CHAPTER ONE

INTRODUCTION

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).

    Theoretical framework

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.

  1.3  Purpose of the study

The general purpose of the study is to find out the factors affecting family planning services among rural women in NsitIbom Local Government of AkwaIbom State.

Specifically, the objectives of this study were to:

    examine how educational background affects family planning services among rural women in NsitIbom Local Government Area of AkwaIbom State.

    examine how culture affects family planning services among rural women in NsitIbom Local Government Area of AkwaIbom State.

    determinehow religion affects family planning services among rural women in NsitIbom Local Government Area of AkwaIbom State.

    determine how economic status affects family planning among rural women in NsitIbom Local Government Area of AkwaIbom State.

1.4 Research questions

The following research questions were formulated to guide the study:

    How does educational background affect family planning services among rural women in NsitIbom Local Government Area of AkwaIbomState?

    To what extent does culture affects family planning services among rural women in NsitIbom Local Government Area of AkwaIbom State?

    How does religion affect family planning services among rural women in NsitIbom Local Government Area of AkwaIbomState?

    How does economic status affect family planning services among rural women in NsitIbom Local Government Area of AkwaIbomState?

        Statement of hypotheses

The following null hypotheses were formulated to guide the study.

    Educational background of rural women does not have any significant effect on family planning services among rural women in NsitIbom Local Government Area of AkwaIbom State.

    Culture of rural women does not have any significant effect on family planning services among rural women in NsitIbom Local Government Area of AkwaIbom State

    Religion of rural women does not have any significant effect on family planning services among rural women in NsitIbom Local Government Area of AkwaIbom State

    Economic status of rural women does not have any significant effect on family planning services among rural women in NsitIbom Local Government Area of AkwaIbom State

 1.5 Significance of the study

Although many scholars have written on the effect of family planning practices in Nigeria, it is significant to notes however that family planning can prevent unwanted pregnancies and unsafe abortions and family planning does not mean abortion. Therefore this study is basically for rural women. Hence the study hopefully is significant to the extent that the above specify persons should be able; to know what family planning is all about, to understand the important, benefits of family planning practices, to know some factors that could affect the practice of family planning, such as religion and cultural belief and also to understand that some family planning methods such as condom usage can protect individuals from Sexually Transmitted Infections (STIs) including HIV/AIDS at the end of the study.

Health workers may also find this study useful because they will be prepared to attend to people who will need their assistance of family planning. Policy makers will not be left out in terms of the significance of this study as they may be able to design policies that could lead to an effective family planning method. As a final point, it possibly would serve as a work of reference to future researchers in that area.

1.6     Assumptions of the study

The study assumes that:

    The rural women have some knowledge regarding family planning practices.

    The result of the study will help to reduce maternal mortality hopefully as family planning acceptor rate would improve.

    The result of the study will help to increase the number of women that would embrace family planning services most especially in rural area

    The result of the study will help in the more involvement men to encourage their women on family planning.

1.7     Scope of the study

The study was restricted only to the rural women in NsitIbom Local Government Area of AkwaIbom State. Since this research aimed at determining the factors affecting family planning services in rural area among women in NsitIbom Local Government of AkwaIbom State, thoughtfulness were paid to the several methods of family planningand independent variables such as educational background of rural women; culture of rural women; religion of rural women as well as economic status of rural women were examined.

  1.8  Limitations of the study

          The challenges that posed a threat to this study include the following; attitudes of rural women turned to be huge obstacles and time constraints due to other academic pressure. However,in spite of these limitations, the study seems promising, possible and achievable.

1.9   Definitions of terms

Family planning: Refers to the practice of controlling the number of children rural women has and the interims between their births, mostly by means of contraception or voluntary sterilization so to improve family planning services and practices.

Factors: Are elements that brings about certain effects or results and also what could cause rural women not to embrace family planning services

Rural area: Refers to location outside towns and cities where women resides in low population density with less social and spatial mobility low social change; agriculture as the major preoccupation and less interest in family planning.

Methods:  are procedures for accomplishing or approaching something or systematic way of involving women in rural area into family planning and established effectiveness of family planning.

Contraceptives: This refers to the several family planning methods that are available for use in controlling birth example; oral contraceptive pill, intrauterine contraceptive device etc.

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