related factors
only the level of formal education (χ2 = 8.208, p = 0.042) was significantly associated
with utilization of modern family planning methods among women of reproductive
age (18-45 years) in Wadajir District, Mogadishu – Somalia. On the other hand, other
personal related factors that included age in years (χ2=1.550, p = 0.461), personal
level of income (χ2= 1.35, p = 0.509), employment status (χ2= 1.440, p = 0.138), and
number of children (χ2= 3.052, p = 0.217) were not significantly associated with
(18-45 years) in Wadajir District, Mogadishu – Somalia.
37
Table 6: Chi-Square Analysis of Family Specific Factors Associated With Utilization
Years) in the Study
Planning Methods
Yes No χ2 df p-Value
Factors
N (%) N (%)
Decision making powers
I make the 2
16(57.1) 12(42.9) 1.747 .418
decisions
My partner makes
84(66.7) 42(33.3)
the decisions
We make the
141(60.3) 93(39.7)
decision together
Spousal communication
We discuss 215(62.1) 131(37.9) .001 1 .551
We never discuss 26(61.9) 16(38.1)
Family support
Yes 26(61.9) 16(38.1) .211 1 .451
No 215(62.1) 131(37.9)
Nature of your family
Nuclear 184(86.4) 29(13.6) 118.222 1 .000
Extended 118
57(32.6)
67.4)
In regard to family specific factors, the results in Table 6 indicate that only nature the
family (χ2 = 118.222, p = .000) was significantly associated with utilization of
modern family planning methods among women of reproductive age (18-45 years) in
Wadajir District, Mogadishu - Somalia. Other family specific factors that included
decision making powers (χ2=1.747, p = 0.418), spousal communication (χ2= 0.001, p
= 0.551), and family support (χ2= 0.211, p = .451) were not significantly associated
with utilization of modern family planning methods among women of reproductive
age (18-45 years) in Wadajir District, Mogadishu - Somalia.
38
Table 7: Chi-Square Analysis of Health System Factors Associated With Utilization
Years) in the Study
Planning Methods
Yes No χ2 df p-Value
Health system factors
N (%) N (%)
Attitudes of FP service providers
Positive 156(57.6) 115(42.4) 7.902 .003
Negative 85(72.6) 32(27.4)
Privacy of service provision
Available 113(73.9) 40(26.1) 14.802 1 .000
Not available 128(54.5) 107(45.5)
Affordability of services (cost)
Yes (affordable) 57(68.7) 26(31.3) 1.932 1 .103
No (not
184(60.3) 121(39.7)
affordable)
Counseled on all family planning
issues
Yes 116(61.1) 74(38.9) .178 1 .375
No 125(63.1) 73(36.9)
Waiting time
30 minutes 5462.8) 32(37.2) 3.809 2 .149
1 hour 5654.4) 47(45.6)
>1 hour 131(65.8) 68(34.2)
Level of knowledge about FP services
Knowledgeable 194(90.2) 21(9.8) 162.016 1 .000
Not
47(27.2) 126(72.8)
knowledgeable
As regards the health facility related factors, chi-square results in Table 7 above
indicate that attitudes of FP service providers (χ2= 7.902, p = 0.003), privacy of
service provision (χ2= 14.802, p = 0.000), and capacity of health services providers
(χ2= 162.016, p = 0.000) were significantly associated with utilization of modern
family planning methods among women of reproductive age (18-45 years) in Wadajir
District, Mogadishu - Somalia. However, affordability of services (cost) (χ2= 1.932, p
= 0.103), family planning counseling (χ2= 0.178, p = 0.375), and waiting time (χ2=
3.809, p = 0.149) were not significantly associated with utilization of modern family
planning methods among women of reproductive age (18-45 years) in Wadajir
District.
39
At the confirmatory level, all factors that were significant at bivariate level of analysis
at 5% were subjected to multivariate binary logistic regression analysis to establish
the factors affecting utilization of modern family planning methods and the results
were as presented in Table 8 below.

Utilization of Modern Family Planning Methods among Women of Reproductive Age
(18-45 Years) the Study
Modern FP method
Utilization
Yes No
AOR (95%CI)
Variable(s) N (%) N (%) COR (95%CI)
Education Level
No formal Education 34(75.6) 11(24.4) 1.81(.73-4.48) .79(.25-2.54)
Primary 120(56.3) 93(43.7) .76 (.39-1.46) .36(.16-.83)**
Secondary 58(69.0) 26(31.0) 1.31(.61-2.79) .44(.17-1.17)
Tertiary 29(63.0) 17(37.0) 1
Nature of family
Nuclear 184(86.4) 29(13.6) 13.14(7.94-21.73) .27(.06-1.42)
Extended 57(32.6) 118(67.4) 1 1
Health Personnel Attitude

Positive 156(57.6) 115(42.4) .51(.32-.82) 1.46(.73-2.91)
Negative 85(72.6) 32(27.4) 1 1
Privacy of service provision

Available 113(73.9) 40(26.1) 2.36(1.52-3.68) 1.37(.74-2.54)
Not Available 128(54.5) 107(45.5) 1 1
Health services providers knowledgeable

Knowledgeable 194(90.2) 21(9.8) 24.77(14.13-43.41) 87.04(17.17-441.02)**
Not Knowledgeable 47(27.2) 126(72.8) 1 1
Education Level
Table 8 findings indicate that specific level of education was not significantly
associated with utilization of modern family planning methods among women of
40
reproductive age (18-45 years) in Wadajir District, Mogadishu-Somalia prior to
controlling for confounding (COR=.76; 95%CI: .39-1.46; p = 0.405). When subjected
to a multivariate analysis, the overall effect of education level showed a significant
association (AOR = 0.36; 95%CI= 0.16-0.83; p= 0.017). The results indicate that odds
of using modern family planning methods among women who had attained only
primary education are lower compared to those with secondary and tertiary education.
This implies that the level of formal education is a significant predictor of utilization
of modern family planning methods among women of reproductive age. The finding
of the current is comparable to the earlier finding by Mona, (2013) who reported that
female education has been seen as a key determinant of contraceptive use in that,
better educated women have more knowledge of contraceptive methods or of how to
acquire them than are less educated women because of their literacy, greater
familiarity with modern institutions, and greater likelihood of rejecting a fatalistic
attitude towards life. Similarly, a study in Ethiopia showed that Women’s level of
education is associated with increases use of FP (Tilahun et al. 2013).
Capacity of Health Workers to offer FP Services
Table 8 findings indicate that capacity of health workers to offer FP services was
significantly associated with utilization of modern family planning methods among
women of reproductive age at bivariate analysis level (COR = 24.77; 95% CI=14.13-
43.41; p = 0.000). When subjected to a multivariate analysis, capacity of health
workers to offer FP services equally showed a significant association (AOR = 87.04;
95%CI= 17.17-441.02; p= 0.000). The results indicate that women who reported that
health services providers were knowledgeable were 1.17 times more likely to use the
modern family planning services than those who reported that health workers were
not knowledgeable. This finding is in agreement with that of found in study by Simbar
41
et al. (2016) reported that adequate knowledge of interns and nurses regarding female
condoms was significantly associated with their use among women of reproductive age in
Iran. The current study finding is comparable is to that of Singhet al. (2014) in Dheli who
indicated that high knowledge about emergency contraception among doctors had
increased its use as they were able to explain to the clients about its effective use.
Nature of Family
Table 8 results show that the nature of the family was significantly associated with
utilization of modern family planning methods among women of reproductive age at
bivariate analysis level (COR=13.14; 95%CI: 7.94-21.73; p = 0.000). When subjected
to multivariate analysis however, nature of the family did not significantly predict the
(AOR=0.27; 95%CI: 0.06-1.42; p = 0.126). It therefore indicated that nature of the
family is not a significant factor in utilization of modern family planning methods
among women of reproductive age. This finding is no in agreement with that of Char,
Saavla and Kulmala (2010) who reported family planning decisions are also affected
by extended family due to the nature of family dynamics.
Health Personnel Attitude
The findings presented in Table 8 show that health personnel attitude was
significantly association with utilization of modern family planning methods among
women of reproductive age (18-45 years) in Wadajir District, Mogadishu - Somalia at
bivariate analysis (COR=0.51; 95%CI: .32-.82; p = 0.005). It however lost its
significance after being subjected to multivariate analysis (AOR=1.46; 95%CI: 0.73-
2.91; p = 0.282). This finding shows health personnel attitude is not a significant
factor in utilization of modern family planning methods among women of
reproductive age (18-45 years) in Wadajir District. This finding is quite different from
42
that of Tilahun et al. (2012) who reported that health workers attitude significantly
influenced use of FP services either positively or negatively, whereby when they
show positive attitude, women are more likely to use the service but when they show
negative attitude it is unlikely that for adolescents to go for FP.
Privacy of Service Provision
The findings presented in Table 8 show that privacy of service provision was
significantly association with utilization of modern family planning methods among
women of reproductive age (18-45 years) in Wadajir District, Mogadishu - Somalia
(COR=2.36; 95%CI: 1.52-3.68; p = 0.000). It however lost its significance after being
subjected to multivariate analysis (AOR=1.37; 95%CI: .74-2.54; p =0.311). This
finding shows that the privacy of service provision is not a significant factor in
(18-45 years) in Wadajir District, Mogadishu - Somalia. This finding in disagreement
with that of Tsegaye and Sena (2015) who reported that clients whose privacy was
maintained during family planning counseling and procedures were more likely to be
satisfied use the services more than those whose privacy was not maintained.
43
CHAPTER FIVE
5.0. SUMMARY OF FINDINGS, CONCLUSIONS AND

RECOMMENDATIONS
This chapter summarizes the major findings of the study based in line with the study
objectives. It also provides the conclusions and recommendations drawn from the
study findings.
5.1. Summary of the Study Findings
The first objective of the study was to determine the prevalence of modern family
planning utilization among women of reproductive age (18-45 years) in Wadajir
District, Mogadishu – Somalia. The results indicate that most (62.1%) of the women
of reproductive age (18-45 years) in Wadajir District are currently using some form of
modern family planning methods.
Results of multivariate binary logistic regression for the association between factors
and utilization of modern family planning methods among women of reproductive age
(18-45 years) in Wadajir District showed that education level (AOR = 0.36; 95%CI=
0.16-0.83; p= 0.017 and capacity of health workers to offer FP services (AOR =
87.04; 95%CI= 17.17-441.02; p= 0.000) were significantly associated with utilization
of modern family planning methods among women.
5.2. Conclusions
There is still a high burden of nonoptimal utilization levels of modern family planning
methods among women of reproductive age 18-45 years) in Wadajir District,
Mogadishu – Somalia with 37.9% reported to be non-users of modern FP methods.
With limited use of modern family planning methods consequent unplanned
44
pregnancies, increased maternal and infant mortality rates are the main health
problems likely to occur in Wadajir District if no interventions are put in place to
increase the levels of FP use. The study also concludes that level of formal education
and capacity of health workers to offer FP services are crucial in increasing FP
utilization among women of reproductive age in Wadajir District.
5.3. Recommendations
The study basing on the key findings in line with the objectives prior set makes the
following recommendations for future redress.
For Practice:
 To further increase the level of utilization of modern FP methods, health should
come up with outreach community programs) that inspire and advocate use of
modern family planning methods.
 The administration of health facilities needs to capacity of the health workers
through on-job training in modern family planning.
 Parents should be encouraged to promote girl child education as the level of
formal education is associated with increased use of FP
For Policy:
 The government need to come with a policy that supports girl child education
through girl child education support programmes
 The government through the Ministry of Health should come up with a policy that
require mandatory re-training of all FP health providers in healthy facilities to
increase the health workers knowledge and skills in offering modern FP services.
Area for Further Research
Assessing the strategies for improved utilization of modern family planning methods
among women of reproductive age.
45
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APPENDICES
Appendix 1: Informed Consent Form
Study Topic: “Factors Associated with Utilization of Family Planning Methods

Among Women of Reproductive Age (18-45 Years) In Wadajir District, Mogadishu-
Somalia”
Purpose of the study
The purpose of the study is to examine the factors associated with utilization of
modern family planning methods among women of reproductive age (18-45years) in
Wadajir District, Mogadishu – Somalia so as to improve the maternal health of
women of reproductive age.
Mohamed Hassan Barow is the researcher. The findings of this study will be used
for academic purposes only. You are selected for participation because you are a
stakeholder.
Procedures: Interview
You will be asked to help the researcher facilitate the completion of a Study. The
questionnaire will take you approximately 25 minutes. You will be asked to provide
necessary information according to the study or schedule for an interview as may be
deemed appropriate to you.
Risks /Discomforts:
There are no known physical risks associated with participating in this study. Any
fears regarding the confidentiality of your information are normal and will be
respected. Potential organizational risks may be involved with the opportunity costs of
your spending time in the interview session. Given the efforts that will be taken to
maintain confidentiality (see below), no additional risks will be associated with this
research.
Benefits:
This research will result in informing your organization on the available literature that
may facilitate policy making for the wellbeing of the community health to your people
of concern. If you request, you may receive a copy of your own Study results for your
records.
50
Confidentiality:
Your identity and your responses will remain confidential and will not be revealed in
published or unpublished results of this study. You will not be asked to divulge any
information that you are uncomfortable sharing. The researcher is under non-
disclosure and confidentiality obligations. The information you share will be kept
confidential. Every effort will be made to insure confidentiality for you, your staff and
your company.
Withdrawal:
Participation in this research is voluntary with no penalties for non-participation or
withdrawal. You may refuse to answer any question during the study. The researchers
will not influence you to provide more information than that which you feel
comfortable sharing. In addition, you may choose to withdraw from this study at any
time.
Concerns:
If you have any concerns or questions at any time during this study, you may contact:
Researcher, Mohamed Hassan Barow of Accord University on this telephone
number +252616550113
I understand the procedures and my questions have been answered to my satisfaction.

I have read understood and received a copy of the above statement of Informed
Consent and agree to participate in this study.
___________________________ ________________________
Participant’s Signature Date
___________________________ ________________________
Researcher’s Signature Date
51
Appendix II: Questionnaire
Dear Respondent,
I am by the name of Mohamed Hassan Barow a student pursuing a Master’s
Degree in Public Health of Accord University. I am conducting research on
“FACTORS ASSOCIATED WITH UTILISATION OF FAMILY PLANNING
WADAJIR DISTRICT, MOGADISHU- SOMALIA” which is part of the
requirement of the award of the Master’s Degree in Public Health of Bugema
University. I kindly request you, to fill in blank boxes and spaces as provided. All the
information provided will be used purposely for academics only and all information
will be treated confidentially.
SECTION A: PERSONAL FACTORS
Please tick where applicable)
1. What is your age? (In complete years)
…………………………………………
2. What is your highest level of education?
1- No formal education 2 - Primary 3 - Secondary
4 - Diploma 5 - Certificate/vocational training 6 = Degree
3. What is your level of income?
4. 1 - less than 100 $ 2 - 150-300$, 3 - More than 300$
5. Employment status
1- Not employed 2 - Employed
6. If employed, please indicate the type of employment
1 - Civil servant 2 - Casual Laborer 3 – Self-employed
52
7. Number of children
A. 1 – 2
B. 3 – 4
C. 5 and above
8. Please choose/tick ONE of the following statements that BEST DESCRIBES

your attitude towards use of family planning (Please Tick in the appropriate box
with the correct answer)
Attitude statement Response

1. Use of family planning is very important to my health because am 1- Yes (_)
able to decide when to produce 2- No (_)
2. Use of contraceptive for family planning cannot lead to loss of 1- Yes (_)
libido thus causing marital breakdowns 2- No (_)
3. Using of family planning contraception while young cannot lead 1- Yes (_)
to loss of fertility resulting in divorce 2- No (_)
4. Modern Family Planning Methods cannot interfere with 1- Yes (_)

menstruation cycles and or cause excusive bleeding 2- No (_)
5. Modern Family Planning Methods does not lead to giving birth to 1- Yes (_)
children with disability 2- No (_)
SECTION B: Family factors influencing utilization of family planning
9. Who makes the decisions regarding family planning?

1- I make the decisions
2- My partner makes the decisions
3- We make the decision together
10. Do you ever discuss matters regarding family planning with your spouse/partner?
1- We discuss
2- We never discuss
11. Do you get support from any of your family members in regard to family
planning?
1- Yes
2- No
53
12. Which of the following describes the nature of your family?
1- Nuclear
2- Extended
SECTION C: Health system factors
13. Attitudes of FP service providers

Attitude statement Response
1. Family planning health providers always listen to my FP 1- Yes (_)
related issues 2- No (_)
2. Family planning health providers are very welcoming 1- Yes (_)
2- No (_)
3. Family planning health providers are friendly to clients 1- Yes (_)
2- No (_)
4. Family planning health providers are polite to clients 1- Yes (_)
2- No (_)
5. Family planning health providers respect clients irrespective 1- Yes (_)
of the status are respectful 2- No (_)
14. There is a private room where you receive birth control methods in the presence of
only the medical personnel
1- Available
2- Not available
15. Are you able to meet the costs which are involved in acquiring and using methods
that limit child birth such as transport costs, consultation fees and medical bills?
1- Yes
2- No
16. Are you counseled on issues concerning all available methods for limiting, space
children, their related effects and which one is most effective for them?
1- Yes
2- No
17. How long do you take in the health facility while receiving FP services?
1= 30 minutes 2= 1 hour, and 3 = >1 hours
18. The health services providers you visit are knowledgeable enough to offers FP
services
54
1- Knowledgeable
2- Not knowledgeable
SECTION D: Prevalence of Modern Family Planning Methods

19. Kindly state whether in the last six (06) months you have used modern family
planning
1= Yes 2 = No
20. If yes, which of the following family planning method have you been using for the
last 6 months? (Please tick appropriately)
Family planning method Tick appropriately
Injectable
Pills (Oral contraceptives)
IUD
Implants
Female condoms
Female sterilization
Emergency contraceptives
55
Appendix III: Map showing the location of the study
56

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Accord University

Knowledge & Vision

Master of from Accord university-Somalia.

Department of Public Health

Department of Master of Public Health

FARHAN MOHAMUD IBRAHIM

MASTER OF PUBLIC HEALTH

METHODS AMONG WOMEN OF REPRODUCTIVE AGE (18-45 YEARS) IN

WADAJIR DISTRICT, MOGADISHU- SOMALIA

Farhan Mohamud Ibrahim

A Thesis Submitted to the School of Graduate Studies, Bugema

University, in Partial Fulfilment of the Requirement for Award of

the Degree of Master of

I, Farhan Mohamud Ibrahim, declare that this thesis proposal on “Factors

associated with utilization of family planning methods among women of

reproductive age (18-45 years) in Wadajir district, Mogadishu, Somalia ” is my

of higher learning for any award.

Farhan Mohamud Ibrahim

This is to confirm that this thesis proposal on “Factors Associated with

Utilization of Family Planning Methods among Women of Reproductive Age (18-

45 Years) In Wadajir District, Mogadishu, Somalia” is under my supervision and

First and foremost, I must thank my research supervisors, Dr. Christopher

understanding over these past four years.

stands as a testament to your unconditional love and encouragement.

been a resource for deeper learning and encouragement to continue to completion of

the research project.

1.1. Background to the Study.................................................................................1

1.2. Problem statement...................................................................................................3

1.3. Research questions..................................................................................................4

1.4. Objectives of the Study......................................................................................5

1.4.1. General Objective............................................................................................5

1.4.2. Specific objectives..............................................................................................5

1.5. Hypothesis of the Study.....................................................................................5

1.6. Significance of the study....................................................................................6

1.7. Study scope........................................................................................................7

1.9. Operational definition of key terms...................................................................8

2.0. LITERATURE REVIEW......................................................................................12

2.1. Personal factors Influencing Family Planning Methods among Women of

3.1. Research Design....................................................................................................20

3.3. Study Area............................................................................................................20

3.4. Sample Size determination...................................................................................21

3.5. Sampling Procedure..............................................................................................21

3.6. Data Collection Instruments.................................................................................22

3.7. Data Collection Procedure....................................................................................22

3.8. Data Analysis........................................................................................................23

3.9. Inclusion and exclusion criteria.......................................................................23

3.11. Ethical consideration......................................................................................24

RESULTS AND DISCUSSION...................................................................................25

4.1. Demographic Characteristics (Personal related Factors) of Women of

Table 2: Demographic/ Personal characteristics of Women of Reproductive Age (18-

4.2. Prevalence of Modern Family Planning Utilization among Women of

Figure 2: Prevalence of modern family planning utilization among women of

reproductive age (18-45 years) in Wadajir District, Mogadishu – Somalia........29

4.3. Factors Affecting Utilization of Modern Family Planning Methods Among

Table 4: Health Facility Related Factors Affecting Utilization of Modern Family

Table 5: Chi-Square Analysis of Personal Factors Associated with Utilization of

Table 6: Chi-Square Analysis of Family Specific Factors Associated With

Table 7: Chi-Square Analysis of Health System Factors Associated With

Table 8: Logistic Linear Regression Analysis of the Factors Associated with

5.0. SUMMARY, CONCLUSIONS AND RECOMMENDATIONS..........................44

5.1. Summary of the Study Findings...........................................................................44

Appendix 1: Informed Consent Form..........................................................................50

Appendix II: Questionnaire..........................................................................................52

Appendix III: Map showing the location of the study.................................................56