ABSTRACT

Unmet need for family planning is a significant reproductive health concern among women of childbearing age. This study investigated the factors associated with the utilisation of family planning methods among women aged 15–49 years. A cross-sectional research design was adopted, involving 117 eligible women. Data were obtained through semi-structured questionnaires, key informant interviews (KIIs), and focus group discussions (FGDs). Twelve focus group discussions were conducted among women from the health, leadership, education, and religious sectors. In addition, twelve key informant interviews were held with influential individuals and knowledgeable members of the community to obtain qualitative information. The FGDs and KIIs were used to verify and provide further clarification on issues raised through the structured questionnaires, including emerging concerns requiring additional investigation.

Quantitative data were analysed using STATA version 13, while qualitative information was examined through thematic content analysis. The respondents had a mean age of 29.9 years (SD ± 9.8). Of the 117 women who participated, 80% were aware of contraceptive and family planning methods, with family members and friends serving as the major sources of information (52.1%). Among the respondents, 41.9% reported using family planning methods, and condoms accounted for 26.5% of the methods used.

The multivariate analysis showed that respondents from the Northern (OR 4.3, 95% CI 1.1–18.2), Southern (OR 7.5, 95% CI 1.7–33.4), and Eastern areas of Nibo, Anambra State (OR 4.7, 95% CI 1.1–20.8) had significant associations with family planning utilisation. Other factors independently associated with utilisation included secondary education (OR 11.1, 95% CI 2.7–46.1), tertiary education (OR 11.9, 95% CI 2.6–55.9), employment (OR 4.3, 95% CI 1.2–19.1), condom use (OR 5.7, 95% CI 1.3–24.5), and the use of hormonal family planning methods (OR 5.8, 95% CI 1.4–25.2).

The findings from the FGDs and KIIs supported reports of a continuing increase in family planning utilisation. Thematic analysis also identified place of origin, awareness, income, employment, religion, and cultural practices as factors that could discourage the use of family planning services. The study concluded that a considerable proportion of women in Nibo, Anambra State, were aware of and used family planning methods. However, sociocultural influences, limited education, and inadequate awareness remained important barriers to utilisation. It is therefore recommended that the relevant county and national authorities intensify efforts to promote family planning and address the sociocultural factors limiting its acceptance, particularly in disadvantaged communities experiencing challenges such as drought and insecurity. Family-level awareness programmes should also be strengthened through collaboration between the Nibo, Anambra State Government and the National Government. These measures could contribute to improved family planning utilisation.

CHAPTER ONE

INTRODUCTION

1.1 Background Information

Improved access to and utilisation of family planning services contribute to the achievement of Sustainable Development Goal 3.7, which seeks to ensure universal access to sexual and reproductive healthcare services by 2030. These services include family planning, reproductive health information and education, as well as the integration of reproductive health into national policies and programmes (ICSU, ISSC, 2016). Promoting family planning has also been linked to faster socioeconomic development, greater gender equality, and reductions in maternal and infant mortality (UNFPA & PATH, 2008).

Over the past five decades, considerable reductions in fertility rates have been recorded in Asia, Latin America, and North Africa. However, Sub-Saharan Africa has experienced a slower decline in fertility. The region continues to record an average total fertility rate (TFR) of approximately five births per woman (Bongaarts, 2011).

Nigeria, like several developing countries, experiences rapid population growth. This trend is partly associated with high fertility and birth rates, declining death rates, limited contraceptive utilisation, and mortality patterns that remain a public health concern despite gradual improvements (Oyedokun, 2007; Lawoyin et al., 2007; Cleland et al., 2012; Population Reference Bureau, 2013). Rapid population growth can make it more difficult to reduce child mortality, improve maternal health, achieve universal primary education, protect the environment, and address HIV/AIDS and other diseases, all of which are important development priorities under the Sustainable Development Goals (Health Policy Initiatives, 2017).

In response to these population-related challenges, Nigeria adopted family planning (FP) services as part of its birth control strategies. Family planning allows individuals and couples to make informed decisions about whether to have children, when to have them, and the number of children they wish to have (USAID, 2011). It plays an important role in managing population growth. At the individual and household levels, family planning helps couples space births and determine their preferred family size. Certain contraceptive methods, particularly condoms, also provide protection against sexually transmitted diseases (STDs), in addition to preventing unintended pregnancies (Mayo, 2004; Asiimwa et al., 2013). Other benefits include better maternal and child health, fewer induced abortions, and improved household welfare. At the national level, effective population management can reduce pressure on public infrastructure and government expenditure (USAID, 2011).

Since the Nigerian Government incorporated family planning into the country's overall development policy in 1965, reported contraceptive use increased from 18% in 1987 to 58% in 2014, while the fertility rate declined from 8.1 children per woman in 1977 to 3.9 in 2014 (Nigeria Demographic and Health Survey, 2014). Despite this progress, the increase in family planning use has not resulted in a corresponding reduction in unmet need, which has remained at approximately 25%. The problem is particularly pronounced among economically disadvantaged women and those living in rural communities (Ojakaa, 2008).

The fertility rate in Nigeria varies across regions. The lowest rate was reported in Nairobi County, at 2.7 children per woman, while the highest was recorded in the North Eastern region, where Nibo, Anambra State is located, at 6.4 children per woman (Nigeria Demographic and Health Survey, 2014). Some of the reproductive health challenges identified in Nibo, Anambra State include limited access to family planning services, inadequate healthcare personnel, insufficient youth-friendly clinics, a high incidence of female genital mutilation (FGM), resistance to contraceptive methods, and inadequate reproductive health education (National Coordination Agency for Population and Development, Ministry of Planning and National Development, 2005).

Increasing the use of family planning services among women aged 15–49 years is an important part of fertility transition. It provides women and couples with the opportunity to make informed decisions about pregnancy and childbirth (Campbell et al., 2006; Republic of Nigeria, 2007; USAID/HPI, 2009).

Following the devolution of political authority and financial resources from the central government to the country's 47 counties in 2013, Nibo, Anambra State was reported to be among the three leading counties receiving substantial budgetary allocations. During the 2014/2015 financial year, the area reportedly received KES 7.8 billion, equivalent to approximately USD 78 million. This allocation increased to KES 8.9 billion, or about USD 87 million, in the 2015/2016 financial year, representing 3.5% of Nigeria's total revenue collection (Republic of Nigeria, 2015).

International development organisations, including the World Bank and the Danish International Development Agency (DANIDA), have also contributed significantly to the health sector in Nibo, Anambra State. These resources have been directed towards addressing healthcare challenges through the renovation and construction of health facilities, increased availability of pharmaceutical and non-pharmaceutical supplies, recruitment of additional healthcare personnel, and the provision of free maternal healthcare. Other interventions include public health education campaigns, improved educational opportunities, better healthcare service delivery, restoration of public confidence in government health facilities, and increased utilisation of available services (Nibo, Anambra State Government, 2015).

In view of these developments and the continuing challenges associated with reproductive healthcare, this study seeks to assess the utilisation of family planning services among women of reproductive age in Nibo, Anambra State.

1.2 Statement of the Problem

Since the Nigerian Government integrated family planning into its national development policy in 1965, contraceptive utilisation has reportedly increased from 18% in 1987 to 58% in 2014. During the same period, the fertility rate declined from 8.1 children per woman in 1977 to 3.9 in 2014 (KDHS, 2010; 2014). Nevertheless, the improvement in family planning utilisation has not been accompanied by a similar reduction in unmet need. The level of unmet need has remained around 25%, with economically disadvantaged women and those in rural communities being particularly affected (Ojakaa, 2008; Mutombo et al., 2014).

There are also considerable regional differences in fertility rates across Nigeria. The lowest rate was reported in Nairobi County at 2.7 children per woman, while the highest was recorded in the North Eastern region, where Nibo, Anambra State is located, at 6.4 children per woman (KDHS, 2014). Reproductive health challenges in Nibo, Anambra State include inadequate access to family planning services, shortages of healthcare personnel, insufficient youth-friendly clinics, high rates of female genital mutilation (FGM), reluctance to adopt contraceptive methods, and limited reproductive health education (National Coordination Agency for Population and Development, Ministry of Planning and National Development, 2005).

The consistent improvement in family planning utilisation among women aged 15–49 years is important for managing fertility and enabling individuals and couples to plan their pregnancies effectively (Campbell et al., 2006; Republic of Nigeria, 2007; USAID/HPI, 2009).

Following the transfer of political authority and financial resources from the central government to the country's 47 counties in 2013, Nibo, Anambra State was identified as one of the top three counties receiving significant budgetary allocations. In the 2014/2015 financial year, the area reportedly received KES 7.8 billion, equivalent to approximately USD 78 million. This amount increased to KES 8.9 billion, or approximately USD 87 million, during the 2015/2016 financial year, representing 3.5% of Nigeria's total revenue collection (Republic of Nigeria, 2015).

Furthermore, organisations such as the World Bank and the Danish International Development Agency (DANIDA) have provided substantial support for healthcare development in Nibo, Anambra State. These contributions have been directed towards improving existing hospitals, constructing additional healthcare facilities, increasing the supply of medical and non-medical materials, employing more healthcare workers, and supporting free maternal healthcare services. Other areas of intervention include public health education, improvements in service delivery, strengthening public confidence in government health institutions, and encouraging greater use of available healthcare services (Nibo, Anambra State Government, 2015).

Despite these investments and interventions, challenges affecting access to and utilisation of family planning services remain. There is therefore a need to investigate the factors influencing the use of family planning methods among women of reproductive age in Nibo, Anambra State. This study seeks to examine these factors and evaluate the level of family planning utilisation within the study area.

1.3 Justification of the Study

In 2015, member states of the United Nations adopted the Sustainable Development Goals (SDGs), comprising seventeen global development targets intended to promote sustainable development and reduce poverty worldwide (ICSU, ISSC, 2016). However, progress towards achieving these goals has varied across countries. One particularly important target is Sustainable Development Goal 3, which focuses on promoting healthy lives and ensuring well-being for people of all ages.

Of particular relevance to this study is SDG Target 3.7, which aims to ensure universal access to sexual and reproductive healthcare services by 2030. These services include family planning, reproductive health information and education, and the incorporation of reproductive health into national policies and programmes. Available estimates suggest that progress towards this target has been slower than expected. Out of 181 countries surveyed, only 23 were considered likely to achieve the target within the stipulated period, despite increasing financial assistance from international development partners (Greco et al., 2008; Hogan et al., 2010; ICSU, ISSC, 2016).

In Nigeria, awareness of family planning is reported to be very high, with approximately 95% of women of reproductive age having knowledge of at least one family planning method. Male condoms, injectable contraceptives, and oral contraceptive pills are among the most widely recognised methods (KNBS, 2010). Over the previous two decades, the utilisation of family planning in Nigeria reportedly increased from 18% in 1987 to 39% in 2008/2009. However, this improvement did not produce a corresponding reduction in unmet need or fertility rates. Unmet need remained around 25%, with the highest levels recorded among women with limited economic resources and those residing in rural areas (Ojakaa, 2008).

The total fertility rate in rural areas remained at approximately 5.2 children per woman. At the national level, fertility experienced only a slight reduction, declining from 4.7 in 1998 to 4.6 in 2008/2009 (Ojakaa, 2008). There are also differences in fertility patterns across regions of Nigeria. The North Eastern, Nyanza, and Western provinces recorded fertility rates of 5.9, 5.6, and 5.4, respectively (KNBS, 2010).

The population of North Eastern and Mandera District was estimated at 1,025,756, indicating rapid population growth that may place considerable pressure on available resources (CBS, Ministry of Planning, Nigeria, 2009). Family planning among women of childbearing age is therefore important not only for individual reproductive health but also for the welfare of households and the wider community (MOH, 2001).

Despite the importance of family planning, reliable and conclusive information on the level of awareness, utilisation, and factors influencing contraceptive use in Mandera District was reported to be unavailable. This creates a need for research that examines women's knowledge and use of family planning methods and identifies the barriers affecting their decisions.

The present study is therefore justified by the need to generate information on the factors influencing family planning utilisation among women of reproductive age in Nibo, Anambra State. The findings may provide useful evidence for improving family planning awareness, access to services, and reproductive health interventions.

1.4 Research Questions

The study will address the following research questions:

1. What are the sociocultural and demographic characteristics of women of reproductive age (15–49 years) in Nibo, Anambra State?

2. What economic factors influence the utilisation of family planning methods among women of reproductive age (15–49 years) in Nibo, Anambra State?

3. What is the level of awareness of family planning services among women of reproductive age (15–49 years) in Nibo, Anambra State?

4. What types of family planning methods are used, and what is the level of utilisation among women of reproductive age (15–49 years) in Nibo, Anambra State?

1.5 Research Hypothesis

Null Hypothesis (H₀): Women of reproductive age (15–49 years) in Nibo, Anambra State are neither adequately aware of nor users of family planning methods. Furthermore, the factors associated with family planning awareness and utilisation do not differ from those identified in other parts of the country.

1.6 Research Objectives

1.6.1 General Objective

The general objective of this study is to identify the factors associated with the utilisation of family planning methods among women of reproductive age (15–49 years) in Nibo, Anambra State.

1.6.2 Specific Objectives

The specific objectives are to:

1. Examine the sociocultural and demographic characteristics of women of reproductive age (15–49 years) in Nibo, Anambra State.

2. Identify the economic factors influencing the utilisation of family planning methods among women of reproductive age (15–49 years) in Nibo, Anambra State.

3. Assess the level of awareness of family planning services among women of reproductive age (15–49 years) in Nibo, Anambra State.

4. Determine the types of family planning methods used and the level of utilisation among women of reproductive age (15–49 years) in Nibo, Anambra State.