|Year : 2013 | Volume
| Issue : 3 | Page : 93-96
Contraceptive choices among women attending the fertility research unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto
Constance E Shehu, Ahmed T Burodo
Departments of Obstetrics and Gynaecology, Usmanu Danfodiyo University/UDUTH, Sokoto, Nigeria
|Date of Web Publication||22-Nov-2013|
Constance E Shehu
Departments of Obstetrics and Gynaecology, Usmanu Danfodiyo University Teaching Hospital, Sokoto
Background: One of the most sensitive and intimate decisions made by any individual or couple is that of fertility control . The knowledge of the factors which influence contraceptive choices may increase its acceptance and uptake. This study determines the choice and reason for contraception among new clients attending the Fertility Research Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto. Materials and Methods: In this prospective study a structured questionnaire was administered to 251 consecutive clients, who attended the Fertility Research Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto between 1 July 2008 and 31 December 2008. Results: Most (58.2%) of the clients were between 21 and 30 years of age. Many (42.6%) were grand multipara. Majority (76.9%) of the clients were married. The main source of knowledge of contraception and referral (45.8%) was the physicians. Child spacing (87.7%) was the most common reason given for contraceptive use. Majority (55.8%) of the clients chose Implanon and the least preferred method of contraception was the condom (2.0%). Conclusion: Our data shows that the most commonly chosen contraceptive method in the study population was the Implanon. Child spacing was the main reason for seeking family planning while the source of contraceptive knowledge was the physicians.
Keywords: Child spacing, contraception, implanon
|How to cite this article:|
Shehu CE, Burodo AT. Contraceptive choices among women attending the fertility research unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto. Sahel Med J 2013;16:93-6
|How to cite this URL:|
Shehu CE, Burodo AT. Contraceptive choices among women attending the fertility research unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto. Sahel Med J [serial online] 2013 [cited 2019 Jan 19];16:93-6. Available from: http://www.smjonline.org/text.asp?2013/16/3/93/121906
| Introduction|| |
Family planning is described as actions by individuals and couples to plan the number, timing and spacing of the children they want in order to promote the health and wellbeing of the family group.  One of the most sensitive and intimate decisions made by any individual or couple is that of fertility control. 
In recent times, much progress has been made in the development of safer and more effective contraceptives and the provision of affordable and accessible family planning services.  In the past two decades, changes in the use of fertility control methods have influenced various facets of human life but to different degrees in various parts of the world. Sub-Sahara Africa however still wallows in the pit of low contraceptive prevalence and high fertility rate with its attendant problems including population explosion, unwanted pregnancies and its sequelae coupled with poor socio economic development.  Nigeria, on one hand, has a population of about 140 million with a population growth rate of 2.7% and a total fertility rate of 5.3%.  On the other hand, she has a contraceptive prevalence of only 11%.  Various factors have been identified as being responsible for this low contraceptive prevalence and they include poverty, ignorance, low educational level, and desire for large family size. , Others are poor access to contraceptive services, community pressure, male or husband dominance, and religious beliefs. 
Factors which influence choice of contraceptive vary from one part of the world to another and within the same country. Permanent methods of contraceptive are more acceptable in the western world, while intrauterine contraceptive devices are more commonly used in the western part of Nigeria.  These differences are probably due to social, economic, educational, and religious factors.  Previous studies from Zaria, Northern Nigeria, showed an increase in the number of clients switching from one method of contraceptive to another with a trend towards Norplant and injectable over the last 20 years. , As the millennium progresses and with the challenges posed by the human immuno deficiency virus (HIV) scourge, there may be further changes in contraceptive choice in different parts of the world including Nigeria. 
Family planning in many parts of Nigeria is influenced by cultural/religious beliefs.  Compounding the problem is the high-unmet contraceptive needs in Nigeria. 
The aim of this study was to determine the choice of contraceptive and the reason for contraception among new clients attending the fertility research unit in a tertiary health institution in sokoto, Nigeria.
| Materials and Methods|| |
In this prospective study, a structured questionnaire was administered to 251 consecutive new clients, who attended the Fertility Research Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto from 1 July 2008 to 31 December 2008. Data on socio-demographic characteristics, source of referral, contraceptive choice, and reason for contraception were obtained. The questionnaires were administered by trained nurses at the unit after informed consent was obtained verbally. Ethical clearance for the study was obtained from the Ethics Committee of the hospital. The data was analyzed by SPSS statistical software package.
The contraceptive services offered and the cost by the unit include oral contraceptive pills (3 cents or N50.00), male and female condoms (1.5 cents or N20.00 each), injectable forms (Noristerat R and DepoProvera R ) ($2 or N300.00 each), copper Intra Uterine Contraceptive Device ($3 or N500.00), Implanon R ($20 or N3,000.00) and sterilization by bilateral tubal ligation ($200 or N30,000.00).
| Results|| |
The age of the clients ranged between 15 and 49 years with a mean age of 28.1 ± 6.1 years [Table 1].
Most of the clients 176 (70.1%) were grand multiparae, and only three (1.2%) were nulliparae. Seventy two clients had parity ranging from 1 to 4. The mean parity was 3.8 ± 0.6
The socio-demographic characteristics of the clients are shown below [Table 2].
Physicians (45.8%) and nurses/midwives (31.9%) were the main sources of contraceptive knowledge [Table 3].
The contraceptives of choice among the clients were Implanon 140 (55.8%) and injectable contraceptives 61 (24.3%) [Table 4].
Majority of the clients 220 (87.7%) wanted contraceptive for child spacing, while 2 (0.8%) were single and wanted to avoid unwanted pregnancy. Only 2 (0.8%) clients wanted contraception because of sole lack of desire for pregnancy.
| Discussion|| |
The women in this study were aged 15-49 years, with most of them being in the age range of 20-29 years. This represents the peak reproductive age group that may most likely be in need of contraception. Our finding is similar to the experience of previous authors on this subject. ,, and reflects the practice of early marriage in the cultural setting where the study was carried out.
Most of the clients were housewives and were educated up to secondary school level; majority of them were married. These are similar to findings from the 2003 National Health and Demographic Survey. 
Many of the clients in this report obtained their information on contraceptives from the physicians; this was the same finding in an earlier study in the hospital  and in Osogbo.  However, it's in contrast to findings in an urban community in Southwestern Nigeria where the Mass Media was the predominant source of family planning information.  Family planning in the setting of the current study is still reluctantly being accepted because of religious belief and the perception that it is synonymous with population control.  It is therefore unlikely to feature prominently in the mass media.
The predominance of Muslims in the study is a reflection of the Islamic background of the population in Sokoto. Most of the clients had more than six children. The demographic health survey of 1992 showed that contraceptive prevalence increases sharply with the number of children a woman has. The finding that less than 1% of the clients were single women is not surprising because the study population belongs to a community where extra-marital sex is considered a taboo.
The main reason for seeking family planning in this study was for child spacing. This is not surprising as there is a strong cultural preference for large families in sub-Saharan Africa, such that grandmultiparous women will accept contraception mainly for child spacing and not because they have completed their desired family size. 
Implanon was the predominant method of contraceptive chosen by new clients. This finding shows a paradigm shift in choice of contraception in the study area where previously the intrauterine contraceptive device followed by injectables were the preferred methods of contraception.  This may not be unconnected with the high efficacy, dosing schedule, lack of partner involvement and ease of reversibility associated with implanon. However, it contrasts with what was found in other centers like Zaria  and Jos  where injectable contraceptive was found to be the most common method chosen by clients. The least chosen method of contraceptive from this study was the condom which is not in agreement with a recent study done in Porthar court  where condom was the most chosen method of contraceptive. It is also lower than 5-33% usage found in other regions of the world.  However, this may be because, most of our clients were married women and most users of condoms are single men and women who need it for protection from HIV as well as for contraceptive. 
| Conclusions|| |
Implanon was the most commonly chosen contraceptive method while child spacing was the main reason for seeking family planning among the study population. Contraceptive knowledge was mainly from the physicians. We recommend measures aimed at information dissemination to increase contraceptive awareness and knowledge.
| References|| |
|1.||Namboze JM. Family planning. In: Sofoluwe GO, Bennett FJ, editors. Principles and Practice of Community Health in Africa. Ibadan, Nigeria, University Press; 1985. p. 359-71. |
|2.||Michelle G, Ronald TB. Contraception and family planning. In: Decherney AH, Nathan I, editors. Current Obstetrics and Gynaecology. Diagnosis and Treatment. 9 th Ed. Los Angeles; McGraw - Hill; 2003. p. 631. |
|3.||Family Planning Research on Reproductive Health at WHO: Pushing the frontiers of knowledge. Biennial Report (2002-2003). Geneva: WHO; 2004. p. 11-7. |
|4.||Nyengidiki KT, Eyindah CE. Contraceptive prevalence among women attending infant welfare clinic at University of Port Harcourt Teaching Hospital. Port Harcourt Med J 2008;3:42-8. |
|5.||Adekunle AO, Otolorin EO. Evaluation of the Nigeria population policy. Myth or reality. Afr J Med Med Sci 2000;29:305-10. |
|6.||Emuveyan EE, Dixon RA. Family planning clinics in Lagos, Nigeria: Clients, method acceptance and continuation rates Nigeria. Med J 1995;28:19-23. |
|7.||Kabir M, Iliyasu Z, Abubakar IS, Mage BS. The role of men in contraceptive decision making in Fashekara village, Northern Nigeria. Trop J Obstet Gynaecol (Special edition) 1990. p. 18-21. |
|8.||Ibrahim MT, Sadiq AU. Knowledge, attitude, practices and beliefs about family planning among women attending primary health care clinics in Sokoto, Nigeria. Niger J Med 1999;8:154-8. |
|9.||Ekewmpu CC. The realities of VSC service at Zaria management, socio-cultural and medical issues. Trop J Obstet Gynaecol (Special edition) 1990. p. 35-6. |
|10.||Haggai DN. The Norplant experience in Zaria: A ten year review. Afr J Reprod Health 2003;7:20-4. |
|11.||Morrison C, Best K. Hormonal contraception and HIV: An update. Research Triangle Park, NC. Family Health International: 2004. p. 31. |
|12.||Ibrahim MI, Okolo RU. Profile of contraceptive acceptors in UDUTH, Sokoto, Nigeria. Nigeria Med Pract 1997;33:913. |
|13.||Oye-Adeniran BA, Adewale IF, Odeyemi KA, Ekanem EE. Contraceptive prevalence among young women in Nigeria. J Obstet Gynaecol 2005;25:182-5. |
|14.||Ameh N, Sule ST. Contraceptive choices among women in Zaria, Nigeria. Niger J Clin Pract 2007;10:205-7. |
|15.||Family planning. In: Nigeria Demographic and Health Survey. National Population Commission Abuja and ORC Macro, Maryland. 2004. p. 61-81. |
|16.||Isah AY, Nwobodo EI. Family planning practice in a tertiary health institution in a North-Western Nigeria. Niger J Clin Pract 2009;12:281-3. |
|17.||Adeyemi AS, Adekanle DA, Komolafe JO. Pattern of contraceptives choice among the married women attending the family planning clinic of a tertiary health institution. Niger J Med 2008;17:67-70. |
|18.||Adekunle LV, Olaseha IO, Adeniyi JO. Potential Impact of the Mass Media on Family Planning in an Urban Community in South Western Nigeria. Trop J Obstet Gynaecol 2004;21:88-90. |
|19.||Kirk D, Pillet B. Fertility levels, trends and differentials in sub-Saharan Africa in the 1980s and 1990s. Stud Fam Plann 1998;13:1-4. |
|20.||Mutihir JT, Pam VC. Overview of contraceptive use in Jos University Teaching Hospital, North Central Nigeria. Niger J Clin Pract 2008;11:139-43. |
|21.||Provider and Patient Misconception about Intrauterine Contraceptive. New Developments in Intrauterine Contraception. ARHP Clinical Proceedings; 2004. p. 1-20. |
|22.||Closing the condom gap. Popul Rep H. 1999 (9):1-35. |
[Table 1], [Table 2], [Table 3], [Table 4]