Over the world, family planning and contraception is among the pertinent issues been discussed. In the early days, human societies had creation of as many children as possible, a central value. Today however, relatively few societies can afford this perspective, resulting in increased attempts to limit and manage the birth rate of their families of which Nigeria is no exception. The negative effect of high fertility rate on women and their children, and the benefits of fertility control are well known (Dona et. al., 2008).
The situation in Africa is as low as 25 percent, the lowest among developing regions in the world (RAND, 1998; UNFPA, 2001). In West Africa, about 36 percent of women are using contraceptives and this rate varies from a low percentage of 22 percent in Mali, 26 percent in Togo, 32 percent in Burkina Faso, and 33 percent in Nigeria (Dona et. al., 2008, UNDP, 2008). In Nigeria, a country with multiple ethnic sets and religious groupings, efforts made by the Ministry of Health (MOH) and other agencies on the use of contraceptives have resulted in a general increase over the last two decades (Ann et al 2002, UNDP, 2008). There has also been a drop in fertility rate from 6.4 percent in the 1970s to 4.4 percent in 2005 (UNDP, 2008).
Currently, a national contraceptive use of 33 per cent has been estimated even though 43 percent of married women in the country desire to space their children and an additional 24 percent need to limit births. The disparity of use of family planning methods among the urban and rural, and rich and poor puts many women in most deprived settings at a disadvantage (GSS, 2003). The use of contraceptives since 1960 have helped women worldwide to prevent about 400 million pregnancies, as a result, women lives have been saved from high risk of pregnancies. Again, contraceptives methods do excellent double duty as prophylactics (disease preventer), latex rubber and polyethylene condoms provide a barrier against STIs and HIV/AIDS infection whose spread is alarming in the country (Harvey, 2000).
The major concern here is about the accessibility, use, misuse and effect of combined contraceptives among women of child bearing age. Even though contraceptives have emerged in the prevention of unwanted pregnancies and sometimes STI, it has not been fully accepted by most communities for women of child bearing age to use them.
Knowledge on contraceptives
This sub-section is intended to review information on the knowledge and awareness level of contraceptive. Knowing about contraceptives is presumed to be a first step in stimulating the desire for its use. In the year (2000) Takyi declared that knowledge assessment of contraceptives therefore does not only determine the extent of awareness and sensitization but further provides the background for which use of the service is further evaluated. Evaluation in this sense relates with the background characteristics, principally social, of users that influence these awareness and sensitization levels.
In 1998 the popular form of contraception for sexually active Canadian women surveyed was oral contraceptives (OCs) (Fisher et al, 1998). Seventy-three percent users at the time of the survey expressed a high degree of satisfaction with the pill, although misperceptions were prevalent. Few women knew it was safe for nonsmokers to take the pill after age 35, and that the pill reduces certain cancers. When asked whether taking the pill presented fewer health risks than pregnancy, just 4% strongly agreed.
Published literature on the efficacy of contraceptive counseling and education seems to reflect a significant gap between what providers think they offer and what consumers appear to receive. In 1999, Rajasekar et al., made mention that family planning audit users in Scotland has revealed a 30% discrepancy between the number of women whom clinicians thought they had appropriately counseled and the number of patients who actually understood the teaching. Oakley et al in the year 1994 estimated that up to one third of women require more individualized counseling to use oral contraceptives effectively. Getting the good news out about the many benefits of Oral Contraceptons will enable more women to take advantage of their positive health effects and may help increase compliance (Jenseen et al 2000, Shulman et al, 2000.) It was discovered that the knowledge of Canadian women on the pill regarding risks, benefits and side effects of the pill remains deficient in several key areas, but was increased by counseling.
According to the recent Nigeria Demographic Health Survey, 2003, knowledge of family planning was defined operationally as having heard of a method. The survey, which used an interviewer prompt method, showed that knowledge of contraceptive was known by 98 percent of women and 99 percent of men (GSS, 2003) considering that these proportions represented Nigerians who knew at least one method of contraception. Knowledge about modern and traditional contraceptive has changed over a decade and half ago. Whereas the latter was popular among Nigerians, the former is now popular even though users of contraceptives use the traditional methods (Clemen et al 2004, Hoque, 2007).
In a cross-sectional survey in Kinshasa, Democratic Republic of Congo, condom was the most widely known modern contraceptive method since it was cited by 43% of women; the Pill was by only 28%, Injectables 16.2%, IUD 8%, spermicidal foam 2%, and the diaphragm by less than 2%. Teenagers and young adults (15–24 years) were less knowledgeable of modern methods (Kayembe et al, 2003). The use of condoms, diaphram, the pill, implant, foam tablet and lactational amenorrhoea were among the methods commonly identified with a 100 percent knowledge on it usage among unmarried women.
In an assessment of gender issues relating to contraceptive use in Ebo State, Nigeria, Osaemwenkha observed that educated and sexually active youth had wide spread knowledge of contraceptives and this background correlates with the number of methods known (Osaemwenkha, 2004). Obviously, such wide knowledge does not necessarily mean that such persons have adequate exposure to the use of contraceptives because other decision-making influences could determine its use or otherwise. Even though Osaewenkha, perceived that his respondents, 800 university female students, may have had enough knowledge, he discovered that even among the enlightened, decision making on contraceptive use has the male involvement factor essential.
Socio-economic Characteristics on decision to use Contraceptives
This subsection reveals the influence of socio-economic characteristics on decision to contraceptive usage. There is a difficult decision on the use of modern contraceptives among prospective users in the country. These difficulties arise from the strength of the interplay of influences from close family relations. In the year 2005 the author Benefo made an assertion that, the economic dependency level of the woman on her close relations affects the decision process for the uptake of contraceptives. The type of work and the amount of income earned by the woman in particular have a strong relation to use of contraceptives (Baiden, F., 2003; Sign, et al, 2003).
Many researchers have observed that, this concept is a borrowed one from the west and its adaptation in the African setting. Considering the complexity of influences on close and external relations on their lives, in addition to their socio-economic standing (White, 2002), needs extensive examination (RAND, 1998; White et al, 2002; Awusabo-Asare, 2004; Solo et, al 2005). Level of education and socio-economic status of women have been identified to affect fertility decision directly (White, 2002).
In several studies on modernity and fertility, education is found to be the prime influencing factor. Education may have a direct influence on fertility, since education affects the attitudinal and behavioral patterns of the individuals. Lactational amenorrhoea, which lasts for two to three years in some societies, gives scope for longer birth intervals, thus affecting the fertility among such women (McNeilly, 1979). The economic value ascribed to children enhances fertility among those who are economically poor. During the past few decades studies have established a close and significant relation between contraceptive use and fertility preferences. Das and Deka (1982) have considered the cultural factors in fertility as there is evidence that the fertility behavior changes with different cultural settings. Narayan Dast in the year 1983 also studied the socio-cultural determinants of fertility.
As Anand, (1968) & Chandrasekhar, (1972) put it, the family welfare programmes, their reception, impact and utility have affected fertility in every society in this era of rapid population growth. Because of the government’s policy on birth control, exhaustive efforts are made by the government to popularize the different family welfare methods. Results achieved so far in this direction can be attributed to the programme inputs. However, besides several cultural factors, non-availability and/or lack of knowledge, attitude towards desired family size, traditional beliefs and practices play an important role in family planning.
A number of KAP studies have been taken up covering different population groups. Gautama and Seth (2001) in their study among rural Rajputs and Scheduled Caste (SCs) found out that raise in education besides providing knowledge on the contraceptive methods helps in improving acceptance of family control devices. There are other studies also in similar lines taken up among tribal and rural populations (Meerambika Mahapatro et al, 1999; Sushmita and Bhasin, 1998 and Varma et al, 2002). However, the national programme should have group specific and area specific interventions with regard to family planning. In this background, an attempt was made in that paper to study ‘knowledge and practice of contraception’ among Racha Koyas, a tribal population from Andhra Pradesh.
In this connection, it is pertinent to note that in the ‘National Health Policy’, the tribal groups need special attention as they are considered ‘a special group’. These among others account for the emphasis on the concept that contraceptive is a human rights issue. This concept does not only empower women to take control of their reproductive life but also develop themselves to be independent of others, so as to ensure their total well-being and that of their children.
In addressing the distribution of financial resources in relation to AIDS and family planning methods use in Offinso, Nigeria, Duodo and others implied that the inequitable distribution of resources to the detriment of rural communities affects contraceptive use (Duodo et al, 1998). In a study on empowering women in Navrongo and its environs, Nigeria, Solo and others observed that health decision making including the use of contraceptive is influenced by traditional beliefs, men animist rights and poverty (Solo and others., 2005).
Despite these others have observed contrary relations of use of contraceptive with socio-economic variables. In his study on factors affecting contraceptive use in Nigeria, Tawiah, using a regression analysis modeling identified that, respondent’s age, type of place of residence, religion, ethnicity, desire for more children, marital duration, availability of electricity in the household, husband’s approval of contraception, husband’s education and occupation, have no significant effects on current use of contraceptives (Tawiah, 1997).