FACTORS AFFECTING FAMILY PLANNING SERVICES IN NIGERIA
1.1 Background to the study
Family planning is widely acknowledged as an important intervention towards achieving Sustainable Development Goals (SDGs) three (3) as it has proven to reduce maternal and child mortality. Family planning can prevent unwanted pregnancies and unsafe abortions. Some family planning methods such as condom usage can protect individuals from Sexually Transmitted Infections (STIs) including HIV/AIDS. Family planning has also been found to promote gender equality as well as promote educational and economic empowerment for women. Despite the enormous benefits of family planning services, the uptake of the service still remains low in Sub-Saharan Africa including Nigeria (Eliason, et al., 2013).
Furthermore, Eliason said that although most people are aware of the benefits of family planning services, they complained that it was difficult to access family planning services as such services were provided by health facilities that were far from their homes. In addition, religious inclination has been noted to be a major constrain to the uptake of family planning services in Africa. Also, some individuals perceived that family planning services were meant for only married couples whilst others fear that they will become sexually promiscuous if they go for family planning services once they cannot become pregnant (Cates, et al., 2010). It has been observed that a large number of women have an unmet need for family planning as the acceptor rate for family planning services remains low. It is on this note thatscholars like Haffner, etal., (2010) argue that the lives of mothers and children will be improved and maternal mortality reduced if family planning acceptor rate is improved.
However, according to World Health Organization, (2016) family planning is the practice that allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility. A woman’s ability to space and limit her pregnancies has a direct impact on her health and well-being as well as on the outcome of each pregnancy (WHO, 2016). Therefore, family planning services are defined as educational, comprehensive medical or social activities which enable individuals, including minors, to determine freely the number and spacing of their children and to select the means by which this may be achieved (Burke, 2010).
Family planning is a wide-reachingoccurrence. The promotion of development and improvement of quality of life require co-ordination of action in all major socio-economic fields including that of population, which happens to be the inexhaustible source of creativity and a determining factor of progress. At the international level a number of strategies and programmes whose explicit aim is to affect variables in fields other than population have already been formulated. In many developing countries, attempts to improve the socio-economic conditions of the population are seriously hindered by the rate of population growth. This is true of both urban and rural areas where population growth is simply above the ordinary (WHO, 2015).
However, making the rural issues concerning family planning more understanding, Etukudo, (2014) opined that in rural areas of AkwaIbom State where there is a high desire for large family size by couples and lack of communication activities and behavior inventions to increase knowledge and use of family planning, lack of access to family planning services can be a barrier to women’s use of family planning services. Besides that, Etukudo further said that, large number of Nigerian women including some of those in NsitIbom Local Government Area of AkwaIbom State do not see the need of family planning. And that a good number of them see family planning as a taboo which is against their culture and many refer to religion to support their argument and disapproval of family planning (Etukudo, 2014). Similarly, Akpan, et al., (2011) in addition said that, a critical look at the issue reveals that ignorant peasant women living in NsitIbom and other communities in Nigeria want to have large families. Hence, there is evidence that women are prepared to have fewer children and adopt family planning if they are provided with adequate information, service and supplies (Akpan et al, 2011). Etukudo, (2014) concluded that urban women are more than twice as likely as rural women to use a method of contraception (20 percent versus 9 percent). Majority of the women hardly gave birth in hospitals and depended on their husbands to decide what ever method will be used to space or limit the number of children they will have. This notwithstanding, there still exist a great challenge of unmet needs regarding family planning especially in the rural part of AkwaIbom State like NisitIbom as the desired attitudinal and behavioral changes towards family planning is yet to be achieved (Etukudo, 2014).
For the purpose of this study, one theory has been selected as guide.
1.2.2 Health Belief Model (Theory)
Health Belief Model is a theory that was proposed by social psychologists Hochbaum, Rosenstock and Kegels in the 1950. The theory uses constructs that represent perceived threats and net benefits such as perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy. The model asserts that these constructs account for a person’s “readiness to act” (Rosenstock, et al., 1988). According to the Rosenstock and colleagues explanations, the health belief model (HBM) is a cognitive, interpersonal framework that views humans as rational beings who use a multidimensional approach to decision-making regarding whether to perform a health behavior. However, the model is appropriate for complex preventive and sick-role health behaviors such as contraceptive behavior and other family planning methods as barriers against unwanted pregnancy. Its dimensions are derived from an established body of social psychology theory that relies heavily on cognitive factors oriented towards goal attainment (i.e. motivation to prevent pregnancy). Its constructs emphasize modifiable factors, rather than fixed variables, which enable feasible interventions to reduce public health problems (i.e. unintended pregnancy, spacing and limiting the number of children).
Rosenstock and other scholars further brought to light that with the application of health belief model,factors affecting family planning services would be wisely fought against. They also put it clear that the reason for the combatis that family planning is a dynamic and complex set of services, programs and behaviors towards regulating the number and spacing of children within a family. For that reason, they maintained that contraceptive behavior is one form of family planning which refers to activities involved in the process of identifying and using a contraceptive method to prevent pregnancy and can include specific actions such as contraceptive initiation (to begin using a contraceptive method), continuation or discontinuation (to maintain or stop use of a contraceptive method), misuse (interrupted, omitted or mistimed use of a contraceptive method), nonuse, and more broadly compliance and adherence (general terms often used to denote any or all of the former contraceptive behavior terms).
In a more sense, these scholars depicted that contraceptive behavior, viewed through the HBM, is motivated by an individual’s: desire to avoid pregnancy and value placed on not becoming pregnant; nonspecific, stable differences in pregnancy motivations and childbearing desires; and perceived ability to control fertility and reduce the threat of pregnancy by using contraception amongst other safe methods.
1.2 Statement of the problem
Previous and recent study findings (Etukudo, 2014) have consistently revealed that fertility level is uncontrollably high in the rural areas of AkwaIbom State because women continue to give birth to many children as their spouses demand, under conditions of unabated poverty, poor feeding and nutrition, and some other complications. The reasons for the demand for large number of children in these areas are not different from those in other societies and include the need for ‘lineage elongation, security at old age, social obligation, among others’ (Akpan, et. al., 2011). Worst still, past family planning programs in Nigeria have been mainly directed toward women (Etukudo, 2014). However, actions to change the perception and attitude of people regarding family planning in AkwaIbom State have been media based and concentrated much in the urban areas. The rural people have little or no time under their conditions of severe poverty to listen to news or watch television, talk less of reading newspapers. In many of the Health Centers, Health Posts, and Dispensaries located in the rural communities there is insufficient health workers (the community health workers) whose specialized duty include to counsel mothers, child mothers, and would-be mothers on family planning, management of pregnancy, and other motherhood issues. On the other hand, the nurses working in these communities are constrained in three areas: their lackadaisical attitude to work and to some cases reported especially by the child mothers, the refusal of some women to attain family planning training and counseling at centers nearby to their homes, and the refusal of most women to accept and use contraceptives as are prescribed. Besides, most people still believe large number of children is equivalent to large economic power.
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