Determinants of non-use of family planning among married women in Kabati Division Kitui District, Kenya

116 

Full text

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Married Women In Kabati Division Kitui District,

Kenya

Julia Waithira

!

!h1!9

_

156/8688/99

A Thesis Submitted In Partial Fulfilment For The Degree Of Master O

f

Public Health And Epidemiology Of Kenyatta Univers

i

ty

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DECLARATION

This thesis is my original work and has not been presented for a degree in any other University or any other award.

~'

Signed _--f~,,4- ~ Date

;}J

/

'

()

b

/2G

Q

2

-.

( I

SUPERVlSORS'APPROVAL

We confirm that the work reported in this thesis was carried out by the candidate under our supervision.

1. Dr. John N. Mbithi Department of Zoology _ Kenyatta University

Signed~' Date

2. Dr. Jedidah Kongoro Department of Zoology Kenyatta University

Signed ~'--- Date

~7·

06

·:;2./??

)

2

3.

Dr. Eliab Seroney Some Directorate of Programmes African Medical.Research

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Dedication

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ACKNOWLEDGEMENTS

This study is as a result of valuable contributions of people and institutions.

First I

wish to acknowledge the valuable contributions of my supervisors: Dr

.

Mbithi, Dr

.

Kongoro and Dr.

Some.

Similarly, many thanks go to the young women of Kabati who

tirelessly assisted in data collection and to Josephine Mailu and the staff of Kalimani

Health Centre for ensuring my comfortable accommodation

,

during data collection.

The

staff of AMREF Kitui Office were very supportive and are acknowledged for their

support.

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ABSTRACT

Family Planning (FP) is one of the most important interventions in health care. As the demand for reproductive health care grows, advocacy for Family Planning is becoming crucial. Yet and inspite of the efforts towards fertility control, there remains a substantial proportion of women in reproductive age-group who are not using Family Planning methods even though they do not want a pregnancy right away. A cross-sectional descriptive population-based study was conducted to determine the reasons for the discrepancy between fertility preferences and contraceptive practice in Kabati division, Kitui district. A total of 450 married women in reproductive age (15-49 years) were interviewed using a structured questionnaire in addition four focus group discussions (FGDs).

The results indicated that majority of the women 281 (62%) did not use any contraceptives (non-users) and only 169 (38%) were users. Majority 320 (71%) of the respondents were aged between 25-39 years. Most respondents aged 15-19 years and 44-49 years were non-users and age-gr~mp 25-29 years had a high number of non-users 88 (60%). In terms of religion, the respondents were mainly of Protestant faith

j

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non-users.

Economic reasons were cited by half of the respondents 140 (51%) as the

main reason for non-intention to have more children.

Most 153 (54%) non-users had inadequate knowledge of Family Planning while most

users 96 (57%) had adequate knowledge

.

A total of 163 (36%) respondents did not

discuss Family Planning issues with their spouse

.

Among these,

119 (73%) were

non-users compared to only 44 (27%) non-users

(X2 =

12.15, P

=

0

.

0001)

.

The nearest health facility was reported to be the health centre and most respondents,

281

(62%) lived a distance of more than 5 km from the nearest facility and only 3 (2%)

obtained Family Planning methods from the Community Base<jDistributor (CBD)

.

The

main reasons cited for Family Planning non-use were the fear of side-effects,

100 (29%)

and husbands' disapproval for Family Planning use,

88

(25%)

.

In the multivariate

analysis,

low socio-economic status (O.R

.

3.5, P

=

0

.

022), inadequate knowledge

(O

.

R

.

2.9, P

=

0.0001) and failure to discuss Family Planning issues with the spouse

(O.R

.

1

.

69, P = 0.031) emerged as important determinants of Family Planning non-use

.

Factors involving knowledge of Family Planning, spousal communication,

improved

CBD services and male involvement in Family Planning use should be addressed to

increase contraceptive prevalence in the area through Information, Education and

Communication (l.E

.

C)

programmes

.

Similarly,

improvement of women's

socio-economic status through encouraging education beyond primary level and encouraging

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Title Page

Declaration

Dedication

Acknowledgement

Abstract

Table of Contents

List of Tables

List of Figures

List of Abbreviations

TABLES OF CONTENTS

CHAPTER ONE

Introduction and Literature Review

General Introduction

Background Information on Family Planning Programme in Kenya

Literature Review

l.3.1 Major Factors Contributing to Non-use ofFamily Planning l.0 l.1 l.2 l.3 l.3.l.1 l.3.l.2 l.3.l.3 l.3.1.4

1.4 Problem Statement

Lack of information

Opposition from husbands, families and communities

Difficulties with Access to Family Planning services

Health concerns and side-effects

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Page

l

.

5

Justification 10

l

.

6

Hypotheses

12

l

.

7

Objectives

12

CHAPTERlWO

2

.

0

Materials and Methods

13

2

.

1

Study Area

13

2

.

1.1

Climate

13

2

.

1

.

2

Health facilities and disease incidence

14

2

.

1

.

3

Infrastructure

14

2

.

2

Study Population

14

2.2

.

1

Inclusion Criteria

14

2

.

2.2

Exclusion Criteria

15

2

.

2

.

3

Sample size determination

15

2

.

2

.

4

Ethical Consideration

16

2

.

3

Research Methods

16

2

.

3.1

Study Design

16

2

.

3.2

Study Variables

16

2

.

3

.

3

Sampling Procedure

17

2

.

3

.

4

Data Collection

18

2

.

3

.

5

Control of biases

20

2

.

3

.

6

Data management and analysis

20

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CHAPTER THREE

Page

3

.

0

Results

22

3.1

Socio-economic and Demographic Characteristics of the Respondents

22

3

.

1.1

Socio-demographic Characteristics of the respondents

22

3

.

1

.

2

Socio-economic status of the respondents

2

8

3

.

1.3

Availabilityof mass Communication Instruments

30

3.2

Intention to have more children

31

3.3

Knowledge on Family Planning

34

3

.

3

.

1

Initial source of information on Family Planning

34

3

.

3

.

2

Knowledge of specificFamily Planning methods

34

3

.

3

.

3

Knowledge of the source of FamilyPlanning methods

37

3

.

3

.

4

Knowledge of Family Planning

37

3.3.5

Respondents knowledge of Community Based Distributors

(C

BDs

) 40

3

.

3

.

6

Knowledge of conception period

40

3

.

4

Family Planning use

41

3

.

4

.

1

FamilyPlanning methods used by the respondents

41

3

.

4.2

Respondents' reasons for non-use of Family Planning

45

3

.

4

.

3

Future intention for use of Family Planning

45

3.4

.

4

Influence of Socio-economic and Demographic Character

i

stics

on Family Planning use

48

3

.

5

Spousal Communication About Family Planning

51

3

.

5.1

Authority on Decision on FamilyPlanning use

52

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3.6.1 Nearest Family Planning Facility

3.6.2 Availability of Family Planning services

3.6.3 Rating of Family Planning services by the Respondents

3.7 Logistic Regression Analysis

3.8 Focus Group Discussions Analysis

Page

56

56

57

60

62

CHAPTER FOUR

4.0 Discussion 64

4.1 Demographic and Socio-economic Characteristics 64

4.2 Knowledge on Family Planning 67

4.3 Family Planning use 68

4.4 Spousal Communication about Family Planning issues 70

4.5 Accessibility and Availability of Family Planning services 72

CHAPTER FIVE

5.1 5.2

Conclusion

Recommendations

References

Appendices

75

76

78

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LIST OF TABLES

Page

1. Distribution of the Respondents in the sub-locations

24

2.

Respondents' Demographic Characteristics

26

3.

Socio-economic Status of the Respondents

29

4. Knowledge of specific Family Planning methods

36

5. Respondents' knowledge of conception period

40

6

.

Family Planning methods used by the Respondents

44

7. Reasons for non-use of contraception

46

8. Influence ofsocio-economic and Demographic Characteristics on Family

Planning use

9. Relationship between Knowledge, Socio-economic status and discussion

on Family Planning issues and status of Family Planning use

10.Focus Group Discussion Task

50

61

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LIST OF FIGURES

1. Age Distribution of the Respondents

2. Respondents Religious Affiliations

3. Availability of Mass Communication Instruments

4. Reasons for not intending to have more children

5. Ideal number of children for a couple

6. Initial source of information on Family Planning

7. Knowledge of the source for Family Planning

8. Knowledge of Family Planning

9. Family Planning use status

10.Non-user Future Intention for Family Planning use

11. Spousal Discussion of Family Planning Issues

12. Spousal approval of Family Planning use

13.Decision on Family Planning use

14.Nearest Family Planning Facility

15.Rating of Family Planning services by the Respondents

Page

25

27

30

32

33

35

38

39

43

47

53

54

55

58

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AMREF

A.N.C.

CBD CBS CDC CPR FGD FP FPAK

G.O.K

·I.E.C

I.G.As

I.P.P.F

IUCDIIUD

KDHS

M.O.H

M.C.HIFP

NCPD

NGO

O.R.

PRB

SDP

LIST OF ABBREVIA nONS

African Medical Research Foundation

Ante-natal Care

Community Based Distributors (of contraceptives)

Central Bureau of Statistics

Centers for Disease Control

Contraceptive Prevalence Rate

Focus Group Discussion

Family Planning

Family Planning Association of Kenya

Government of Kenya

Information, Education and Communication Income Generating Activities

International Planned Parenthood Federation

Intra Uterine Contraceptive Device

Kenya Demographic Health Survey

Ministry of Health

Maternal Child Health and Family Planning

National Council for Population and Development

Non-governmental Organization

Odds Ratio

Population Research Bureau

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SPSS

STIIHIV

Statistical Package for Social Sciences

Sexually Transmitted Infection and Human Immunodeficiency

Virus

Total Fertility Rate

United Nations

World Health Organization TFR

UN

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CHAPTER ONE

1.0 Introduction and Literature Review

1.1 General Introduction

One of the major aims of reproductive health services is to reduce levels of unwanted

pregnancies in all women of reproductive age group (WHO, 1998)

.

Reproductive health

indicators have shown that countries in sub-Saharan Africa (Kenya included) are generally

i

n a

poorer state of reproductive health when compared to other parts of the world (Okonfua,

1

997)

.

Several interventions have addressed the state of reproductive health in Africa. The

International conference on population and Development in Cairo and the Internat

i

onal

.

Conference on women in Beijing, China,

made particular reference to the reproductive health

problems of women in Africa and urged countries to take steps to ameliorate the situation (UN

,

1996)

.

The reproductive health strategy as a tool was adopted to help planners and implementers

to direct the focus of their work, assess priorities to meet needs and fill gaps in reproductive

health matters (Muia

et al.

;

2000)

.

Reproductive health is a relatively new concept and

it

recognizes that with regard to the reproductive process and functions, women have special needs

,

before, during and beyond childbearing age and considers special needs of men

,

(Benagiano

,

2000)

.

Among the factors that influence reproductive health, fertility regulation is absolutely one

of the most important as it has a bearing on,

among others, the prevention of unwanted

pregnancy and its consequences (WHO, 2000)

.

The world population is well over six billion and is growing by nearly 80 million people

each year, (Robey,

et aI

.

,

1996) and almost one half of married women are not using family

planning considering Contraceptive Prevalence Rate (CPR) of 56% world-wide (PRB

,

1998).

It

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countries want to avoid a pregnancy and are not doing so (Finger, 1999).

In Africa,

t

he family

planning services are able to meet the needs of less than one third of all potential users (WHO

,

1994).

Some of the significant pre-disposing factors for many reproductive health problems have

been reported to be illiteracy, poor socio-economic and living conditions

,

low educational leve

l

and social status of women,

(Okonfua,

1997)

.

Although fertility levels are falling in much of the world

,

rapid population growth

remains a critical issue in most developing countries where needs are great and resou

r

ces are

scarce

.

Advocacy for family planning therefore is becoming crucial as demand for reproductive

health care grows, (Robey,

et al.,

1996).

Lowering fertility levels will therefore enable

achievementof sustainable development.

Studies have revealed that an estimated 22% of all births are unwanted and this is

probably an underestimation considering that many parents do not want to acknowledge that a

child was unwanted (Bongaarts and Bruce, 1995).

The use of family planning has significantly

increased over the past 30 years with more than half of women practicing family planning.

Th

i

s

portion however varies greatly by region from 13% in Western Africa,

17% in Eastern Africa,

76% in North America

,

75% in Western Europe and 81% East Asia (PRB, 1998).

1

.

2

Background information on Family Planning Programme in Kenya

.

The concept of family planning in Kenya was introduced in the 1940s

.

After the

1

948

census revealed the population to be 5.4 million,

people were permitted to adopt birth control

methods

.

This led to the starting of the organized Family Planning Services in 1955

.

Family

Planning Services organized by Family Planning Association of Kenya (FPAK) were started in

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through various outlets, Ministry of Health

,

private clinics, hospitals and non-governmental

organizations (Toroitich-Rutto, 1998). The FPAK became affiliated to International Planned

Parenthood Federation (IPPF) and Kenya became the first African country south of Sahara to

become a member of IPPF

.

In subsequent years in a sessional paper No.

10 of 1965, the Kenya

government formally accepted Family Planning as part of the National Planning Strategies and

public health agenda.

This led to integration of Family Planning Services into maternal and child

health services (MCH) (MOR

,

1996).

By 1969, the fertility rate was 7.6 children per woman and

population growth rate of 3.3% per year.

However,

the intended goals were not achieved and by

1979 census, the population growth rate had risen to 3.8% per year (MOH,

1996)

.

Subsequently,

to supplement the services of FPAK

,

a National Council for Population and Development

(NCPD) was established in 1982 with the following goals:

- to reduce population growth rate,

encourage Kenyans to have a small family, to reduce fertility level and to reduce

infant

morbidity and mortality rate

.

Currently there are 2700 Service Delivery Points (SDPs) in the

country compared to 775 SDPs in 1989

.

The pills and injectable hormonal contraceptives

(Noristat and Depoprovera) are the most popular methods of contraception (Population Council

and MOH; 1997, MOH; 1996).

Contraceptives prevalence rate among married women in Kenya has increased greatly

over the last twenty years from 7% in 1977/78 to 27% in 1989 and 39% in

1998 (NCPD

e

t a

l.

,

1998)

.

However, despite this progress towards fertility control, there remains a substantial unmet

"

need for family planning. The current population policy aims at attaining a balance between

Kenya's population growth rate on the one hand and sustained rate of economic growth for

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people through increased Contraceptive Prevalence Rate and reduction of Total Fertility Rate

(TFR) from 5.0 in 1995 to 2.5 by 2010 (NCPD; 1997).

Although Kenya's fertility is on the decline currently at 4.7 children per woman in 1998

compared to 8.1 in 1970s (NCPD

et al.,

1998),24% of married women contraceptive non-users want to avoid pregnancy yet they are not practicing family planning (NCPD

et

al., 1998). It is the

right of every woman to achieve her reproductive health goals. This study therefore aims at

investigating the factors that may contribute to the non-use of contraception among married

women.

1.3 . Literature Review

Family planning is one of the most important reproductive health interventions provided

by health ministries as well as non-governmental organizations in the country. The family planning services provide the choice for families to have the number of children they intend to

have. The families and individuals are enabled to exercise their right to have the desired number of children. The family planning programmes help the people to make an informed choice

regarding reproductive health. Saving women's lives could prevent about 25% of all maternal

deaths in developing countries. Unsafe abortions and unintended pregnancies are also prevented through use of family planning. Women have healthier children and infants' survival is improved

by about 50 % (Upathway and Robey, 1999).

In addition, Family Planning offers women more choices through education, employment

and community involvement. With support Family Planning programmes could help more

people adopt safer sexual behaviour by making sexual decisions responsibly avoiding sexually

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transmitted infections (STls) and unwanted pregnancies. Fertility control reduces maternal and child morbidity and mortality by ensuring women bear children during the healthiest times for

both mother and child.

Estimates of non-use of Family Planning from demographic health surveys show that

about 150 million or about one in four married women in developing countries want to avoid a pregnancy and yet they are not using any contraception (Finger, 1999). Asian countries have the largest number of married women with unmet need for Family Planning, with 31 million in terms

of total population and in terms of percentage of married couples whose needs for family planning are unmet, Sub-Saharan Africa leads where an unmet need for spacing predominates .

(Robey,

et al.,

1996, Finger, 1999). Other countries with a large number of unmet need are

Pakistan at 5.7 million, Indonesia at 4.4 million, Nigeria at 3.9 million and Phillipines at 3.1

million (Robey,

et aI.,

1996). The unmet need in developing countries is 20% on average with Kenya at a significant 24%. (Robey,

et aI.,

1996) (NCPD

et aI.,

1998).

Induced abortions worldwide are estimated at a minimum of 45 million each year or one abortion for every three live births (Robey,

et aI.,

1996). This is a clear evidence that millions of

women want to control their fertility but have not used effective contraception (Robey,

et

al.

1996). According to Salter (1997), many women treated for abortion complications are ever

users of contraception. This implies that post-abortion services are essential in addressing the

non-use of family planning in this group of women. Surveys among women aged under 20 years

old show that 20% - 60 % of currently pregnant women have unwanted or mistimed pregnancies

(Me Cauley and Salter, 1995). Similarly, those who have given birth report that their last birth was unintended. The outcome of unmet need for family planning manifests itself in the many

(20)

shows that there is a growing number of unmarried women most of them ado

l

escen

t

s

in

need o

f

family planning services

.

These challenges call for an expansion of Family Planning

s

er

v

ices

(MOR,

1996).

1.3.1 Major factors contribnting to the non-use of Family Planning

Numerous factors are thought to determine the use and non-use of Fam

i

ly

Pl

ann

ing

among women in child-bearing age

.

These factors include socio-demograph

ic

and

s

oc

i

o

-economic characteristics of women, knowledge and spousal communication on family

Pl

an

nin

g

i

ssues, accessibility and availabilityof FamilyPlann

i

ng services (Casterline

et al., 1997).

1.3.1.1 Lack of Information

Lack of awareness of an appropriate method for contraception may be assoc

i

ated

wi

t

h

low contraceptive use

.

If a woman is not well info

r

med about contraception

,

she

c

annot

c

i

t

e

other reasons for non-use such as availability or side effects of a method.

Lac

k

o

f su

ffic

ient

knowledge may contribute to more than two-thirds of all unmet need for fami

l

y plann

ing

.

The

knowledge index developed by researchers to measure knowledge of Family Pl

a

nn

i

n

g us

a

ge

consists of mentioning a modem contraceptive method without being prompted, be

i

ng

aw

are

of

its source and having an opinion about its side effects (Bongaarts and Bruce

1

995

)

.

L

ac

k of

knowledge can be addressed through information

,

education and communication

(r

nC

)

act

iviti

es.

Women must be informed about availability of services

,

where and when offered

(

Casterl

i

ne

,

et

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1.3.1.2 Opposition from husbands, families and communities

Opposition from the husbands or male partners contributes to a significant level of Family Planning non-use. In certain societies other significant people in the family such as the

mother-in-law or elder sisters may influence use of Family Planning. This may be attributed to the high social cost of challenging the opposition from her spouse or anyone else in her social

life (Bongaarts and Bruce 1995). Among women who stop using contraception, in 12% of the cases, it is because the husband wants another child particularly where there is preference for a

son (Ferguson, 1992). A study by National Council for Population and Development (1997) revealed that 4.9% of married women do not use contraception due to the husbands' disapproval.

(Keekovole, et a/., 1997). A man's disapproval for Family Planning use or his fertility preference

may encourage non-use or secret use of contraception among women (Ezeh, 1993). In a study in Turkey, 43% of the women reported that their husbands decidedwhich method to use (Ozvarix,

et al.,

1998). Because women bear the physical burden and pain of child bearing and are

primarily responsible for child care, some say that the decision to use Family Planning should be theirs (Barnett and Stan, 1998). Men's reasons for opposing Family Planning range from desire

for more children particularly where there is cultural preference for sons to the value placed on

children for economic reasons such as providing labour and taking care of old parents. Other

husbands worry about their wives' fidelity if protected from pregnancy and hence want to control

their behaviour. Others object due to fear of side effects of contraceptions and more still have religious objections to. contraceptive use (Casterline, et a/., 1997). Women with an unmet need for Family Planning cite their husbands' disapproval as the principal reason for non-use of

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lack of support by extended families such as elders, sisters and mother-in-law and community

leaders prevents women from using contraception (Robey et al., 1996).

1.3.1.3 Difficulties with access to Family Planning services

In most countries, non-use of Family Planning is greatest among women who have least

access to Family Planning programs, such as the rural women and women with little education.

Inaccessibility to Family Planning programmes is a persistent problem for some women

particularly in developing countries (Robey et aI., 1996). Accessible contraception services implies a mean distance of five kilometers or less or travel time of 30 minutes or less to Family

Planning services, satisfying peoples various contraceptive needs by offering a wide range of

contraceptive methods; having access to a variety of sources for Family Planning such as

community based distributor, non governmental organization clinics, private clinics, government

clinics and social marketing through retail outlets and ensuring high quality services that ensure

privacy and confidentiality coupled with fair treatment of clients. Other aspects that should be

considered in accessibility are availability of accurate and useful information through prompt

counseling (piotron, 1994; Bongaarts and Bruce, 1995). Policy makers, programmes managers and service delivery personnel should therefore ensure a variety of contraceptive options

acceptable to the target population to enhance effectiveness of family planning programmes

(Sekadde-Kigondu et al., 1996).

1.3.1.4 Health concerns and side effects

Side-effects from use of contraception are a senous concern for women. A study in

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contraception (Best, et ai1998). The impact of contraceptives on a woman's health whether real or perceived is often a barrier to Family Planning use (Barnett and Stan, 1996). Concerns include side-effects or health consequences based on lack of knowledge or false information (Hatcher, et al., 1997). Counseling can address obstacles related to side-effects, health concerns and incorrect knowledge about contraception (Finger, 1999). In a study in Philippines, fears of side-effects ranked the most important identified obstacle to Family Planning use (Casterline et al., 1997). In Nepal, women with unmet need reported that they feared sterilization because they knew of women who had died of sepsis following the procedure (Stash, 1999). In a study in Baba Dogo, Nairobi and Bungoma in Western Kenya, women reported fear of failure to return to fecundity . after discontinuing contraceptives as a major barrier to contraception (Kamau, et al., 1996). In Bangladesh, women feared that physical side effects would curtail their ability to work, something that would be unacceptable to the family's financial provider (Barnett and Stan, 1998). Some women would rather risk an unintended pregnancy than use contraception particularly when they lack information on side effects (Robey, et al., 1996). The fear of side effects whether real or perceived has clear implication for the training of family planning providers and improving information communication and education efforts.

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unpopular to use because of inconvenience and frequent visits for physical examinations which

may not be very comfortable to women (Hatcher,

et aI

.

,

1997). Socio-demographic

characteristics such as literacy level, religious faith, age, parity, number of children and

socio-economic reasons are factors that similarly influence contraceptive use and non-use. Such

characteristics not only influence the contraceptive use or non-use but also the type of

contraception to use (Cavalho,

et aI

.

,

1996; Anate, 1995).

1.4

Problem Statement

The Kenya government was first concerned about the high rate of population growth rate

after the publication of the population census of 1948. In Kenya like many other Sub-Saharan

countries, the family planning programmes show minimal success compared to western

countries. The 1998 KDHS report showed that the efforts to reduce the population growth rate

are showing positive results. However, there is a substantial proportion of married women in

reproductive age group who are not using contraception despite the fact that they do not want

pregnancy right away. Family Planning programmes in Kenya aim at improving health for all

especially women through adequate spacing and delaying of births. It is the right of every

woman in reproductive age to achieve her reproductive health goals. The present study therefore

will shed more light on the factors that hinder achievement of the reproductive health goals

particularly with reference to family planning practice among married women.

1.5 .JUSTIFICATION

Women of reproductive age group should be able to achieve their reproductive goals.

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women. Approximately 78% of married women do not want to get pregnant now. They want

either to space their next birth or to end child bearing all together (limit births). Therefore,

approximately 39% of married women are currently at risk of an unwanted pregnancy and are not using any form of family planning. In addition, there is a growing number of unmarried

women, half of them adolescents and most of them sexually active who are in need of family

planning services (NCPD

et al.,

1998). The reasons for this discrepancy between non-use of

contraception and fertility preferences have not been adequately addressed in Kenya. Addressing the reasons for this discrepancy between the non-use of family planning and fertility preferences

would result in achievement of increased contracecptive prevalence and the resultant decline in fertility. This study aims at determining the factors underlying the non-use of family planning.

With the high population growth rate in Kenya particularly among uneducated rural women, there is need to generate information on barriers for non-use of contraception among married

rural women. The information obtained may be useful in the improvement of family planning programmes through training of family planning providers, equipping Service Delivery Points,

expanding Family Planning services and improving information, education and communication

activities to overcome the barriers against non-use of contraception. In this way, family planning

acceptance and sustenance would improve thus reducing the growth rate. The spill over effect

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1.6 Hypotheses

1. There is no difference between the characteristics of women not using family planning

(non-users) and family planning users.

2. There is no difference in knowledge on Family Planning between non-users of family

planning and Family Planning users.

3. There is no difference in spousal communication on family planning issues between

Family Planning users and non-users.

1.7 Objectives

General Objective

To determine the reasons for non-use of familyplanning among married women in

Kabati Division, Kitui District.

Specific Objectives

1. To identify the characteristics of married women who do not use family planning in Kabati

Division.

2. To determine the knowledge of family planning among the married women III Kabati Division.

3. To determine the accessibility offamily planning services to married women.

(27)

CHAPTER TWO

2.0 Materials And Methods

2.1 Study Area

The study was carried out in Kitui district, Kabati Division. Kitui district is one of the

twelve districts in Eastern Province. The district extends over 20,555 km2 with an estimated

population of 652,603. It borders Machakos and Makueni to the west, Mwingi to the north, Tana

River to the east and Taita Taveta to the south. It is located between latitudes 0°3.7' and

ro'

South and longitudes 37°45' and 39°0' East (Maps showing study area are shown in Appendix

VIII and IX). Administratively, the district is divided into nine divisions namely, Tsavo National

Park which is uninhabited, Central, Chuluni, Mutitu, Mwitika, Mutomo, Ikutha, Yatta and Kabati

(currently divided into Matinyani and Mutonguni divisions). Kabati division covers an area of

approximately 765.69 km2 and has a population of 124,389. It is divided into 13 locations and

31 sub-locations. The following sub-locations were covered in the study: Kavuvuu, Musosya, Kauwi, Kalia, Kyondoni, Kithumula, Kalindilo, Musengo and Katutu.

2.1.1 Climate

The climate of the area can be described as hot and dry for most of the year. It is

classified as arid and semi-arid area with very unreliable rainfall ranging from 500-1050 mm per

(28)

2.1.2 Health facilitiesand disease incidence

Kabati division has one mission hospital, one health centre, two sub-health

centres and four dispensaries.

The area is vast and these facilities are sparsely

distributed.

Malaria is the leading disease and other main diseases are respiratory

conditions, skin and diarrhoeal disorders

.

Malnutrition is highly prevalent during the

drought periods.

2.1

.

3 Infrastructure

The division is traversed by partly bitumized road that links Kitui town with

Thika

.

The main shopping centres are linked by poorly maintained marrum and earth

roads which are impassable during rainy seasons

.

Transportation is provided by old

poorly maintained

matatus

that are irregular and unreliable.

.

In the interior areas of the

division

,

ox-carts and bicyclesbecome very handy for transportation

.

2.2

Study population

The group under study were married women in reproductive age group (15-49

years). Other studies address this age group. It was therefore necessary to study the same

age group in order to have a comparison of the results. Also menarche signifying

beginning of fertility occurs at 15 years and menopause at 49 years on average

.

2.2.1 Inclusion criteria

Women who were married or living in union and in reproductive age group (15

-49 years), who were residing in Kabati division, were willing to participate in the study

(29)

2.2.2

Exclusion criteria

Women who-were not married, not willing to participate in the study, not residing

in Kabati division, women under the age of 15 years and women over 49 years of age were not included in the study.

2.2.3

Sample size Determination

The sample size was determined using the standard sampling formula by Fisher et

al (1998).

where n

=

Required minimum sample size

z

=

The standard normal deviate, set at 1.96 which corresponds

to the 95% confidence limit.

p= Expected population proportion of married women using

contraception (CPR =39%)

q = 1 -P(non-users of contraception) = 61%

d = Degree of accuracy set at 0.05 level

Thus: n 1.962 x 0.39 x 0.61 =366 0.052

Therefore the minimum sample size was 366 subjects. The researcher considered

(30)

2.2.4

Ethical consideration

Written petrnission to collect data was sought and granted by the Office of t~e

President and local administrators of the area. Participation in the study was based on

respondents' willingness to be interviewed. Considering the sensitive nature of the

subject under study, the information obtained was treated as confidential to protect the

source.

2.3

Research methods

2.3.1

Study design

The study was a descriptive cross-sectional observation to elucidate factors that

influence non-use of contraception among married women in Kabati division, Kitui

district.

2.3.2

Study Variables

The following are the variables that were included in the study:

Independent variables:

Age

Religion

Educational level

Occupation

Parity

• Number and sex ofliving children

Intention to have more children

Ideal number of children

Socio-economic status (Appendix V)

• Knowledge on Family Planning methods (Appendix IV)

(31)

• Intention to use Family Planning in future

• Spousal discussion about Family Planning

• Spousal approval of Family Planning use

• Distance to health facilities

• Availability of Family Planning methods

Dependent variable:

• Family Planning use status

2.3.3 Sampling procedure

Kabati division was selected because of its unique problems such as food and

transportation in a vast area hence difficult access to health services and especially

maternal and child health services and family planning. Also AMREF the collaborator in

this study has other activities in the area geared towards provision of water supply to

alleviate the suffering experienced in the area. Multistage sampling procedure was used.

Out of thirteen locations in Kabati division, eight locations were randomly selected using

simple random sampling method. All the sub-locations (18) in the selected locations

were then listed and nine sub-locations were randomly selected using the same method.

The first household in each sub-location was selected by toss of a pen to determine the

direction of the movement. After selecting the first household the interviewer moved to

every house where there was an eligible woman for the study until the required number

for the sub-location was interviewed. Any household without a woman who satisfied the

criteria for selection was skipped and the interviewer moved to the next nearest

household. The following sub-locations were used in the study, after simple random

sampling: - Kavuvuu, Musosya, Kauwi, Kalla, Kyondoni, Kithumula, Kalindilo,

(32)

2.3

.

4

Data coUection

A structured pretested questionnaire (Appendix I) was administered using face to

face interview

.

The first pilot study was carried out at Naaro sub-location,

Maragwa

district on 2nd September, 2000

.

This was to find out whether the questions were

sequential and clearly understood by the clients

.

Thereafter necessary corrections were

made. The second pilot study was then carried out in Kyambusya sub-location in Kabati

division. There were 25 respondents

.

It was from 23rd October 2000 to 27th October

2000

.

This was a community with demographic characteristics similar to those of the

study community.

This second pretest was important to enable the investigator

familiarize herself with the language and the area

.

Necessary corrections were made in

preparation of the final tool for data collection

.

Due to the vastness of the area research

assistants were recruited

.

An interview was conducted to determine eligible candidates

who had to be females who had completed secondary school education or above

.

Eigh

t

candidates were selected and trained at Kalimani Health Centre for one day

.

After

preliminary training they were given one day to pretest the questionnaire after which a

discussion was held with the principal researcher

.

This was to ensure that they

understood the questionnaire and how to ask the questions

.

Data collection started on

19

th

November, 2000 to 28

th

November 2000. The questionnaire was designed to provide

information on demographic characteristics of the subjects, family planning knowledge

and practice, spousal communication on family planning issues, accessibility and

availability of family planning services and socio-economic status of the respondents

.

Additional qualitative data was collected from 13th February, 2001 to 16th February

,

(33)

interviews. Four focus group discussions were held in Kalia, Katutu, Kavuvuu and Kauwi

sub-locations. Each focus group had 10 - 12 participants who were currently married and

had not participated in the structured interviews. They were also in the age group 15 - 49

years and they were willing to participate in the FGDs. The participants were invited

from their homes.

The discussions were held in a quiet room or place convenient for the participants.

A focus group discussion guide was used as outlined in Appendix III. During the

discussions, the proceedings were tape recorded by the principal researcher while a

research assistant took notes and acted as the observer, looking at any non-verbal sign or

body language that the group demonstrated. The discussions were scheduled at a time

convenient to the participants. After collecting the information, the transcription was

done and similar categories selected.

To assess the socio-economic status of the respondents, a socio-economic index

was developed based on three variables thus household income, amount of land in acres

and the type of house lived in (Appendix V). The type of house was assessed based on

the following criteria:

-Temporary - grass thatched roof, wall made of mud and poles

Semi-permanent - roofed with iron sheets, wall made of mud and poles

Permanent - Roofwith iron sheets, wall made of blocks, bricks or stones

Similarly, to assess the knowledge on Family Planning, a knowledge index was

calculated as set out in Appendix IV based on the respondent's ability to mention a

Family Planning method without being prompted, being aware of the source of the

(34)

2.3.5 Control of biases

The questionnaire was pre-tested before data collection to ensure clarity of the

questions. Local research assistants were also trained who were literate and conversant ,

with the local language and culture. In addition, any problems encountered during data

collection were evaluated and dealt with during the whole period of data collection.

2.3.6 Data management and analysis

Questionnaires filled were screened every day and errors corrected. At the end of

data collection period it was entered into the computer using SPSS for Windows (version

8.0, Chicago Illinois, U.S.A.) package. The results were summarised in form of

descriptive statistics. The data was then subjected to statistical tests chi-square (:i), and

logistic regression to examine association between the variables. The qualitative data

from the focus group was transcribed and summarized. The FGD results were

collaborated with results from structured questionnaire. Similarities and disparities were

described.

2.3.7 Study Limitations and Difficulties Encountered

Only married women were targeted in this study. Men, unmarried women and

adolescents can also contribute to the extent of contraceptive non-use. The exclusion of

these groups was due to the nature of the design of the study.

The area of the study was vast which made the study time consuming and costly

hence financial difficulties encountered. The weather was also harsh. It was very hot and

dry during the preparation stages for data collection and starvation was apparent.

(35)

the start of data collection and planting started, so the researcher and research assistants

had to wait so that women who are the ones mainly involved in planting could be

available. The rains had to subside for us to move since some of the seasonal rivers which

are pathways during dry season were impassable during the rainy season.

Transportation was a problem because public transport is scarce and there is poor

road infrastructure. This caused delays in planned activities. However collaboration with

AMREF office in Kitui and staff of Kitui district hospital eased the transport problem.

Some respondents were suspicious of why we wanted to know about their Family

(36)

CHAPTER THREE

3.0 RESULTS

The aim of this study was to establish the factors that determine non-use of

Family Planning among married women. A total of 450 married women in reproductive

age group were interviewed in nine sub-locations of Kabati division, Kitui district using

structured questionnaire (Appendix I) and Focus Group Discussions Guide (Appendix

ill).

The following results represent the survey findings of socio-economic and

demographic characteristics, knowledge of family planning, family planning practice,

spousal communication of family planning and access to family planning by the

respondents. Respondent distribution among the sub-locations of the study area (Kabati

division) was almost equal (Table 1).

3.1 Socio-Demographic and economic Characteristics of the Respondents

3.1.1 Socio-Demographic Characteristics of the Respondents

The age distribution of the respondents was a range of 15-49 years with most of

the respondents 320 (71%) falling in the age group 25-39 years (Figure 1).

There were

few 9 (2%) respondents in age groups 15-19 years and 45-49 years, 12

(2.7%)

suggesting that these are extremes of reproductive age (Figure 1).

In terms of religion, the Protestants comprised majority of the respondents,

254

(56%), while Catholics contributed 192 (43 %) of the respondents and the rest 4 (1%)

(37)

Concerning the type of marriage, majority of the respondents, 415 (92%) were in

-monogamous marriages while 35 (8%) were in polygamous marriages.

Education levels of the respondents also varied with majority, 251 (58%) of them

having completed primary education while 148 (33%) had secondary education and 24

(5%) had no formal education while only 27 (6%) had attained college or university

education (Table 2). Similarly,most respondents, 363 (81%) were housewives

,

56 (12%)

were businesswomen and 31 (6%) were professionals

.

About one third of the

respondents, 150 (33%) had carried four pregnancies and over while 132 (29%) had

three pregnancies, 95 (21%) two pregnancies and 73 (16%) one pregnancy (Table

1

)

.

Further, 261 (58%) of the respondents had three or more living children and 318 (71%)

of them had the youngest child aged between 0-3 years while 37

(8

.

2%) had the

(38)

Table 1: Distribution

of

the

Respondents in the Sub-locations

Sub-locations No. of Respondents Percent, %

Katutu

53

12

Kauwi

48

11

Musosya

56

12

Kavuvuu

51

11

Musengo

47

10

Kyondoni

51

11

Kalia

44

10

Kithumula

51

11

Kathivo

49

11

(39)

Figure 1: Age Distribution of the Respondents

100

90

80

70

en

60

-

c:

(1)

"C

e

0 50

e

,

en

(1)

a::

~ 40

0

30

20

10

0

•••••••••••••• H••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• ] ~ ~ ~

32

15-19 20-24 25-29 30-34 35-39

Age groups in years

(40)

Table 2: Respondents' Demographic Characteristics

Education level Number, n =450 Percent, %

None 24 5

Primary 1-4 18 4

Primary 5-8 233 52

Secondary uncompleted 80 18

Secondary completed 68 15

College education 25 6

University 2 1

Occupation

Housewife 361 80

Businesswoman 56 12

Professional 31 7

Student 2 1

Parity

One 73 16

Two 95 21

Three 132 29

Four and over 150 33

Number ofliving children

None 2 1

One 89 20

Two 98 22

Three 123 27

Four 49 11

Five 34 8

Six 34 8

Seven or more 21 5

Age of the younaest child

Less than 1 year 109 24

1-2 years 109 24

2-3 years 100 22

3-4 years 40 9

4-5 years 55 12

(41)

Figure 2: Respondents' Religious Affiliation

100

90

80

70

U)

60

-

c

G)

"0 C

0

SO

Q. U) G) 0:::: ~0 40

30

20

10

0

...-...•...•... -- .

1 1

Protestants Catholics Islam Traditional

(42)

3.1

.

2

Socio-economic Status of the Respondents

The source of income for most respondents was mainly from their spouses, 299

(66%) concurring with their role as housewives

.

The other common source

-

of income

was from farm produce, 164 (36%) and only 32 (7%) of the respondents had formal

employment (Table 3)

.

,

When the respondents were asked whether they had any income generating

activity, 151 (34%) reported having an income generating activity while 298 (66%) had

no income generating activity

.

To assess the socio-economic status of the respondents,

socio-economic index was developed as shown in Appendix V

.

Based on this index,

majority of the respondents, 252 (56%) were in the middle socio-economic class and 41

(9%) were in low socio-economic class. There were 157 (35%) respondents in the high

socio-economic class. Further, the highest number of respondents lived in

semi-permanent houses, 167 (37%) while 151 (34%) lived in semi-permanent houses and

1

32

(29%) lived in temporary houses (Table 3)

.

.

.

Based on acreage of land, 190 (42%) of the respondents owned between

1-

2

acres, 172 (38%) owned more than two acres and 88 (20%) owned less than one acre

.

Respondents' monthly income was also variable with most, 208 (46%) respondents

earning Kshs

.

2,000-7,999, 193 (43%) had an income of less than Kshs

.

2,000 and 49

(43)

Table 3: Socio-economic Status of the Respondents

Variable

Number, n

=

450 Percent (%)

Source of income

Formal employment 32 7

Business 56 12

Husband 299 66

Farm produce 164 36

Type of house owned

Temporary 132 29

Semi-permanent 167 37

Permanent 151 34

Amount

of land

owned (acres)

<

1 acre 88 20

1-2 acres 190 42

>2 acres 172 38

Income per month (Kshs)

<

2,000 193 43

2,000-7,999 208 46

>8,000 49 11

Socio-economic status

Low 41 9

Middle 252 56

(44)

3.1.3 Availability of Mass Communication Instruments in the Home

Majority of the respondents, 366 (69%) owned a radio as an

i

tem for

communication affirming that radio is a domestic item in the study area

.

There were 31

(5.8%) respondents who owned a television set while 24 (5%) and 23 (4%) had access

to magazines and daily newspapers respectively. Only 85 (16%) respondents

r

eported

that they did not own any Mass Communicationinstrument (Figure 3)

.

Figure 3: Availability of Mass Communication Instruments

E

I

Radio

• Television

mI

Daily Newspapers

• Magazines

• Video

(45)

3.2.0

Intention to Have More Children

On account of more children

,

majority, 274 (61%) of the respondents did not

intend to have any more children

,

while 176 (39%) intended to have more children

.

Economic reasons were cited by the majority of the respondents, 140 (51%) as the main

reason for non-intention to have more children

,

followed by enough family size

,

120

(44%) and poor personal health

,

8 (3%). Other respondents 6 (2%) perceived themselves

as being too old to bear children while others had no reason (Figure 4)

When the respondents were asked to state their opinion on the ideal number of

children a couple should have, about 145

(32%) of the respondents regarded four

children as ideal number for a couple while 94 (21%)

cited three children as ideal and

82 (18%) cited two children as ideal and the rest 51 (11%) said one can have as many

(46)

Figure 4: Reasons for not Intending to Have More Children

100

...,----

---90+---~

80+---~

70

!l

60

s:::

Q)

"C

51

s:::

0

50

0

-f/)

Q)

It:

40

?fl.

30

20

+--

-10

+--

-O

+

--

-3

2

EnoughfaTily

size

Eccnonic

reasons

(47)

Figure 5: Ideal Number of Children for a Couple

10+----

-90+---~

20+

----

---~

=----

-1

TVIO

llTee

Far

FI\e

(48)

3.3 Knowledge on Family Planning

3.3.1 Initial Source of Information on Family Planning

Majority of the respondents, 409 (99%) had heard about Family Planning for the

first time from the health clinic or hospital. The other popular source of the information

was the relative or friend, 83 (20%) followed by the radio, 73 (18%) (Figure 6).

3.3.2 Knowledge of Specific Family Planning Methods

A total of 387 (86%) of the respondents had knowledge of at least one Family

Planning method while 63 (14%) did not know any Family Planning method. Out of the

respondents who had knowledge of at least one Family Planning method, 189 (49%) did

not know the side effects of the methodes) they mentioned with majority, 125 (66%)

being non-users while 64 (34%) were users.

Majority of the respondents 323 (84%) knew pills as a specific Family Planning

method while 271 (70%) knew about the injection. The 100pIIUD and condoms were

spontaneously mentioned by 188 (31%) and 116 (30%) of the respondents respectively.

Norplant and tubal ligation were mentioned by 53 (14%) and 63 (16%) respondents

(49)

Figure 6: Initial source of Information on Family Planning

100

00

80

70

t/)

••••

c

60

CI) "C C 0

eo

Q. t/) CI)

0::

40

~ 0

30

20

10

0

20

10

2

1

ro

S

0 c ro "0 ~

.

..

.

I

:c

0

:

c

c Q)

"a

.

ro

"

w

Q) Q) s:

rn 0

0:::

"S> E "C

.

..

.

0 0

-

Q) LL 0

I CD Q)

.

c

..

.

-

Q)

"0 >

0

r

-

·c :;:;

'

c

0.. ro

0 Q)

.c

0:::

.

..

.

ro Q) I

(50)

Table 4: Respondents' Knowledge of Specific Family Planning methods.

Method

Number of Responses

Percent cases

(%)

N=387

Pills/oral tablets

323

83

.

5

Injection

272

70

LooplLUCD

118

30

.

5

Condoms

116

30

Norplant

53

13

.

7

F oarn tablets

11

2

.

8

Diaphragm

18

4

.

7

Rhythm

32

8

.

3

Natural Family Planning

14

3

.

6

Withdrawal

8

2

.

1

Abstinence

4

1

.

0

Tubal Ligation

63

16

.

3

Vasectomy

15

3

.

9

(51)

3.3.3 Knowledge of the Source of Family Planning Methods

The results indicated that majority of the respondents 388 (86%) knew where to

obtain Family Planning methods while 62 (14%) did not know the source (Figure 7).

Multiple responses were given regarding the source of the Family Planning methods. The

responses were government clinic or hospital, 371 (82%), chemist/pharmacy, 34 (8%),

relatives or friends 12 (3%) and Community Based Distributors (CBD) or Community

Health Workers (CHW), 8 (2%).

3.3.4 Knowledge of Family Planning

To determine knowledge of Family Planning, a knowledge Index was calculated

as set out in Appendix IV. Overall, majority of the respondents 226 (50%) had inadequate knowledge on Family Planning. However, there were no users of family planning who

lacked knowledge while 57 (20%) of the non-users had no knowledge on Family

Planning. About 96 (57%) of the users had adequate knowledge with only 71 (25%) of

the non-users have adequate knowledge. There were also more non-users, 153 (54%) who

had inadequate knowledge than the users, 73 (43%) (Figure 8). The results showed a

highly significant difference between the users and non-users. (X 2

=

66.4; P

=

0.00000)

Knowledge on Family Planning was found to have a relationship with spousal

communication on Family Planning issues. Women with adequate knowledge on FP, 113

(68%) discussed FP issues with the spouse compared to 20 (35%) of women with no

(52)

Figure 7: Knowledge of the Source for Family Planning

mJ

Did not know the source

(53)

Figure 8: Knowledge ofFamily Planning

100

90

80

70

tJ)

-

c: 60

CD

"0

e

0 50

Co tJ)

CD

~

~ 40

0

30

20

10

0

~

% user

m

%

non-user

---

r

-

--'-

-

~~~~---

-'

-'-~--

-

--

"

-""'-

--

--

--

l

-

==

-

---

=

-

-

=

---

:

"'

:

"=

"

:'-

=

---

==

-

==-=

--,

J

o

No knowledge Inadequate knowledge Adequate knowledge

(54)

3.3.5 Respondents Knowledge of Community Based Distributors (CBDs)

A total of 264

(59%) of the respondents had never heard of the Communit

y

Based Distributors, 300 (67%) did not know of one near their homes and 373

(

83%) had

never spoken with any CBD and only 77 (17%) had ever held a conversation with a

CBD

.

3.3.6 Knowledge of Conception Period

On the question of appropriate time for conception

,

most respondents, 157 (35%)

reported that pregnancy can occur after bleeding

.

Among the users 69 (41%)

correctly

knew that pregnancy can occur in the middle of the menstrual cycle compared to non

-users 86 (31%)

.

Only few of the users

,

8 (5%) did not know when pregnancy is likely

t

o

occur compared to 44 (16%) of non-users

.

There was a statistically significant difference

between the two groups

.

(X

2

=

14

.

156; P

=

.

007) (Table 5)

Table 5: Respondents Knowledge of Conception Period.

Status of FP use

Timing of pregnancy n = 169 n =281 Statistics

Users Non-users Total

No. % No. 0/0 No. %

During bleeding

8

5

12

4

20

4

After bleeding

59

35

98

35

157

34

2

In the middle of the cycle

69

41

86

31

155

34

X = 14.156, P = 0.007

A few days before

25

14

41

15

66

15

menstrual period

Not known

8

5

44

16

52

12

(55)

3.4 Family Planning Use

Out of 450 respondents interviewed, 281 (62%) were non-users of Family

Planning while 169 (38%) were users of Family Planning (Figure 9). Majority of the

respondents 411 (91%) had heard about Family Planning. All the users interviewed had

heard about Family Planning and only 39 (14%) of the non-users had not heard about

Family Planning. The rest 242 (86%) of the non-users had heard. However, most of the

non-users 237 (84%) had not used any contraception prior to the study hence only

44 (16 %) non-users were ever users of contraception at the time of study.

3.4.1 Family Planning Methods Used by the Respondents

Among the Family Planning users, the injection emerged as the most popular

method of contraception used by 85 (50%) of the respondents, followed by the pills, 67

(40%) and rhythm method 8 (5%). Condoms were preferred by only 6 (4%) of the users

while only 4 (2%) of the women had had tubal ligation performed. The 100plIUCD was

used by only 3 (2%} of the clients, Norplant by 4 (2%), Rhythm method by 8 (5%) while

Natural Family Planning (NFP) and foam tablets were the least popular methods

(Table 5).

The duration of use of anyone method by the respondents was found to vary.

Thus, 72 (43%) of the respondents had used the FP method for less than one year while 9

(5%) had used the method for a period of 1-2 years, 43 (25 %) had used the method for

over 2-3 years while 22 (13%) had used the method for over 3-4 years. There were 13

(8%) of the respondents who had used the method for over 4-6 years and 10 (6%) had

Figure

Table 1: Distribution of the Respondents

Table 1.

Distribution of the Respondents. View in document p.38
Figure 1: Age Distribution of the Respondents

Figure 1.

Age Distribution of the Respondents. View in document p.39
Table 2: Respondents'

Table 2.

Respondents . View in document p.40
Figure 2: Respondents'

Figure 2.

Respondents . View in document p.41
Table 3: Socio-economic

Table 3.

Socio economic. View in document p.43
Figure 3: Availability of Mass Communication

Figure 3.

Availability of Mass Communication. View in document p.44
Figure 4: Reasons for not Intending to Have More Children

Figure 4.

Reasons for not Intending to Have More Children. View in document p.46
Figure 5: Ideal Number of Children for a Couple

Figure 5.

Ideal Number of Children for a Couple. View in document p.47
Figure 6: Initial source of Information on Family Planning

Figure 6.

Initial source of Information on Family Planning. View in document p.49
Table 4: Respondents'

Table 4.

Respondents . View in document p.50
Figure 7: Knowledge of the Source for Family Planning

Figure 7.

Knowledge of the Source for Family Planning. View in document p.52
Figure 8: Knowledge

Figure 8.

Knowledge. View in document p.53
Table 5: Respondents

Table 5.

Respondents. View in document p.54
Figure 9: Family Planning Use Status

Figure 9.

Family Planning Use Status. View in document p.57
Table 6: Family Planning Methods Used by Respondents

Table 6.

Family Planning Methods Used by Respondents. View in document p.58
Table 7: Reasons for Non-use of Contraception

Table 7.

Reasons for Non use of Contraception. View in document p.60
Figure 10: Non-user Future Intention for Family Planning Use

Figure 10.

Non user Future Intention for Family Planning Use. View in document p.61
Table 8: InfluencePlanning

Table 8.

InfluencePlanning. View in document p.64
Figure 11: Spousal Discussion of Family Planning Issues

Figure 11.

Spousal Discussion of Family Planning Issues. View in document p.67
Figure 12: Spousal Approval of Family Planning Use

Figure 12.

Spousal Approval of Family Planning Use. View in document p.68
Figure 13: Decision on Family Planning use.

Figure 13.

Decision on Family Planning use . View in document p.69
Figure 15: Rating of Family Planning Services by the Respondents

Figure 15.

Rating of Family Planning Services by the Respondents. View in document p.73
Table 9: RelationshipFamily Planning issues and Status

Table 9.

RelationshipFamily Planning issues and Status. View in document p.75

References

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