OPEN ACCESS JOURNALS
International Journal of Medicine and Medical Sciences
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The study investigated factors influencing the choice of family planning among couples in South West Nigeria. Six hundred couples were selected from five South Western States in Nigeria through a multistage sampling technique. Questionnaire was used to collect information from the subjects. Five research questions were raised and five hypotheses were formulated, chi-square statistics was employed for the purpose of data analysis at 0.05 alpha level of significant. The findings revealed that socio-economic status, religious factors and cultural norms do not influence couples’ choice, whereas, educational background of the couples, and involvement of partners toward the choice of family planning significantly influence the choice of family planning among couples. On the basis of findings, it was recommended among others that, every couple should be well informed about the importance of family planning’s choice so as to improve their reproductive health and economic standard of living, to reduce maternal mortality, morbidity and reduce unwanted pregnancy.
Key words: Family planning, couples, socio-economic.
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Child bearing and contraceptive use are among the most important reproductive health decision that many have to make (Gertner, 2009). Family decision and choices are most likely to meet based on accurate, relevant infor-mation, and are medically appropriate that is, when they are informed choices (AUSC International, 1998).
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Family Planning is the planning of when to have children and the use of birth techniques to implement such plans. Other techniques commonly used include sexual educa-tion, prevention and management of sexually transmitted diseases, pre-conception counseling, management and infertility management (Olaitan, 2009). However family planning is usually used as a synonym for the use of birth control. It is most adopted by couples who wish to limit the number of children they want to have and control the timing of pregnancy, also known as spacing of children (Olaitan, 2009). Family planning may encompass sterili-zation as well as pregnancy termination. It also includes raising a child methods of which require significant amount of resources viz; time, social, financial and environmental. Family planning measures are designed to regulate the number and spacing of children within a family, largely to curb population growth and ensure each family has access to limited resources. The first attempt to offer family planning services began with private groups and often aroused strong opposition. Activists (such as Margaret Sanger in the U.S., Marie Stopes in England and Dhanvanthis Rama Rou in India) eventually succeeded in establishing clinics for family planning and health care. Today many countries have established national policies and encourage the use of public family services (The United Nations and World Health Organisation Offer Technical Assistance, 2006). The concept of informed choice in family planning can be applied to a wide range of sexual and reproductive health decisions. It focuses on whether to seek, to avoid pregnancy, whether to space and time one’s childbea-ring, whether to use contraception, what family methods to be used, and whether or when to continue or switch methods. The term family planning choice could also refers to as family decision making (Diaz et al., 1999). The principles of informed choice focuses on the indivi-dual, however it also influences range of outside factors such as social, economic and cultural norms, gender roles, social networks, religious and local beliefs, (Bosveld, 1998). To a large extent, these community norms determine individual childbearing preferences and sexual and reproductive behaviour. It is usually thought that community and culture affect a person’s attitudes towards family planning, desire for sex of children, preferences about family size, family pressures to have children and whether family planning accords with customs and religious beliefs (Dixon–Meuller, 1999, Greenwell, 1999; Vickers, 1994). Community norms also reflect how much autonomy individuals have in making family planning decisions. The larger the differences in reproductive intentions within a community, the more likely that community norms support individual choices (Bosveld, 1998; Dixon–Mueller, 1999). Household and community influences can be so power-ful that they can obscure the line between individual desires and community norms. For instance, in some culture, many women reject contraception because bearing and raising children is the path to respect and dignity in the society (International Planned Parenthood Federation, 1996, Cherkaoui, 2000; Barnett and Stein, 2001). In either country most women use contraception because having small families is the norm (Mkangi 2001; Lutz 2003). People are often unaware that such norms influence their choices. In other cases, they are particu-larly aware. For examples, young people often decide not to seek family planning because they do not want their parents or other adults to know that they are sexually active. Many fear ridicule, disapproval and hostile attitude from service providers and others (Jejebhoy, 2004). A person’s social environment usually has more influence on family planning decisions that influence the attributes of specific contraceptives. In Kenya, for examples, when new clients were asked to give a single reason for their choice of a specific family planning method, most cited the attitudes of their spouse or their peers, or their religious value (Kim et al., 1998). In many countries, family planning programmes are part of the national economic and social development efforts. Efforts to foster equity in decision making and raise awareness about reproductive right of the family, community and society also promote informed choice of family planning (Jaconson, 2000). As a woman gain more autonomy, they are better able to claim their rights as individuals including the right to act and protect their own reproductive health (Heise et al., 1999). People chose contraceptive methods that are com-monly used in their community because they know that, it is socially acceptable to do so, and they tend to know more about these methods (Rogers and Kincaid, 2004; Valente, 1995). Many women use the same family planning methods that others in their social network use, (Godley, 2001). A 1998 study in urban Nigeria found that the more widely used method was the one that was popular in other cities and villages (Entwisle et al., 1999). Entire community may be encouraged to one type of contraceptive based on the choices of early contraceptive users, rather than individual needs (Potter, 1999).
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A myriad of different factors affect a person’s personal decisions about what types of family planning method to be used.
Effectiveness
People who are not in a financial or emotional situation to have children might opt for the most effective type of family planning in order to avoid pregnancy. A couple or woman with a casual approach towards parenthood, such as not actively pursuing it but not unwilling to take it on, might choose a less certain form of contraception, such as natural family planning.
Religion
Some religions such as Catholicism, have restrictions on contraception based on the belief that, it is God’s will to bring children into the world. According to Dixon-Muller (1999), religious believers or observers might choose to avoid certain methods of family planning, such as birth control pill, in an effort to live their lives according to the teachings of their religion.
Cost
Some forms of contraception, such as minor surgery like vasectomy, carry a fairly significant amount of one’s time and cost hence couples engage in other options, such as condom or the calendar cycle methods which are less expensive.
Health risk
For people with multiple sexual partners the choice to use family planning devices helps them to keep healthy. For example, using condoms can reduce the chance of contracting sexually transmitted diseases.
Permanence
Some contraception choices, such as vasectomy, are usually permanent. Therefore couples who do not want to have children at present but would like to have one in the future might want to choose a less permanent option such as condoms or birth control pills.
Partner involvement
One has to consider the preferences of his or her partner when choosing a birth control option. For example, some men do not like to have sex using a condom; in that case birth control pills might be a better choice for preventing an unwanted pregnancy, according to the National Institute of Health (Olaitan, 2009).
Socio-economic factors
There are some contraceptive methods of family planning that are expensive, and some couples cannot afford to use or purchase them due to their financial situations in the society. For instance, people in rural areas cannot afford to use the expensive contraceptive methods of family planning such as vasectomy, Intra-uterine devices (IUD) (which are small, flexible, plastic frame inserted in the vagina of women), female sterilization method.
Cultural norms factors
This is the most important factor influencing the choice of family planning among couples. This includes: Community norms, religious belief and gender role
Community norms
Community norms also prescribe how much autonomy an individual has in making family planning decisions. The larger the differences in reproductive intentions within a community, the more likely the community norms support individual choices. Household and community influence can be so power-ful that they can obscure the line between individual desires and community norms. For instance, in some cul-ture, many women reject contraception because bearing and raising children is the path to respect and dignity in the society. People are often unaware that such commu-nity norm influences their choices. In other cases they are particularly aware. For example, young people often decide not to seek for family planning because they do not want their parents or other adult to know that they are sexually active Some couples in the community feel that bearing children is the major aim of their marriage, as tradition, customs and beliefs. In some Northern part of Nigeria especially the Islamic religion, they believe that bearing more children will indicate how wealthy they are, in which they tend to withdraw themselves from use of family planning.
Religious factors
Family planning choice depends on the religion of the couple. It may be Islam or Christianity that calls for raising and bearing of more children in the society. Some religions, such as Catholicism, have restriction on contra-ception based on the belief that it is “God’s will to bring children” into world.
Gender role
Some couple want to have a male child however the child born to them may be female in which the family is not happy. Therefore the couple may wish to have another child in order to have a male child.
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1. Does the socio-economic status of the couples influence the choice of family planning pertaining to the cost of the choice of family planning method? 2. Do religious factors influence the choice of family planning among couples? 3. Do cultural norms of the society influence the choice of family planning among couples? 4. Does the educational status of the couple influence the choice of family planning? 5. Does the involvement of the partners (that is, couple) influence the choice of family planning methods?
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1. Economic status of couples has no significant influence on the choice of family planning method. 2. The religion of the couple has no effect on the choice of family planning method. 3. Cultural norms of the society have no significant in-fluence on the choice of family planning among couples. 4. The educational status of the couple has no significant influence on the choice of family planning method. 5. The involvement of the partners has no significant influence on the choice of family planning method among couples.
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The study employed descriptive survey and the population for this study comprised of couples across South West Nigeria. Questionnaire on factors influencing the choice of family planning among couples in south west Nigeria which include socio-economic status, religious factors, cultural norms, educational status and the involvement of partners was developed by the re-searcher. The questionnaire was validated and tested for reliability using a test retest method, reliability coefficient level of 0.89r was obtained, which indicated that the instrument was reliable. For the purpose of data collection, researcher with the help of ten trained research assistants distributed the questionnaire to the respondents. The copies of the questionnaire were collected and score on the data obtained from the respondents. The data were analyzed using descriptive and inferential statistics of frequency count, simple percentages and chi-square (X2).
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The result of the data analysis is presented in a way as to highlight the background variables of the respondents, test of hypotheses and discussion of findings. Table 1 reveals the distribution of gender respondents. 40% of the respondents are male, while 60% are female respondents. This indicate that majority of the respondents are female. The distribution of states of respondents shows that. 30% of the respondents are from Lagos, 20% of the res-pondents are from Oyo, 17.5% are from Osun, 21% are from Ogun, 11.5% from Ondo and 0.99% are from Ekiti. In the distribution of religion respondents, 48% of the respondents are Christianity, 42% of the respondents are Islam and 10% of the respondents are traditional. This indicates that the majority of the respondents are Christianity. In the distribution of respondent’ age range, 40% of the are ≤30 years old, 35% of the respondents are between 31 to 39 years old and 25% of the respondents are ≥40 years. This shows that the majority of the respondents are aged 30 years and below.
Testing of hypotheses
There are five (5) research hypotheses in this study. Table 2 indicates that the calculated value of 6.32 is less than the critical value of 16.92, therefore the hypothesis which states that there would be no significant influence on socio-economic status of couples in the choice of family planning in south west Nigeria, so there-fore, it is accepted. It is seen that the calculated value is 8.53 while the critical value is 16.92. The calculated value is less than the critical value at 0.05 alpha level of significant. Since the calculated is less than the critical value, the hypothesis which states that there would be no significant influence toward religious factors of the couples on the choice of family planning in south west Nigeria is therefore accepted. In this case, religious of the couples discussed fully on the choice of family planning. From the result obtained therefore, the hypothesis stating that there is no significant influence the cultural norms of the couples toward the choice of family planning in south west Nigeria is accepted. So therefore, cultural norms of the couples do not neglect the choice of family planning. From Table 2, this reveals the calculated value of 21.26 while the critical value is 16.92. Since the calculated value is greater than the critical value, so therefore the hypothesis should be rejected. In this case, there is a significant influence on the level of educational status of the couples toward the choice of family planning in south west Nigeria. The study also reveals that there is a change or differences between educated couples and non-educated couples toward the choice of family planning. Table 2 reveals that the calculated value (X2) is 23.26 while the critical value is 16.92 at 0.05 alpha level of significant. Since the calculated value is greater than the critical value. So therefore, the hypothesis is hereby rejected. In this case, there is a significant influence on the involvement of partners toward the choice of family planning in south west Nigeria. In this study it was also reveals that the agreement and involvement of partners is very important or crucial when choosing the method of family planning among couples. Also family planning me-thod should not be only one side of the couples, it involve both couples when deciding decision on family planning method. The study was conducted to investigate the socio-eco-nomic factors and norms influencing the choice of family planning among couples in south west Nigeria. The result of H1 which states that there is no significant influence on socio-economic status of the couples toward the choice of family planning in South West Nigeria is accepted. In agreement to this, the cost to couples in terms of affordability, availability and accessibility. The common choice of family planning is located in our various societies such as use of condoms for both male and female, calendar-based method in terms of sexual intercourse, etc. It is also reveals in the findings that both upper and lower class level, rural and urban areas have equal chances to the accessibility, affordability and availability of family planning choice stated by the researcher.
Table 1. Bio-data of respondents in percentages.
Table 2. X2 result of the respondents on factors influencing family planning’s choice N=600.
p≤0.05
H2: There is no significant influence on the religious factors of the couples in the choice of family planning in South West Nigeria is accepted. Rasheed (2010) notes that the Qur’an actually states the limitation of children, which is having not more than four children with a stated age of marriage and also states that father should take proper care of the children in terms of responsibility. The Bible also confirms that family planning is very crucial in a couple’s life so as to adjust favourably to the economic demands of life (Schonfield, 2008). H3 shows that there is no significant influence on the cultural norms of the couples toward the choice of family planning in South West Nigeria and is thus accepted. Habiger (2007) reveals that the cultural norms of the couples should not neglect the choice of family planning. It was also indicated that family planning method should be encouraged among couples. H4: There is no significant influence on the educational status of the couples toward the choice of family planning in South West Nigeria is rejected. This is supported by Olaitan (2009) who opined that level of education of the couples determine their attitudes toward the choice of family planning. For instance, ignorant and illiterate cou-ples will not know the benefit of family planning methods even though the family planning service provider informs them on their importance, he/she will be confused and will not listen to the service providers, especially couples in the Northern part of Nigeria. Most of them said that family planning service providers want to make them bar-ren for life and they tend to withdraw from their services. Finally, the result of H5 shows that there is no significant influence on the involvement of partners toward the choice of family planning among couples in South West Nigeria was rejected, that is, there existed a significant influence on the involvement of partners toward the choice of family planning among couples in South West Nigeria. It is supported by Potter (1999) who shows that the agreement and involvement of partners is very crucial when determining the choice of family planning among couples. Also, both couples should make the right decisions on the choice of family planning.
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The socio-economic status, religion, cultural norms and educational status do not significantly influence the choice of family planning among of couples in South West Nigeria. However, the involvement of partners signi-ficantly influences the choice of family planning methods among couples in the area.
RECOMMENDATIONS
Having studied the factors influencing the choice of family planning among couples in South West Nigeria, the following recommendations are made:
1. Every couple should be encouraged to visit family planning service providers so as to enlighten them on various family planning choices that will suite their economic status. 2. The community emphasize importance of family planning. 3. Religious leaders should encourage their followers on the needs for family planning choice as related to their holy book. 4. Community leaders should discourage the habit of not having family planning choice in their cultural norms. 5. Federal Government should build reproductive health centres where family planning education on the choice of family planning methods both educated couples and non-educated couples. 6. Family planning service providers should educate the couples on the effectiveness of family planning choice. 7. Every couples should be discourages about their thought in the health risk of family planning choice. 8. Couples with one baby and new couples should be discourages on the use of the permanent surgical method (vasectomy) of family planning. 9. Every couple should agree and involve when deciding the family planning choice.
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