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Journal of Sociological Research
ISSN 1948-5468
2012, Vol. 3, No. 2
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249
Women Age at First Birth and Knowledge of Family
Planning Methods in Yoruba Society, Nigeria
John Lekan Oyefara, Phd
Department Of Sociology, Faculty Of Social Sciences, University Of Lagos, Akoka, Yaba,
Lagos, Nigeria
E-Mail: Oyefara@Yahoo.Com, Loyefara@Unilag.Edu.Ng
Accepted: August 12, 2012 Published: September 16, 2012
Doi:10.5296/jsr.v3i2.2394 URL: http://dx.doi.org/10.5296/jsr.v3i2.2394
Abstract
This article investigates the relationships that exist between women age at first birth and
knowledge of family planning methods in Yoruba society, Nigeria. This central objective was
based on the identified and documented benefits associated with the adoption of family
planning devices by women globally. Family planning programmes are integral and central
parts of safe motherhood initiatives and maternal health programmes of the United Nations.
The understanding of interrelationship between women age at first birth and family planning
variables is of direct relevance to health planners and policymakers attempting to control
population variables and encourage safe motherhood in Yoruba society. To achieve the central
objective of the study, quantitative data were generated from 1,000 women in one of the six
Yoruba speaking States in Nigeria: Osun State. A multi-stage random sampling technique was
adopted to select the respondents, while simple percentages and chi-square statistical method
of analysis were adopted to analyze generated data. Findings of the study show significant
relationships between women age at first birth and family planning variables at P<0.01.
Specially, adolescent mothers exhibit significant low level of knowledge, ever use and current
use of family planning methods compared with older mothers. On the basis of the findings, it
has been recommended that State governments, local and international non-state actors
working on safe motherhood in Yoruba society need to reach adolescent mothers
in-and-outside health institutions through community health workers with contraceptive
methods messages and services in order to improve maternal health and reduce high
population growth rate in Yoruba society.
Keywords: Women Age at First Birth, Family Planning Methods, Safe Motherhood, Yoruba,
Nigeria.
Introduction
Family planning involves a conscious effort by couple to limit or space the number of
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children they want to have through the use of contraceptive methods. It also refers to the
steps, practices and techniques adopted to determine, influence or decide when to have
children (Mischell, 2007; NPC, 2009). The term is sometimes used synonymously with birth
control, i.e. to have children according to plan (Akin, 2007). It has been demonstrated that
family planning benefits the health and well-being of women throughout the world. Using
contraception, which is an integral part of family planning, can help to avoid unwanted
pregnancies and space birth. Some contraceptive methods are capable of playing the dual role
of both preventing pregnancies as well as protect against STDs, including HIV/AIDS, and
provide other health benefits (Bloom and Canning, 2003). As noted by Isiugo-Abanihe
(1996:105) “family planning saves lives. It enables couples to decide for themselves when to
have their children as well as how many children to have. By helping women bear their
children during healthiest times for both mother and baby, family planning helps to prevent
deaths of infants, children and mothers. The use of family planning allows women to avoid
unwanted pregnancies, dangerous illegal abortions, and childbearing under circumstances
that will threaten their infants‟ lives and their health. Thus, modern family planning is
beneficial even though it remains a controversial issue”.
The term birth control is said to have been coined by Margaret Sanger (1879-1966), a young
American nurse in the first decade of 20th century (Guttmacher, 1969). Sanger was said to
have been disturbed by the numerous deaths faced by women who wanted to avoid childbirth
through induced abortion, as well as slow death women suffer from too many pregnancies.
Against oppositions from church and state at the time, Sanger rose to start a movement that
would give women control over their body and sexuality. During this period, birth control and
fertility were seen as entirely women‟s problem, so, men were hardly involved. It was the
efforts of people like Sanger that brought the issue of family planner to public recognition as
a vital component of human life. However, literature reveals that attempts at regulating births
dates back to pre-Sanger period. As early as 1789, Thomas Robert Malthus, an English
clergyman and college professor had started sounding warning about the implication of rapid
population increase in his essay “The Principle of Population” (Weeks, 2002: 86). By that
warning, Malthus was echoing the need for family planning and birth control; even though he
did not use the terms. He enjoined his listeners to exercise “moral restraints” (an equivalent
term for periodic abstinence) to check overpopulation. Furthermore, according to Akin (2007),
ancient historical records indicate that humans have always sought means to control fertility
through earlier methods. These earlier methods are generally referred to as Folk Methods, and
some of them still persist till date. They include: withdrawal method, abstinence, douche
method and vaginal sponge (Akin, 2007; Guttmacher, 1969).
In the above introduction, it is clear that family planning is a means by which individuals or
couples space the process of conception, pregnancy and childbirth at intervals mutually
determined by both husband and wife in order to have the desired number of children that
they can conveniently maintain. Family planning also assists couples who have difficulties in
having children to have the expected number of children they desired (Delano, 1988). In the
contemporary world, family panning can be achieved by birth control methods. Specifically,
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birth control can be defined as both spacing and limiting the number of children. Birth control
also refers to infertility therapy which allows childless women to have their desired number
of children. In modern times, birth control is popularly associated with contraception and the
desired number of children is determined by various social, cultural and economic factors.
Against this background, this study seeks to provide answers to the following research
questions: what is the current knowledge of family planning methods in Yoruba society?
Does age at first birth affect the knowledge, ever use and current use of family planning
methods in the study location? What method of family planning is more prevalent in Yoruba
society? In the next section, various studies in the areas of family planning were carefully and
thoroughly reviewed.
Literature Review
Contraception as a concept can also be defined as means of controlling fertility by using
various methods that prevent conception. These methods can be traditional or modern.
Traditional methods include: withdrawal method, abstinence, douche method and vaginal
sponge (Akin, 2007; Guttmacher, 1969). Withdrawal method, also referred to as coitus
interruptus (Isiugo-Abanihe, 2003), is probably the oldest technique which couples adopted
in order to avoid having children. It refers to the withdrawal of the penis from the woman‟s
vagina just prior to ejaculation so that the semen is deposited outside of the genital tract. The
method is said to have been well known even before the time that the first book of the Old
Testament, Genesis was written, about 1500 B.C. This establishes the antiquity of family
planning habits (Akin, 2007; Guttmacher, 1969).
In Europe, particularly Western and Northern Europe, where relatively late marriage have
been customary at all social levels (Bloom and Canning, 2003; Guttmacher, 1969), it appears
that withdrawal was the principal method by which pregnancy was prevented in premarital
love affairs (Dixon-Mueller, 1993). In America, Bloom and Canning (2003) reveals that
about five couple out of a hundred use coitus interruptus as their main method of birth
control. No side effect had been recorded except that some authors (e.g. Tsui and Burke, 2010)
stress that the method can cause some men to ejaculate prematurely; and women are slow to
achieve orgasm; therefore, pre-ejaculatory withdrawal by the male gives female less than
normal opportunity to have orgasm which causes congestion of blood on pelvic organs,
resulting in chronic pelvic pain. The absence of any substantial body of evidence to support
these claims makes it difficult to assess. Authors like Guttmacher (1969) believe that this
claim might have stemmed from dislike of withdrawal method than from scientific evidence.
The cause of failure in this technique is reluctance by the man to withdraw before ejaculation.
Another oldest method is the Douche. It consists of flushing out the vagina with water after
sexual intercourse in an effort to prevent pregnancy by removing semen. If the semen can be
washed out of the vagina before any sperm have a chance to enter the womb, pregnancy will
not occur. Literature reveals that the douche is relied on by about 6% of American couples
and also popular in many parts of Europe (Bell, 1992). It is however rated as poor in
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effectiveness. The other is Vaginal Sponge. This involves the plugging of the upper vagina
before intercourse by leaves or other barriers. This technique is said to have been in existence
before the birth of Christ (Tsui and Burke, 2010). Natural sea sponges have been used as
vaginal plugs for hundreds of years. Finely grained rubber bath sponges have been substituted
for them recently. A piece of sponge one-half to three-quarters of an inch thick and two to
three inches in diameter is cut out and a string tied to one edge. A spermicidal substance is
rubbed on the moistened sponge to create lather before insertion into the vagina (Bell, 1992).
Beyond the so-called traditional methods, Sanhueza (2007) notes that the late 1950s through
early 60s witnessed the emergence of modern contraceptive methods. In 1958, the first oral
contraceptive pill was tested and subsequently introduced in May 1960. Before then however,
a German physician, Ernest Graefenberg, had developed the intrauterine device (IUD) in
1929 (Sanhueza, 2007); but the knowledge of the existence of IUD was limited to a few
countries in Europe and America.
Other modern medical advances in family planning include surrogacy and sperm donor. In
surrogacy, a woman agrees to become pregnant and deliver a child for another couple or
person. There are two types of surrogacy: Traditional Surrogacy and Gestational Surrogacy.
In traditional surrogacy, a woman uses her own eggs and carries the child for her intended
parents. This type involves a genetic connection between the surrogate and the child. On the
other hand, a gestational surrogacy occurs when the intended mother‟s or a donor egg is
fertilized outside the body and then the embryos are transferred into the uterus. The woman
who carries the child is often referred to as a gestational carrier (Tsui and Burke, 2010). The
method is not popular in Africa, but records show that is a common practice in some parts of
India, and now a preferred destination to many North American women who patronize the
system (Bhagat, 2004).
In sperm donor, pregnancies are usually achieved by using donated sperm through artificial
insemination (either by intracervical insemination or intrauterine insemination) and less
commonly by Invitro fertilization (IVF), usually known in this context as Assisted
Reproductive Technology (ART). Insemination may also be achieved by a donor having
sexual intercourse with a woman for the sole purpose of initiating conception. This method is
known as natural insemination (Tsui et al, 2010). Agigian (2010) notes that there is a
generally a demand for sperm donors who have no genetic problems in their family, 20/20
eyesight, with excellent visual acuity and sometimes, a value on a certain height and age.
Current Use of Contraceptive Methods in Nigeria
Information on current use of contraceptive methods, from NDHS (2008), shows that the
overall contraceptive prevalence among all women in Nigeria is 15%. The use of any family
planning method increases with age from 7% among women age 15-19 to 20% among
women age 35-39, and then declines to 10% among women age 45-49. Most women
currently using contraception use a modern method (11%), while 5% are using traditional
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methods. The male condom is the most commonly used modern method (5%), followed by
the injectable and pills (2% for each); while IUD and female sterilization are the least used
modern methods (less than one percent). Among the traditional methods, the rhythm method
and withdrawal are the most commonly used (2% each) (NPC, 2009:69). Among currently
married women, existing literature shows that the most commonly used method in the
injectables (3%), followed by the male condom (2%), while the rhythm method is the most
commonly used traditional method (2%). Among sexually active unmarried women, the most
commonly used modern method is the male condom (35%), followed by the pill (4%); while
the rhythm method and folk methods are the most widely used traditional methods (7%). At
the zonal level, current use of any modern method among currently married women
according to zones in Nigeria includes: North Central (11%), South-East (4%), North-West
(3%), South-East (12%), South-South (16%) and South-West (21%). The data reveal a
generally low level of use of modern contraception in the North, especially North-East and
North West. This might be indicative of why these zones have the highest fertility rates in the
country. For instance, TFR in North-West is 7.3 children per woman; North-East is 7.2
children per woman. Compare this with South-West (4.5), South-South (4.7) and South-East
(4.8) (NPC, 2009).
Adolescents And Use Of Contraceptive Methods
While knowledge about family planning services is now more widespread in Nigeria, its
usage is very low among adolescent girls. Several studies in the past three-decades confirm
the low usage of contraception among adolescents in Nigerian societies. For instance, the
National Fertility Survey (1982/83) shows that only 3.5 percent of adolescents had used at
least one efficient method of contraception in early 1980s (NPB/WFS, 1984). Nearly a
decade later and after the official adoption of a national population policy to curtail child
bearing, the 1990 Nigerian Demographic and Health Survey (NDHS) reveals that only 4
percent of girls in the age group 15-19 had ever used a modern method of contraception (FOS,
1992). The 1999 NDHS also corroborates the low usage of contraception among adolescent
girls in Nigeria as reported in the first two national surveys. According to the reports of this
current national demographic survey, only 5.9 percent of adolescent girls in the age group
15-19 had ever used a modern method of contraception, while just only 3.2 percent of girls in
this age group are currently using any of the modern methods (NPC, 2000).
Study on sexual behaviour of post secondary school students in Enugu State, Nigeria shows
that all the respondents were sexually active, 51 percent of these students had never used a
contraceptive method, and 76 percent had not used a method the first time they had intercourse;
60 percent of those who had ever used a method had first done so between the ages of 20 and 24
years. Some of the students reported using rhythm and barrier methods, and some had fears
resulting from their misperceptions about contraception (Ozumba and Amaechi, 1992). In a
study among adolescent girls in rural Nigeria, 70 percent did not know about contraception and
only 10 percent could identify the monthly fertile period. Additionally, only 16 percent of
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adolescents in the sample were using contraceptives and more than 80 percent of those who
were pregnant had not intended to conceive (Okonofua, 1995).
In a study among in-school adolescents in Nigeria, respondents were asked to name method
of contraception they had ever used to avoid pregnancy; 15 percent of sexually active
students reported having used condoms, 2 percent abstinence, 2 percent the pill and less than
1 percent the injectable. The pattern of ever-use was roughly the same regardless of students‟
characteristics. However, it was discovered that the proportion of SSS2 students who had
used condoms was twice that among their SSS1 counterparts (19 percent versus 10 percent).
Similar differences in condom use were found between urban and rural students (17 percent
and 11 percent respectively), and between young men and young women (17 percent and 13
percent respectively) (Amazigo et al. 1997). The overall level of ever-use of a contraceptive
was higher among students who engaged in relationships with multiple sexual partners (20
percent) than among those who had one partner (14 percent). Ever-use of condoms also was
more prevalent among students who had multiple partners (19 percent) than among those
with one partner (12 percent).
The rate of contraceptive use in Nigeria is considerably lower in relation to some other
developing countries in other continents of the world. For example, data from Brazil show
that 94 percent of women of reproductive age living in Union in 1996 used some method of
family planning, and the vast majority of these women were using a modern contraceptive
(Martine, 1996). Evidence from the 1996 Brazil DHS suggests that contraceptive usage is
widespread among adolescents, with 72 percent of sexually experienced adolescent girls
reporting in 1996 that they had ever used contraceptive, a striking increase from the rate 10
years earlier (55 percent) among this age group. Among sexually experienced adolescents, the
pill is the most prevalent method (27 percent), followed by the condom (10 percent) (Gupta
and Leite, 1999). Despite these relatively high levels of contraceptive use among adolescents
in Brazil, an unmet demand for family planning services seems to persist. Data from the 1996
DHS in the country suggest that up to half of all births across the country are unplanned. In
the Northeast, 51 percent of adolescents reported their last birth was unplanned. This marks a
considerable increase from 40 percent in 1986, although birth spacing seems to be a greater
issue among the teenagers than family-size limitation (Gupta and Leite, 1999).
In Nigeria, the use of condoms increased with age. Specifically, 9 percent of 15 years old
adolescents who were sexually active did, and the proportion climbed to 27 percent among 19
years old respondents. Focus groups discussions and in-depth interviews about contraception
yielded information concerning alternative methods of birth control used by adolescent in
Nigeria. In interviews, adolescents mentioned commercial products such as liver salt,
broad-spectrum antibiotics and a mixture of gin and akawu (sodium sesquicarbonate, which
is used locally to tenderize breadfruit as contraceptive methods. Students described the gin
mixture as a drink taken after sexual intercourse to “wash everything away”. They also
mentioned that young women often take liver salts to terminate pregnancy (Amazigo et al
1997).
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Particularly in sub-Saharan Africa and South Asia, young married women often face cultural
expectations and social pressure to “prove” their childbearing abilities to their families and
their husband‟s families immediately after the marriage (Mensch et al. 1998; Pachauri, 1996).
As a result, few married adolescents use contraception. Conversely, sexually active young
unmarried women have strong motivation to avoid pregnancy, and so they tend to use
contraception (McCauley and Salter, 1995). In sub-Saharan Africa, married women between
age 15 to 19 years have particularly low levels of contraceptive use, at about 13 percent.
Among unmarried sexually active adolescents, however, the level of contraceptive use
reaches 39 percent. In the region some 20 percent of married women between age 20 to 24
years use contraception compared with 49 percent of sexually active unmarried women in the
same age group. Unmarried women most often use condoms, while married women most
often use oral contraceptives or traditional methods (Zlider et al. 2003).
In Latin America and Caribbean an average of 39 percent of married women ages 15 to 19
use contraception. By comparison, 60 percent of sexually active unmarried women of this age
group use contraception. Women ages 20 to 24 are even more likely to use contraception, at
52 percent of married women and 69 percent of sexually active unmarried women. Among
married women, pills and injectables are the most widely used; among unmarried women,
pills, condom, and traditional methods are predominant (Zlider et al. 2003). In Eastern
Europe and Central Asia nearly 30 percent of married adolescents use family planning,
mostly traditional methods. Eight (8) of every ten (10) unmarried sexually active adolescents
use a family planning method; half use condoms. Among married women ages 20 to 24,
IUDs and traditional methods are most used, while unmarried women in this age group rely
on condoms as well as traditional methods (Zlider et al. 2003). The above comparable survey
data show that contraceptive use prevalence rate is very low in sub-Saharan Africa than any
other continent or region of the world. Consequently unwanted pregnancies and childbirths
are very high among adolescent girls in the region.
Data on when adolescents normally start using contraceptive methods reveal the major reason
why unwanted pregnancies are rampant among adolescents all over the world. Studies in
U.S.A and other countries have found that women delay about one year on the average
between starting sexual activity and first using modern contraceptives (AGI, 1994; CR, 1995;
Kau et al. 1989). Thus premarital sexual activity often results in unintended pregnancy. In
Mexico nearly two-thirds of women ages 18-19 with premarital sexual experience reported
that they had been pregnant at least once (Morris, 1992). In a Zimbabwe study, 46 percent of
premarital sexually active women ages 11 to 19 had been pregnant (Boohene et al. 1991).
Many unplanned pregnancies occur within a year after first sexual intercourse (CR, 1995;
Zabin et al. 1979). For example, of 200 16-year olds delivering at Harare Maternity Hospital,
Zimbabwe, over one-half had become pregnant within just three months of starting sexual
activity (Mahomed and Masona, 1991).
The most common reason that both young men and women give for not using contraception
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is that they did not expect to have intercourse. The second most common reason is that they
did not know about contraception (Kiragu, 1991; Morris, 1992 McCauley and Salter, 1995).
Young people often know little or have incorrect information about fertility and contraception.
Young men are more likely than women to mention lack of knowledge and are much more
likely to say that it is their partner‟s responsibility to avoid pregnancy (Barker and Rich, 1992;
Berganza et al. 1989; Morris, 1992). Even when young people can name contraceptives, they
often do not know where to get them or how to use them (Agyei and Epema, 1992). It has
also been documented that when many young adolescents know about contraceptives, few
use them because it is more difficult for adolescents to obtain contraceptives than it is for
older, married couples. Often times, adolescents do not know where to go or what to expect.
Many are unable to pay for services or for transportation to clinics (McCauley and Salter,
1995). Often, laws prohibit or limit providing contraceptives, services, or even information to
young people (Daly et al. 1994; Paxman and Zuckerman, 1987). It has also been noted that
even where access is not restricted by law, some family planning services have policies or
prejudices against serving unmarried people. Rude or judgmental staff deter some young
people from seeking contraceptives. For example, in a South African study young field
workers posing as clients reported that personnel at some clinics resisted their requests for
condoms and often provided no instructions on condom use (Abdoel-Karim et al. 1992).
Other contextual factors affecting contraceptive practices among adolescents are the extent of
communication between partners, attitudes about social and sexual roles, and the taboo nature
of sexual activity (Billy, et al. 1994). For example, young unmarried people may be even less
likely to discuss contraception since in many cultures; sex-related issues are rarely discussed,
even between spouses (McCauley and Salter, 1995). Many adolescents see contraception as
something only for married adults who want to space their children (Schensul et al. 1993).
Some men and some women themselves may disapprove of contraception because they
believe it encourages women to be promiscuous (Berganza et al. 1989).
Contraceptive methods are not often used at the first intercourse as stated earlier mainly
because of the belief that a girl cannot become pregnant the first time she has sex. For
instance, Makinwa-Adebusoye in 1991 reported that 30 percent of male and female
adolescents sampled in five major urban centres in Nigeria did not realize that the first
intercourse could result in pregnancy, thus they do not use contraceptive methods to prevent
unwanted pregnancy (Makinwa-Adebusoye, 1991). When adolescents use contraceptives at
all, they often rely on traditional methods, which are less effective than the modern methods
(FOS, 1992; NPC 2000). The most poignant issue about the high prevalence rate of sexual
networking among the Nigerian adolescents is the low use of modern contraception most
especially, the condom. Nationwide, the 1990 NDHS reports 5 percent of adolescents
between 15-19 years old females as currently using any method of contraception; two-thirds
of this proportion use traditional methods including rhythm or withdrawal which are
ineffective. One percent use oral contraceptives, less than one percent use condoms,
foaming tablets or IUDs (FOS, 1992). There is no significant difference in the levels of use of
contraceptives in Nigeria 10 years after 1990 NDHS study except the relative increase in the
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use of condoms from 0.4 in 1990 NDHS to 3.5 in 1999 NDHS reports (NPC, 2000). In
general, only 9.2 percent of adolescent women aged 15-19 were currently using contraceptive
during the 1999 NDHS data-gathering period. Five percent of them were using the
ineffective traditional methods (NPC, 2000). In addition, 2003 NDHS report shows general
low rate of modern contraceptive methods among women in Nigeria. Specifically, the report
reveals that 3.4 percent of all women sampled are using condom, 2.0 percent are using pills,
while 1.6 percent are using injectables (NPC, 2004).
The reasons for the low contraceptives prevalence among adolescents in Nigeria may be due
to lack of access to contraceptives or lack of adequate information, since many adolescents
often know little or have incorrect information about contraceptives. A study of female
students in Enugu, for example, shows that 61 percent of the respondents believed that
contraceptives cause infertility (Ozumba and Amaechi, 1992). In a study of oral
contraceptive use among female students, 92 percent were aware of the method, yet only 17.5
percent had ever used it (Adinma and Okeke, 1993). This implies that there is a wide gap
between knowledge and practice of family planning methods among adolescents in Nigeria.
Another crucial effect of high sexual networking and low contraceptives use, particularly the
use of condom, is a high possibility of contracting Sexually Transmitted Diseases (STDs)
including infection with Human Immunodeficiency Virus (HIV), which results in AIDS. This
means that the high rate of unprotected sexual networking among adolescents in Nigeria
increase their risk of contracting STDs/HIV/AIDS. Since most adolescents are active sexually
but lack adequate knowledge of the risks involved, they constitute the group that is highly
vulnerable to HIV/AIDS pandemic. It should be noted also that STDs including HIV are
more rampant in the developing nations including Nigeria due to the lack of education. Most
of the adolescents do not receive family life education and hence, they are not aware of
precautionary measures to adopt in order to prevent and protect themselves in sexual
relationship/intercourse. Even in the event of getting in contact with any of these diseases,
most adolescents do not know their symptoms, what to do next, or where else to go. Instead,
they prefer to conceal it until it almost gets out of hand, or ask for advice from their peers
who are just as ignorant as them. For instance, Focus Group Discussions in Nigeria revealed
that some young people consider Cancer, Asthma, Smallpox, Polio, and Diabetes to be STDs.
Some believe that STDs are transmitted by eating together and sharing of cooking utensils
(Barker and Rich, 1992). In summary, empirical data from different parts of Nigeria show
that modern contraceptive prevalence rate is grossly low across the country, coupled with
high sexual networking identified in the country; unwanted pregnancies and childbearing are
very high in the country. The next section of the article delves into the methodology adopted
in the study.
Research Methods
Research Design
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The research design adopted in the study is a non-experimental research design. In this design,
a cross-sectional survey method was used to generate primary data in the study. The reason
for this was to generate quantitative information concerning the topic under study. Thus the
quantitative was geared toward identifying the mechanism by which age at first birth
determines the knowledge, ever use and current use of family planning methods in Yoruba
society of Nigeria.
Yoruba Society: Study Location
The Yoruba, largely located in the Tropical Rain Forest and Guinea Savanna Zones of coastal
West Africa, are concentrated in Southwestern Nigeria otherwise known as Yoruba land.
Presently, there six (6) Yoruba speaking States in the Federal Republic of Nigeria. These are
Oyo, Ogun, Osun, Ekiti, Lagos, and Ondo. It is imperative to note that the Yoruba can also be
seen in Kwara and Kogi State with other ethnic groups. The major subgroups of Yoruba
include the Egba, Egbado, Ekiti, Igbomina, Ijebu, Ijesa, Kabba, Ondo, Owo, and Oyo. All
these people speak a common language known as Yoruba. Demographically, about 30-35
million people speak Yoruba language making Yoruba to be one of the largest ethnic groups
in Nigeria, constituting about 20% of the poplation (Oyefara, 2011). It is imperative to note
that the subgroups of Yoruba mentioned above speak distinct dialects of Yoruba language. In
addition, the Yoruba have several towns that are distinct from one another in terms of their
migration origin, ancestral lineage and clan, and kinship institution. Each of these towns
creates its own meaning in the wider Yoruba cosmos through festivals that are linked to
myths, rituals, and religions.
Study population, sample size and sampling method
Out of the six (6) Yoruba speaking States in Nigeria, Osun State was randomly chosen for the
study using simple random sampling method. The State was created on August 27, 1991.
Osun State is composed of thirty (30) Local Government Areas (LGAs) during the time of
survey. Two (2) LGAs out of the 30 LGAs in the State were randomly selected for the study
with the aid of stratified random sampling system of sampling method. The procedures
adopted here involved the stratification of the 30 LGAs into two main strata on the basis of
rural/urban-characteristics of the Local Government Areas in the State. One LGA each was
randomly selected from each stratum of the two strata. The two (2) LGAs selected are
Osogbo LGA with headquarter in Osogbo the State capital of Osun State and Ola-Oluwa
LGA with headquarter in Bode-Osi. Osogbo LGA represents the urban centres in the State.
The 2006 Population Census figures show that the total population of this LGA was 115,507
in 2006 and its current estimated population is about 188,197 in 2012. Ola-Oluwa is purely a
rural LGA. The local government is made up of one hundred and fifteen (115) rural
communities, out of which 9 are major communities (NPC, 1998). Ola-Oluwa LGA had a
total population of 76,227 people in 2006 and the current estimated total population of the
LGA is about 92,251 in 2012. The LGA represents the rural communities in Osun State for
the study.
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The study population of the survey are women within the child bearing age (15-49 years)
with at least a live birth as at the time of survey. A multistage random sampling technique was
utilized to select the respondents in the Survey. The non-existence of a sampling frame (i.e.
the list of all women within the childbearing age that posses the three features stated above in
Osun State) necessitated the adoption of a multi-stage random sampling technique in the
survey exercise. SPSS software package (version 10.0) was used to survey data after returned
questionnaires had been thoroughly screed and edited to eliminate all possible errors.
Percentages, means, Pearson Chi-squares and contingency coefficients were the statistical
methods used in the interpretation of quantitative data.
Findings
Age At First Childbirth And Knowledge Of Family Planning Methods
The 1990 Nigeria Demographic and Health Survey (NDHS) provides us with the first
detailed national and comparable data on the knowledge and prevalence of family planning
methods in the country. The NDHS data show that knowledge of family planning methods
witnessed a remarkable improvement between 1981 and 1990 because about 46 percent of all
women aged 15-49 at the time of the study in 1990 knew at least one method of family
planning, with about 44 percent identifying modern methods of which the pill, injection,
condom, IUCD and female sterilization were most commonly known (FOS, 1992).
The 2003 NDHS results also confirmed the relative improvement in knowledge of family
planning methods in Nigeria. Knowledge of these family planning methods experienced more
than 100 percent increase between 1981 and 1990. In addition, the knowledge of family
planning methods increased from 45.7 percent in 1990 to 65.4 percent in 1999 and 78.5
percent in 2003 among all women interviewed in the country (FOS, 1992; NPC, 2000; 2004).
In fact, the 2003 NDHS report shows 76.7 percent of the respondents have knowledge of any
modern family planning method (NPC, 2004:62). This recent improvement in knowledge of
modern planning methods may be related, at least in part, to the National Population Policy
which was first launched in Nigeria in 1985 (FRN, 1988). The policy has tended to give
legitimacy to family planning through widespread discussion and communication in the
media, hospitals and clinics and even in civic activities (Isiugo-Abanihe, 1996:113).
Table 1 shows that older mothers had relatively better knowledge about methods of family
planning methods than adolescent mothers in Osun State, Nigeria. Specifically, 94.0 percent
of older mothers as against 83.2 percent among adolescent mothers had knowledge about
methods of family planning in the study area. Those respondents that have knowledge about
family planning methods were asked to mention the one they know very well. Using the first
method mentioned by the respondent, responses to this question can be seen on Table 1. Data
on the table show relatively poor knowledge among adolescent mothers in relation to older
mothers in all methods mentioned except knowledge on condom and finger ring (a traditional
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method) which many adolescent mothers mentioned more than older mothers.
An analysis of the relationship between age at first childbirth and knowledge of family
planning method shows that age at first childbirth has effects on knowledge of family
planning in Osun State, Nigeria. This relationship was significant at 0.01 level of significance.
The degree of the relationship between the two variables as revealed by Contingency
Coefficient was 0.164. This means that about 16.0 percent of differences in knowledge of
family planning methods can be explained by age at first childbirth. The proportion of
adolescent mothers who could mention a method of family planning was considerably lower
compared to older mothers for all methods mentioned except in condom and fingers rings (a
traditional method) where adolescent mothers showed higher knowledge than older mothers.
Specifically, older mothers have better knowledge of most of the effective methods of family
planning such as pills, IUCD, and injection, but adolescent mothers‟ knowledge of these three
methods is very low.
Table 1: Percentage distribution of respondents showing the relationship between age at first
birth and knowledge of family planning methods
Knowledge of family planning
methods
Adolescent
mothers
Older
mothers
Total
No
%
No
%
No
%
Do you know any of the family
methods?
Yes
No
Total
X2 = 28.590
d.f. = 1, C = 0.164, P = 0.000
416
84
500
83.2
16.8
100.0
470
30
500
94.0
6.0
100.0
886
114
1000
88.6
11.4
100.0
Mention the one you know (first
method mentioned)
Pills
IUCD/Copper T
Injectable
Condom
Abstinence
Safe Period/Rhythm
Withdrawal
Finger Ring
Waist Band
No Knowledge
Total
115
29
26
179
2
6
3
53
3
84
500
23.0
5.8
5.2
35.8
0.4
1.2
0.6
10.6
0.6
16.8
100.0
199
51
32
114
3
9
16
40
6
30
39.8
10.2
6.4
22.8
0.6
1.8
3.2
8.0
1.2
6.0
100.0
314
80
58
293
5
15
19
93
9
114
1000
31.4
8.0
5.8
29.3
0. 5
1.5
1.9
9.3
0. 9
11.4
100.0
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500
Age At First Childbirth And Ever Use Of Family Planning Methods
Table 2 reveals that out of all the methods of family planning methods mentioned by the
respondents in Table 1, a much smaller proportion of adolescent mothers compared with
older mothers reported ever used of any of the family planning methods mentioned, except
finger ring (a traditional method). The Low levels of modern contraceptive use among
adolescent mothers, despite their widespread knowledge about these methods, may reflect
lack of interest in the use of family planning methods among adolescents in the study area,
especially immediately after commencement of childbearing. The result of Chi-Square
analysis on Table 2 shows that age at first childbirth was a significant factor that influences
the use of contraceptive methods in Osun State, Nigeria. According to Table 2 below, about
70.6 percent of older mothers had ever used a method of contraception, while only 33.4
percent of adolescent mothers claimed to have ever used at least a method of contraception in
their lifetime. This relationship between age at first childbirth and ever use of contraception
was significant at 0.01 level of significance and the degree of the relationship was 0.348
which is very high. Data on specific methods of family planning ever used by adolescent
mothers on Table 2 showed that condom had the highest frequency of 55 respondents
constituting 11.0 percent of adolescent mothers.
Table 2: Percentage distribution of respondents showing the relationship between age at first
birth and ever use of family planning methods
Ever use any of the family planning
methods
Adolescent
mothers
Older
mothers
Total
No
%
No
%
No
%
Have you ever used any of the family
methods?
Yes
No
Total
X2 = 138.606
d.f. = 1, C = 0.348, P = 0.000
167
333
500
33.4
66.6
100.0
353
147
500
70.6
29.4
100.0
520
480
1000
52.0
48.0
100.0
Mention the one you commonly use
Pills
IUCD/Copper T
Injectable
Condom
28
15
10
55
5.6
3.0
2.0
11.0
94
50
25
112
18.8
10.0
5.0
22.4
122
65
35
167
12.2
6.5
3.5
16.7
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Abstinence
Safe Period/Rhythm
Withdrawal
Finger Ring
Waist Band
Never use
Total
2
1
3
52
1
333
500
0.4
0.2
0.6
10.4
0.2
66.6
100.0
3
8
16
40
5
147
500
0.6
1.6
3.2
8.0
1.0
29.4
100.0
5
9
19
92
6
480
1000
0.5
0.9
1.9
9.2
0.6
48.0
100.0
Age At First Childbirth And Current Use Of Family Planning Methods
Information on current use of contraceptive methods can be seen on Table 3. The data on the
table show that adolescent mothers consistently had low rates of current use in each of the
contraceptive methods mentioned by the respondents during the survey. In particular, the rate
of condom use among adolescent mothers (8.0 percent) was very low in comparison with its
current use (21.2 percent) among older mothers in the State. Furthermore, 4.0 percent of
adolescent mothers compared with 9.4 percent of older mothers were currently using oral
pills, while 1.2 percent of adolescent mothers in relation to 4.0 older mothers stated that they
were currently using injectables. The current use of IUCD/Copper T was also higher among
older mothers in comparison with adolescent mother. Specifically, 7.2 percent of older
mothers compared with 2.2 percent among adolescent were currently had ever used IUCD.
Table 3: Percentage distribution of respondents showing the relationship between age at first
birth and current use of family planning methods.
Current use of any of the family
planning methods
Adolescent
mothers
Older
mothers
Total
No
%
No
%
No
%
Are you currently using a method of
family methods?
Yes
No
Total
X2 = 85.983
d.f. = 1, C = 0.287, P = 0.000
131
369
500
26.2
73.8
100.0
275
225
500
55.0
45.0
100.0
406
594
1000
40.6
59.4
100.0
Mention the one you are currently
using
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Pills
IUCD/Copper T
Injectable
Condom
Abstinence
Safe Period/Rhythm
Withdrawal
Finger Ring
Waist Band
Not currently using a method
Total
20
11
6
40
1
1
2
49
1
369
500
4.0
2.2
1.2
8.0
0.2
0.2
0.4
9.8
0.2
73.8
100.0
47
36
20
106
-
7
16
38
5
225
500
9.4
7.2
4.0
21.2
-
1.4
3.2
7.6
1.0
45.0
100.0
67
47
26
146
1
8
18
87
6
594
1000
6.7
4.7
2.6
14.6
0.1
0.8
1.8
8.7
0.6
59.4
100.0
Age At First Childbirth And Decision To Use Family Planning Method
Women empowerment which has the features of economic and financial independence with
educational advancement has been identified to play a significant role in a woman‟s decision
to adopt a method of family planning. Adolescent mothers are usually financially dependent
on their husbands and parents; consequently many of them may not be able to solely adopt a
method of contraception (Oyefara, 2011). As can be seen in Table 4, among small proportion
of adolescent mothers that were currently using at least a method of contraception 13.0
percent of them rely on instruction from their husbands/partners as against just 4.4 percent
among older mothers. In addition the table shows that many of older mothers enjoyed more
support from their husbands (72.0 percent) compared to 63.3 percent among adolescent
mothers when it comes to decision on whether to use a method of family planning method or
not.
Table 4: Percentage distribution of respondents showing the relationship between age at first
birth and who decides on the use of method of family planning and attitude toward family
planning method
Variable
Adolescent
mothers
Older
mothers
Total
No
%
No
%
No
%
Who decides on the method of family
planning currently using?
Woman alone
Husband/Partner alone
31
17
23.7
13.0
65
12
23.6
4.4
96
29
23.6
7.1
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Both
Total
X2 = 8.551
d.f. =2, C = 0.094, P = 0.032
83
131
63.3
100.0
198
275
72.0
100.0
281
406
69.2
100.0
Do you approve the use of modern
methods of family planning?
Yes
No
Total
X2 = 11.538
d.f. =1, C = 0.107, P = 0.001
388
112
500
77.6
22.4
100.0
436
64
500
87.2
12.8
100.0
824
176
1000
82.4
17.6
100.0
Do you intend to use a modern method
of family planning to prevent
pregnancy in the future?
Yes
No
Total
X2 = 12.511
d.f. =1, C = 0.112, P = 0.000
383
117
500
76.6
23.4
100.0
435
65
500
87.0
13.0
100.0
818
182
1000
81.1
18.2
100.0
Age At First Childbirth And Attitude Towards Modern Family Planning Methods
Coale (1973) argued that one of the three pre-conditions for a substantial decline of fertility
within marriage is that fertility must be within the calculus of conscious choice. This means
that potential parents must consider it an acceptable mode of thought and form of behavior to
balance advantages and disadvantages before deciding to have another child. This conscious
choice is an important factor that determines the attitude of an individual toward adoption of
a family planning method. Table 4 shows that adolescent mothers attitude towards family
planning although relatively good was lower in comparison with those of older mothers. The
data show that 77.6 percent of adolescent mothers compared with 87.2 percent among older
mothers approved of the use of modern methods of family planning. As expected, high
proportion of adolescent mothers (76.6 percent), although relatively lower than the proportion
of older mothers (87.0 percent) stated that they are willing to use a modern method of family
planning to prevent pregnancy at anytime in the future.
Discussion Of Findings And Recommendations
The findings of this study had revealed the nexus between age at first birth and five variables
in relation to family planning methods in the study location. These findings will be identified
and discussed one after the other in the section. This study reveals that older mothers had
relatively better knowledge about methods of family planning than adolescent mothers in
Osun State, Nigeria. Specifically, 94.0 percent of older mothers as against 83.2 percent
among adolescent mothers had knowledge about methods of family planning in the study
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area. The 2003 and 2008 NDHS reports also reveals better knowledge of pills, male condom
and injectables among all women sampled in the study in Nigeria. Specifically, the 2003
report shows 60.4 percent knowledge of pills, 59.2 percent knowledge of male condom and
57.1 percent of knowledge of injectables among all women sampled (NPC, 2004:62; NPC,
2009: 68). Information on age of respondents and knowledge of modern contraceptive
methods in Nigeria show low level of knowledge of family planning methods among
adolescent women in ages 15-19 years compared with older mothers. Specifically, the
knowledge of modern contraceptive methods was 61.6 percent among adolescents of ages
15-19 years compared with 83.4 percent among older women in age group 25-29 years in
2003 (NPC, 2004:64).
The study reveals that out of all the methods of family planning methods mentioned by the
respondents, a much smaller proportion of adolescent mothers compared with older mothers
reported ever used of any of the methods mentioned. Low levels of modern contraceptive use
among adolescent mothers, despite their relatively high knowledge about these methods, may
reflect lack of interest in the use of family planning methods among adolescents in the study
area, especially immediately after commencement of childbearing. Data on specific methods
of family planning ever used by adolescent mothers show that condom had the highest
frequency of 55 respondents constituting 11.0 percent of adolescent mothers. This finding is
similar to 2003 and 2008 NDHS reports on ever use of contraceptive methods by all women
in Nigeria. According to these national reports, male condom has the highest frequency of
10.1 prevalence rate compared with 7.7 percent for pills, 5.5 percent for injectables, 1.6
percent for IUCD and 0.1 percent for implant (NPC, 2004:65; NPC, 2009).
It was discovered in the study that adolescent mothers consistently had low level of use in
each of the contraceptive methods mentioned by the respondents during the survey. The low
rate of contraceptive use among adolescent mothers suggests two important things. One, the
high fertility rate observed among adolescent mothers may be a reflection of the low rate of
adoption of contraception among this group of women in relation to older mothers in the
State. Two, adolescent mothers in the study area may be at higher risk of contracting STIs
including HIV relative to older mothers in the study area. This is because; the rate of condom
use among adolescent mothers (8.0 percent) is very low in comparison with its use (21.2
percent) among older mothers in the State. Furthermore, many of the adolescent mothers
married older, more sexually experienced and polygynous men within the community
(Oyefara, 2011). This condition may predispose adolescent mothers to STIs including HIV
more than older mothers in Osun State, Nigeria. Data on current use of contraceptive methods
in 2008 NDHS are similar to the findings of this study. In particular, 2008 NDHS report
shows general low rate of modern contraceptive methods among all women sampled in the
study. For example, 3.4 percent of all women sampled are using condom, 2.0 percent are
using pills, while 1.6 percent are using injectables (NPC, 2008:67).
The study further reveals that among small proportion of adolescent mothers that were
currently using at least a method of contraception, 13.0 percent of them rely on instruction
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from their husbands/partners before they can adopt any method. In addition the study shows
that many of older mothers enjoyed more support from their husbands (72.0 percent)
compared to 63.3 percent among adolescent mothers when it comes to decision on whether to
use a method of family planning. This information suggests that interpersonal communication
between husbands and wives on the use of contraception was relatively higher among older
mothers compared with adolescent mothers in the study area. The reasons for relatively poor
communication between adolescent mothers and their spouses may be because many of them
married older men as their husbands/partners and these older men were more likely to be
polygynists with more than one wife who may not have opportunity of having deep
discussion with any of their wives (since a polygynist must share his time among his wives)
(Oyefara, 2011). It should be noted that inter-spousal communication and agreement among
spouses is one of the factors that can bring about rapid fertility transition to any given country
or community.
The study shows that adolescent mothers attitude towards family planning although relatively
good was lower in comparison with those of older mothers. The data in the findings show
that 77.6 percent of adolescent mothers compared with 87.2 percent among older mothers
approved of the use of modern methods of family planning. As expected, high proportion of
adolescent mothers (76.6 percent), although relatively lower than the proportion of older
mothers (87.0 percent) stated that they are willing to use a modern method of family planning
to prevent pregnancy at anytime in the future. As stated earlier, this information suggests that
many of the adolescent mothers see the adoption of modern contraceptives as advantageous;
consequently, their attitude and plan to use the modern contraceptive methods was very high,
although lower than among older mothers. Thus the fertility transition that has just started in
Yoruba society, Nigeria (NPB/WFS, 1984; FOS, 1992; NPC, 2000; 2004) may be quickly
completed if both adolescent and older mothers in the region can be motivated, encouraged
and made to see the benefits of the use of modern contraception in conjugal union.
In summary, findings in this study show that knowledge of contraceptive methods is
gradually increasing among women in childbearing age in Osun State, Nigeria, but the
proportion of women using modern or efficient methods of family planning is very low in the
State. In addition, it is essential to note that the knowledge, ever used and current use of
contraceptive methods is generally low among adolescent mothers compared with older
mothers in the study location. Consequently, State governments, local and international
non-state actors working on safe motherhood in Yoruba society need to reach adolescent
mothers in-and-outside health institutions through community health workers with
contraceptive methods messages and services in order to improve maternal health and reduce
high population growth rate in Yoruba society.
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Author’s Profile
Dr. John Lekan Oyefara has a B.Sc in Demography and Social Statistics from Obafemi
Awolowo University, Ile-Ife, Nigeria. In addition, he obtained M.Sc and PhD in Sociology
from the University of Ibadan, Nigeria. He specializes in demography, population studies,
social research methods and statistics. His areas of research include fertility, mortality,
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migration, nuptiality, family planning, gender studies, and public and reproductive/family
health including HIV/AIDS. He has worked for over fifteen years in the development sector
with local and international organizations in Nigeria. He is currently a senior lecturer in the
Department of Sociology, Faculty of Social Sciences, University of Lagos, Nigeria.
