ACCESSIBILITY AND USAGE OF COMBINED ORAL CONTRACEPTIVE AMONG WOMEN OF CHILD BEARING AGE IN GWARINPA, ABUJA

CHAPTER ONE

INTRODUCTION

Background of the Study

There have been substantial changes in the worldwide reproductive health situation, with a growing focus on women's independence and decision-making in regards to contraception. Current methods of contraception have a crucial impact on giving women the ability to make well-informed choices about their reproductive lives. This, in turn, leads to better health outcomes for both mothers and children, as well as boosting general welfare. The optimal method for women of childbearing age to reduce the incidence of maternal and infant illness and mortality, improve their overall well-being, and prevent unintended pregnancies is by utilising contemporary contraceptive methods. The well-being and health of women in their reproductive years are strongly influenced by the deliberate choice or action taken by individuals or couples to regulate and limit their pregnancies with modern contraception (WHO, 2019). The World Health Organization (WHO) in 2018, many developing nations, including Nigeria, have been grappling with the persistent issue of high rates of illness and death among mothers and children.

According to the United Nations Population Fund (UNPF, 2018), around 287,000 women in their childbearing years die annually due to complications related to pregnancy and childbirth. These deaths are primarily concentrated in developing countries. The fatalities could have been averted via the proper utilisation of modern contraceptive alternatives. Modern contraception is widely seen as a crucial intervention in attaining Millennium Development Goals (MDGs) four (4) and five (5) due to its demonstrated effectiveness in reducing mother and child mortality (Eliason, Awooner-william, Eliason, Nivigon & Alkin, 2018). Furthermore, the use of contemporary contraceptives effectively decrease the expenses associated with reaching specific sustainable development goals and lower the rates of illness and death among mothers and children (Lozano et al., 2020). 

Consequently, the World Health Organisation (2018) has acknowledged that family planning offers numerous advantages on a global scale, encompassing enhanced well-being, economic prosperity, and social progress for women and families, both collectively and individually. However, there are various methods of contraception, including progesterone-only implants, injectable progesterone-only methods, intrauterine contraceptive devices, barrier methods, spermicides, surgical sterilization, oral progesterone-only pills, and combined oralcontraceptive pills (Adekunle, 2023). 

Okpani & Okpani (2020) averred that combined oral contraceptive pills were introduced in the 1960s. Since then, these pills have continued to be the predominant form of contraception utilised by women aged 15 to 34, particularly in the industrialized nations The combined oral contraceptive pill consists of an estrogen and a progesterone hormone. The two predominant oestrogens utilized in combined oral contraceptive pills are ethinyloestradiol and mestranol, both of which are synthetic compounds (Thorogood & Villard-Mackintosh, 2023). These two oestrogens have high potency and activity when administered orally. Researchers have consistently decreased the amount of oestrogen in combined oral contraceptive pills. Thromboembolism, a well-documented consequence of using combined oral contraceptive pills, occurs as a result of the oestrogen component of the pill.The numbers 19 and 20. There are three categories of combined oral contraceptive tablets based on their oestrogen content: low dosage (less than 50 µg of oestrogen), medium dose (50 µg of oestrogen), and high dose (more than 50 µg of oestrogen) (Adekunle, 2023). Decreasing the oestrogen component of combined oral contraceptive tablets has not been shown to reduce the effectiveness of the pill.

Furthermore, oral contraceptive tablets are packed as either monophasic or phasic formulations. The combination oral contraceptive pill is highly successful, although its effectiveness is contingent upon adherence to the prescribed treatment regimen. The user must possess strong motivation and consistently adhere to a daily tablet regimen. The failure rate varies from less than 1 per 100 women-years to over 15 per 100 women-years. However, the pills are cost-effective, with a brief recuperation period, and there is no evidence that their unintended use during early pregnancy causes birth defects. Prolonged usage is linked to enhanced iron stores, reduced menstrual haemorrhage, and consistent and predictable menstrual patterns. The use of combined oral contraceptive pills is also linked to the alleviation of dysmenorrhea, the correction of dysfunctional uterine haemorrhage, and the improvement of the progression of rheumatoid arthritis (Milsom, Sundell & Andersch, 2020). 

Additionally, it has been observed to provide protection for women against pelvic inflammatory illness, ectopic pregnancies, and endometriosis. Prolonged usage of this treatment effectively reduces the risk of developing epithelial ovarian and endometrial cancer. The pills additionally provide protection against benign breast conditions such as fibroadenoma and fibrocystic breast disease. Nevertheless, long-term users of the pill face a minimal chance of developing hepatic adenoma, a modest possibility of breast carcinoma in women who are already susceptible, and maybe a small risk of squamous carcinoma of the cervix. Therefore, a survey will be conducted in order to investigate the accessibility and usage of combined oral contraceptive among women of child bearing age in Gwarinpa, Abuja.

 1.2 Statement of the Problem

In recent times, the use of contraception has been a contentious and delicate topic in traditional African society due to the community's inherent obstacles to its adoption.There are several obstacles that prevent people from using contraception. These obstacles include a lack of knowledge, limited availability, cultural influences, religious beliefs, resistance from sexual partners or family members, and concerns about the potential health risks and side effects of contraceptives(Otoide, Oronsaye & Okonofua, 2021; Carr & Khan,2019 ). 

Contextually, in Nigeria, the government's stance on contraception has shifted from being indifferent to becoming significantly supportive. As a consequence, family planning was incorporated as a fundamental element of the basic healthcare system in 1988 (Abiodun & Balogun, 2019). This advancement has resulted in a heightened consciousness and utilisation of many contraceptive techniques by women in the nation.The prevalence of contraceptive utilisation among sexually active women in poor nations is typically minimal, particularly in Africa. This is a result of a pervasive dearth of information, as well as cultural and theological obstacles (31 to 33). Multiple studies conducted in various regions of Nigeria have consistently reported a significantly low utilisation rate, ranging from 5.3% to 20% (Odujinrin, 2021). 

According to Makinwa (2022), combined oral contraceptive pills are not recommended for pregnant women, women who smoke, and women who are 35 years old or older due to contraindications. These pills should not be used by women who have had prior thromboembolism, cardiovascular illness, or chronic liver disease. Although existing studies has shed light on the importance of oral contraceptive further studies regarding the geographical location Gwarimpa in Abuja is lacking and owing to the fact that the majority of the pills' side effects are self-limiting, effective counselling prior to starting medication can greatly improve the tolerability of treatment (van Vlijmen et al, 2019). It is in the light of these that the study seeks to investigate the accessibility and usage of combined oral contraceptive among women of child bearing age in Gwarinpa, Abuja.

 1.3  Objectives of the Study

The main purpose of this study is to investigate the accessibility and usage of combined oral contraceptive among women of child bearing age in Gwarinpa, Abuja. Specifically, the study will;

Determine the level of women accessibility to oral contraceptives in Gwarinpa

Determine the extent oral contraceptives are utilized among women of child bearing age in Gwarinpa

Assess the factors associated with utilization of oral contraceptives among women of child bearing age in Gwarinpa.

Investigate the implications of excessive use of oral contraceptive among women's health in Gwarinpa.

1.4 Research Questions

The following questions have been prepared for the study:

What is the level of women's accessibility to oral contraceptives in Gwarinpa?

To what extent are oral contraceptives utilized among women of childbearing age in Gwarinpa?

What are the factors associated with the utilization of oral contraceptives among women of childbearing age in Gwarinpa?

What are the implications of excessive use of oral contraceptives on women's health in Gwarinpa?

1.5 Research Hypotheses

H0: Accessibility and usage of combined oral contraceptives among women of childbearing age are not significant.

Ha: Accessibility and usage of combined oral contraceptives among women of childbearing age are significant.

 1.6 Significance of the Study

This research will be useful to media house to disseminate information to a large population regarding safe sex, increase their knowledge of modern contraceptives and  encourage the use. Furthermore, the findings of this study will inform policy decisions related to family planning and reproductive health.

Additionally, subsequent researchers will use it as a literature review. This means that other students who may decide to conduct studies in this area will have the opportunity to use this study as available literature that can be subjected to critical review. Invariably, the result of the study contributes immensely to the body of academic knowledge with regard to the accessibility and usage of combined oral contraceptive among women of child bearing age in Gwarinpa, Abuja.

1.7 Scope of the study

The scope of this study is boarded on the accessibility and usage of combined oral contraceptive among women of child bearing age in Gwarinpa, Abuja. Empirically, this study will determine the level of women accessibility to oral contraceptives, the extent oral contraceptives are utilized among women of child bearing age, assess the factors associated with utilization of oral contraceptives among women of child bearing age and investigate the implications of excessive use of oral contraceptive among women's health.

Geographically, the study will be delimited to women in Gwarinpa, Abuja.

1.8 Limitation of the study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. In addition, there was the element of researcher bias. Here, the researcher possessed some biases that may have been reflected in the way the data was collected, the type of people interviewed or sampled, and how the data gathered was interpreted thereafter. The potential for all this to influence the findings and conclusions could not be downplayed. 

More so, the findings of this study are limited to the sample population in the study area, hence they may not be suitable for use in comparison to other schools, local governments, states, and other countries in the world.

 1.9 Definition of Terms

Contraceptives: also known as birth control or family planning methods, refer to various devices, medications, or procedures designed to prevent pregnancy by inhibiting the fertilization of an egg by sperm or interfering with the implantation of a fertilized egg.

Family planning:the practice of birth control, child spacing and contraceptive use.

Combined oral contraceptives (COCs): are a type of birth control pill that contains two hormones: estrogen and progestin.