|Year : 2019 | Volume
| Issue : 2 | Page : 42-45
Factors affecting uptake of natural family planning methods among clients at the reproductive health clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
Hauwa Shuaib Umar, Nkeiruka Ameh, Umma Bawa Suleiman, Fadimatu Bakari
Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
|Date of Submission||02-Apr-2019|
|Date of Decision||02-Sep-2019|
|Date of Acceptance||22-Oct-2019|
|Date of Web Publication||20-Jan-2020|
Hauwa Shuaib Umar
Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State
Source of Support: None, Conflict of Interest: None
Background: The use of natural family planning (NFP) methods is low worldwide with few existing data. Aim: The aim of the study is to determine the factors affecting the use and discontinuation of NFP methods in our setting. Methodology: In this descriptive cross-sectional study, 302 clients who presented at the Reproductive Health Clinic of Ahmadu Bello University, Zaria, were interviewed, with the aid of pretested questionnaires. Sociodemographic variables, reasons affecting the use, and discontinuation of NFP methods were recorded and analyzed using SPSS software version 15. Results: Among the 302 clients interviewed, 88.1% (266) had used a form of family planning method: 38.4% (116) used NFP, 49.7% (150) used artificial methods, whereas 37.1% (43) discontinued the NFP methods. Major factors hindering the use of an NFP method include lack of awareness (24%), been single (17%), unknown reason (17%), irregular menstrual cycle (10%), and fear of method failure (8%). Major factors for discontinuing the NFP methods include high failure rates (21%), irregular menstrual cycle (18%), introduction to other methods (14%), want of conception (12%), and fear of pregnancy (12%). Conclusion: The most common factor affecting the uptake of NFP was lack of awareness. Failure rates and irregular menstrual cycles were the common denominators, affecting both the use and discontinuation of NFP methods.
Keywords: Discontinuation, natural family planning, uptake
|How to cite this article:|
Umar HS, Ameh N, Suleiman UB, Bakari F. Factors affecting uptake of natural family planning methods among clients at the reproductive health clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Arch Med Surg 2019;4:42-5
|How to cite this URL:|
Umar HS, Ameh N, Suleiman UB, Bakari F. Factors affecting uptake of natural family planning methods among clients at the reproductive health clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Arch Med Surg [serial online] 2019 [cited 2021 Dec 4];4:42-5. Available from: https://www.archms.org/text.asp?2019/4/2/42/276179
| Introduction|| |
Family planning is the voluntary planning and action taken by individuals or couples to achieve, delay, or prevent pregnancy. Family planning methods could be broadly classified as either natural or artificial. Natural family planning (NFP) methods are based on the observation of the naturally occurring signs and symptoms of the fertile and infertile phases of a woman's menstrual cycle, and referred to as the “fertility awareness methods.” The fertility awareness methods include the periodic abstinence, the Billings, lactational amenorrhea (LAM), basal body temperature, cycle beads, and the symptom-thermal methods. Worldwide, the use of NFP was reported to be low, with only 2%–3% of the world's reproductive age population using periodic abstinence. The LAM method was believed to reduce the world's fertility rate by 30%–45%. In Brazil, NFP is the third most popular family planning method. The “safe period” method of fertility awareness is the most common family planning method used in India, although condoms are used by some. Among American women on birth control, only 1.5% were on periodic abstinence.
In Africa, only 27% of married women were using any method of contraception, with less than 5% in some parts of the continent using modern methods. Despite the high total fertility rate in Nigeria (5.5), there is low uptake of modern contraceptive methods (10%). Similarly, the uptake of NFP method is low, with the rhythmic and withdrawal methods reported as the most common methods with a rate of only 2%. Knowledge of the fertile period was reported to be minimal among Nigerian women, with only 20% of women correctly reporting the fertile period. In Maiduguri, Nigeria, low level of awareness, poor description, and utilization of the methods were the most common reasons stated for not using a NFP method.
Despite the low uptake of NFP, some clients still have reasons to discontinue the methods. Previous studies revealed that the major factors affecting the use of NFP methods were the lack of awareness and high contraceptive failure rates. However, all the natural methods of family planning can be effective in preventing pregnancies when used consistently and correctly. Furthermore, the fact that some of the methods of NFP could be more than 95% effective in the avoidance of pregnancy seems unknown to most of the general public including health-care providers, hence the need to determine the factors affecting the uptake and discontinuation of NFP methods in our setting. This study will contribute to the existing literature on NFP.
| Methodology|| |
This was a descriptive cross-sectional study conducted at the Reproductive Health Clinic of Ahmadu Bello University Teaching Hospital, Zaria, from January 1, 2013, to June 30, 2013. The study included all consenting women of reproductive age group (15–49 years) seeking family planning services at the clinic.
The minimum sample size was 216 after correction for attrition rate, using the following formula:
n = zᾳ2pq/d2
Where zᾳ2 is the standard normal deviate = 1.96, P = prevalence of all methods of contraceptive use in Nigeria = 0.15, and d = 0.05.
Convenience sampling technique was employed to select the clients for this study.
After correction for attrition, a total of 310 clients at the clinic for family planning services during the study period were recruited.
Pretested questionnaires were administered by the researcher and trained nurses. Sociodemographic variables of the clients, NFP methods used by the clients, and factors affecting the uptake and discontinuation of NFP methods were recorded. Data were analyzed by SPSS Inc. Released 2006. SPSS for Windows, Version 15.0. Chicago, SPSS Inc. Chi-square test was used to test the association for the qualitative data. P = 0.05 was considered statistically significant.
Ethical approval was obtained from the Ethical Committee of the Ahmadu Bello University Teaching Hospital, Zaria. Informed verbal consent was obtained from each client or guardian for those under 18 years (only one client was 17 years).
| Results|| |
Among the 310 clients who were interviewed, 302 gave adequate information, and their questionnaires were analyzed, giving a response rate of 97.4%. Majority (64.9%) of the respondents were within the age group of 20–29 years and multiparous (44.7%). Majority of the clients were married, whereas 32.5% were single, 93.4% had formal education, while a little above half were Muslims (53.0%) [Table 1].
A total of 266 (88.1%) clients used a form of family planning method: 116 (38.4%) used the NFP methods, whereas 49.7% (150) used artificial methods. The NFP methods used by the clients include cycle beads (47%), withdrawal method (2%), calendar method (25%), and lactational amenorrhea (26%). Among the clients using the natural methods, 43 (37.1%) discontinued. Factors hindering the use of a NFP method included lack of awareness of the methods (24%), unknown reasons (17%), single (17%), irregular menses (10%), and fear of failure of method (8%) [Table 2].
|Table 2: Factors hindering the use of natural family planning method among the clients (n=150)|
Click here to view
Factors leading to the discontinuation of natural methods include high failure rates (21%), irregular menses (18%), introduction to other methods (14%), want of conception (12%), and fear of pregnancy (12%) [Table 3].
|Table 3: Factors leading to the discontinuation of natural family planning among the clients (n=43)|
Click here to view
Sociodemographic variables such as educational status, religion, and parity were statistically significantly associated with low uptake and discontinuation of natural methods (P < 0.05). However, age was significantly associated with low uptake but not significantly associated with discontinuation [Table 4].
|Table 4: Cross tabulation of sociodemographic factors affecting the uptake and discontinuation of natural family planning methods among the clients|
Click here to view
| Discussion|| |
The majority of the clients in the study were within the age group of 20–29 years, which was similar to the Nigerian multicentric (Kano, Enugu, Lagos, and Abuja) study by Odimegwu. Majority were married, educated, and Muslims, similar to the previous Zaria study by Ameh and Sule. These findings could be explained by the fact that the study was from the same setting. Similarly, the level of education of the majority of the clients was up to tertiary level, which was similarly reported in a South Nigerian study by Adeyemi et al. The use of NFP methods was lower than that of artificial family planning (AFP) methods, which was similar to the findings of Audu et al. and Chandra et al. from the Maiduguri and American studies, respectively., However, this finding was contrary to the findings of Nakiboneka andManiple from Uganda, where the uptake of NFP was higher than the AFP methods as the majority of the clients were Catholics from Roman Catholic Church (RCC) who preferred the NFP. The factors hindering the uptake of NFP in our study include lack of awareness, fear of failure, and difficulties in the correct use of such methods, which was similarly reported by Audu et al. from the Maiduguri study. In this study, discontinuation in the use of the NFP was mainly due to the high failure rate, coupled with the fear of pregnancy, which was similar to the NDHS 2013 report, hence the need for more education regarding the reproductive physiology of women and correct use of the methods. Other factors such as lack of regular menses and spouse compliance had been reported to have great influence on the discontinuation of any NFP., However, factors affecting both uptake and discontinuation of the NFP include poor quality service, inadequate record keeping, poor client follow-up, and inadequate training of staffs in counseling and provision of NFP.
The sociodemographic variables such as religion, educational status, and parity were significantly associated with low uptake and discontinuation of NFP in this study. However, religion was associated with higher uptake of NFP from the study of Nakiboneka andManiple among the Catholics from RCC, Uganda. Educated women tend to have less children and tend to rely on the more effective AFP methods unlike the NFP. However, contrary to our finding, the more educated clients from Southwestern, Nigeria, were reported by Ajayi et al., to have fallen back to the less effective NFP methods due to fear of side effects associated with the AFP methods. High parity has been associated with increased demand for family planning methods.,, However, from our study, the low uptake of NFP methods among the multiparous women could be as a result of the general lack of awareness of the methods (24%) because it was the main factor for nonuptake among our clients. Similarly, high parity has been associated with difficulties in understanding the techniques of NFP. Discontinuation of NFP methods among the clients was significantly low despite the high failure rates and fear of pregnancy associated with NFP methods. However, majority of our clients were using the cycle beads (47%), which has the lowest failure rate (5%) compared to other NFP methods.
Irregular menstrual cycles played a vital role in both the use and discontinuation of NFP methods in this study as was similarly reported by Abel et al. from the Burkina Faso study. This can explain the reason why some women had failure of the NFP method. Most NFP methods use the fertility awareness method to track the safe and unsafe time for sexual exposure and those clients with irregular menses cannot benefit from NFP.
| Conclusion|| |
The most common factor affecting the use of NFP was lack of awareness of the methods, while discontinuation was mainly due to high failure rate. Irregular menstrual cycles influenced both the use and discontinuation of the NFP methods.
The study was hospital based, thus the findings may not necessarily reflect the uptake and discontinuation of NFP in the community.
There is a need for more awareness regarding the natural family methods, especially effective methods such as the Standard Days Method (cycle bead).
All clients interested in NFP methods should be able to track their menstrual cycle and avoid unprotected sex during the fertile days of their cycles in order to reduce the failure rate.
All staff involved in counseling clients on family planning must have in-depth knowledge of the physiologic basis of all the NFP methods.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Emuveyan EE, Kwawukume Y. Advances in contraception. Compr Gynaecol Trop 2005;1:233.
World Health Organization. Eligibility Criteria for Contraceptive Use: Fertility Awareness – Based Method. Johns Hopkins University; 2004.
Urmil D, Ishita G, Rebecka L. Feasibility of Incorporating the Standard Days Method into CASP Family Planning Services in Urban Slums of India. The Institute for Reproductive Health, Georgetown University; 2005.
Che Y, Cleland JG, Ali MM. Periodic abstinence in developing countries: An assessment of failure rates and consequences. Contraception 2004;69:15-21.
John FK, Sheila KK. The Art of Natural Family Planning. Cincinnati, OH: Couple to Couple League International; 1996.
Chandra A, Martinez GM, Mosher WD, Abma JC, Jones J. Fertility, family planning, and reproductive health of U.S. Women: Data from the 2002 National Survey Of Family Growth. Vital Health Stat 23 2005;(25):1-160.
United Nations. World Population Prospects: The 2004 Revision: Highlights (ESA/P/WP. 193). New York: Population Division, Department of Economic and Social Affairs, United Nations; 2005.
National Population Commission (NPC). Nigeria and ICF International. Nigerian Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International; 2014.
Audu BM, Yahya SJ, Bassi A. Knowledge, attitude and practice of natural family planning methods in a population with poor utilisation of modern contraceptives. J Obstet Gynaecol 2006;26:555-60.
Arévalo M, Jennings V, Sinai I. Efficacy of a new method of family planning: The Standard Days Method. Contraception 2002;65:333-8.
Lameshow S, Hosmer DW, Klar J, Lwanga SK. Adequacy of Sample Size in Health Studies. New York: John Wiley and Sons; 1990.
Odimegwu OC. Family planning attitudes and use in Nigeria: A factor analysis. Int Fam Plan Perspect 1999;25:86-91.
Ameh N, Sule ST. Contraceptive choices among women in Zaria, Nigeria. Niger J Clin Pract 2007;10:205-7.
] [Full text]
Adeyemi AS, Olugbenga-Bello AI, Adeoye OA, Salawu MO, Aderinoye AA, Agbaje MA. Contraceptive prevalence and determinants among women of reproductive age group in Ogbomoso, Oyo State, Nigeria. Open Access J Contracept 2016;7:33-41.
Nakiboneka C, Maniple E. Factors related to the uptake of natural family planning by clients of catholic health units. 2008;3:126-1.
Ajayi AI, Adeniyi OV, Akpan W. Use of traditional and modern contraceptives among childbearing women: Findings from a mixed methods study in two Southwestern Nigerian states. BMC Public Health 2018;18:604.
[Table 1], [Table 2], [Table 3], [Table 4]