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Knowledge, attitude and practice of natural family planning methods in a population with poor utilisation of modern contraceptives
Abstract
Sub-Saharan Africa has one of the highest fertility rates in the world, which is further promoted by the low utilisation of modern contraceptive methods. Yet, many communities claim to have traditional methods of family planning that pre-date the introduction of modern contraceptives, implying that contraception is a culturally acceptable norm. It was therefore postulated that the study population would have a high level of awareness and practice of natural methods of family planning. We aimed to obtain an insight into the extent and correctness of knowledge about natural family planning methods, and its practice as a guide to the general acceptance of contraception as a concept. Pre-tested structured questionnaires were administered to women of childbearing age in households properly numbered for primary healthcare activities. The level of awareness of natural family planning methods was significantly less than awareness for modern methods of contraception. The awareness rate for rhythm method, lactational amenorrhoea method and coitus interruptus was 50.7%, 42.1% and 36.1%, respectively. For all three national family planning methods, there is a steady decline between awareness, correct description of method and utilisation, a difference that was statistically significant in all cases. The sociodemographic factors of the responders had varying influence on utilisation of all three natural family planning methods studied. Rural dwellers practised the lactational amenorrhoea method significantly more often than urban dwellers. Significantly more Muslims than Christians with four children or more practised coitus interruptus or the rhythm method, while the use of lactational amenorrhoea method was significantly increased with the number of living children in both religious groups. There is a relatively low level of awareness of natural family planning methods in the study population, poor utilisation and wrong use of methods. Therefore, improving the correct level of information on natural family planning methods is likely to improve the use of both natural family planning and modern contraceptive methods.
... The hormone-based methods include oral contraceptive pills, progestin only pills, emergency pills, injectable contraceptives, and subdermal implants and intrauterine contraception devices (IUCDs) as long acting reversible contraceptive devices (LARCs) [6,7]. The traditional contraception methods include behavioural practices such as periodic abstinence method, calendar method, withdrawal or pull out method (coitus interruptus), and other traditional methods such as tinctures and herbs [8]. ...
... The social and demographic characteristics of the participants are presented in Table 1. The hormone-based modern contraception methods include combined oral contraceptive hormonal pills for continued daily use, emergency contraceptive pill (morning after pill) or ulipristal (once only), long acting reversible contraceptives (LARCs) including intrauterine contraceptive devices (IUCDs), hormonal injectables, and subdermal implants [8]. The barrier methods include male and female condoms. ...
... The surgical methods include non-reversible, permanent modern contraceptive methods including female and male sterilisation. The traditional contraception methods include periodic abstinence method, calendar method, withdrawal or pull out method and other traditional methods such as tinctures and herbs [8]. There are missing values of 375 women in the variable "person to decide for respondent's health care" in the dataset. ...
(1) Background: Women using unreliable traditional contraception need to be included in the proportion of women having an ‘unmet need for modern contraception’ instead of the current classification which presumes they have a ‘met need’. (2) Methods: Mix methods research design comprising initial quantitative analyses utilizing data from the nationally representative 2014 Cambodian Demographic and Health Survey (CDHS) for 4823 Cambodian, sexually active females aged 15–29 years. Then a qualitative phase explored knowledge about the menstrual cycle and misconceptions about modern contraception with 30 females aged 15–29 years in urban Cambodia using semi-structured interviews, transcribed verbatim with quality checks. Purposive and snowball sampling strategies were used until data saturation was reached. Inductive thematic data analysis was conducted; (3) Results: Unmet need for modern contraception increased to 25.4% when traditional contraception users were included. The qualitative themes show women have a lack of information about the menstrual cycle and misconceptions about modern contraception which contributed to increased use of traditional contraception; (4) Conclusion: Major drivers of increased unmet need for modern contraception include lack of literacy, misconceptions and low autonomy to choose modern contraception. Cambodia needs to endorse a policy shift to implement targeted, countrywide sexual and reproductive health literacy and family planning services.
... Studies indicate a need for the knowledge about the various methods of natural family planning as it is of paramount importance due to its influence on the attitude, acceptance, and utilization of NFP methods. [7,8] As studies reveal the level of knowledge is low, so negative attitudes towards NFP methods are to be expected. [9] This hereby indicates that a positive attitude and high motivation in relation to the use of NFP methods facilitates acceptance. ...
... [9] Studies reveal that knowledge of NFP methods and attitude towards NFP methods affects its utilization. [7,11] Research has shown that in Nigeria, there is a reduction in the awareness of NFP methods, its correct description, and its utilization. [7] This study by researchers from the departments of Obstetrics and Gynaecology, University of Maiduguri, Nigeria revealed that there is a low level of knowledge, wrong use and poor utilization of natural family planning methods in the population under study. ...
... [7,11] Research has shown that in Nigeria, there is a reduction in the awareness of NFP methods, its correct description, and its utilization. [7] This study by researchers from the departments of Obstetrics and Gynaecology, University of Maiduguri, Nigeria revealed that there is a low level of knowledge, wrong use and poor utilization of natural family planning methods in the population under study. [7] Therefore, in order to improve the utilization of NFP methods, it is paramount to improve the level of knowledge of NFP methods. ...
... 1 Besides the quality of health services, the main objective of family planning required for the continuity of population planning is to regulate general women's health, to improve maternal and fetal health levels, to inform people correctly, providing counseling to prevent unwanted pregnancy. [1][2][3] With this objective, the priority is to ensure that women have a safe pregnancy. Giving birth at intervals of less than two years, being under the age of 18 and over 35, giving birth four times and above causes physical and psychological exhaustion in the mother and an increase in maternal and infant mortality. ...
... While some studies claimed that modern methods are used at higher educational level traditional methods are preferred at the low educational levels. [1][2][3][4][5][6][7][8][9][10] We think that the reason for the use of IUD in our region at all educational levels is due to our population's desire to have fewer children and to prefer long-acting contraceptive methods. Additionally, the easy access to health institutions and the successful implementation of the IUD application by health personnel can be considered as a reason for preference. ...
... Two of these studies included respondents who have never had a child together with those who have. 47 50 The first such study, 47 assessing married adolescents from Bangladesh, found that 13.2% of adolescents who were not using contraceptives at the time of survey cited postpartum amenorrhoea as a reason for non-use. Audu and colleagues found that in their sample which included women with and without children in Nigeria, the percentage reporting ever-use of LAM was lowest among adolescents (5.0% among those 15-19 years), increasing to 10.0% among those 20-24 years and highest among women 35-39 years old (p value of differences<0.001). ...
... Audu and colleagues found that in their sample which included women with and without children in Nigeria, the percentage reporting ever-use of LAM was lowest among adolescents (5.0% among those 15-19 years), increasing to 10.0% among those 20-24 years and highest among women 35-39 years old (p value of differences<0.001). 50 One potential reason for the low percentage among the adolescent age group is that not all respondents in this sample have ever had children and therefore had the opportunity to have ever used LAM. ...
Introduction:
Fertility levels among adolescents remain high in many settings. The objective of this paper was to review the available literature about postpartum and lactational amenorrhoea among adolescents in low-income and middle-income countries (LMICs).
Methods:
We searched Medline, Embase, Global Health and CINAHL Plus databases using terms capturing adolescence and lactational or postpartum amenorrhoea. Inclusion criteria included publication date since 1990, data from LMICs, and topic related to lactational amenorrhoea as a postpartum family planning method or as an effect of (exclusive) breast feeding among adolescents. Thematic analysis and narrative synthesis were applied to summarise and interpret the findings.
Results:
We screened 982 titles and abstracts, reviewed 75 full-text articles and included nine. Eight studies assessed data from a single country (three from India, two from Bangladesh, two from Turkey, one from Nigeria). One study using Demographic and Health Survey data included 37 different LMICs. The five studies measuring duration of postpartum or lactational amenorrhoea reported a wide range of durations across the contexts examined. Four studies (from Bangladesh, Nigeria and Turkey) examined outcomes related to the use of lactational amenorrhoea as a family planning method among adolescents. We did not find any studies assessing adolescents' knowledge of lactational amenorrhoea as a postpartum family planning method. Likewise, little is known about the effectiveness of lactational amenorrhoea method among adolescents using sufficiently large samples and follow-up time.
Conclusion:
The available evidence on lactational amenorrhoea among adolescents in LMICs is scarce. Given the potential contribution of lactational amenorrhoea to prevention of short interpregnancy intervals among adolescents and young women, there is a need for a better understanding of the duration of lactational amenorrhoea, and the knowledge and effective use of lactational amenorrhoea method for family planning among adolescents in a wider range of LMIC settings.
... Among these proposed fertile window, method from 9 th to 19 th days is considered as standard days method [4] and it is 95 percent effective when used correctly [8]. There was lack of correct knowledge of fertile window period of a menstrual cycle among women [6,9]. The percent of users with correct knowledge of the fertile period varies from 8% to 91% [10]. ...
... Also this logic may be true for women (31.5%) who think that first 10 to 15 days of a menstrual cycle are fertile period. Sub-Saharan African women had low level of awareness of natural family planning methods and hence, wrong use of methods [9]. Wrong practice of method was also found in the present study. ...
The use of contraceptive method to avoid pregnancy is a multifaceted phenomenon. Worldwide, 20 percent of married women of reproductive age are currently using periodic abstinence. To assess the knowledge and practice of periodic abstinence among currently married pregnant women, data were collected from the pregnant women attending the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India. One thousand three hundred and thirty one (1331) currently married pregnant women were interviewed face-to-face. Approximately 29.3 percent of women were aware of the abstinence method, 11.5 percent women had history of using it. In-depth finding shows that 84.9 percent women did not have correct knowledge of fertile window of a menstrual cycle. Counseling about the correct fertile window of a menstrual cycle may increase the effectiveness of methods and hence reduce the incidence of unwanted pregnancies.
... In the same study, among those not using contraceptives, some identifiable barriers include: desire for more children, partner disapproval and fear of side-effects [20]. In southeast, Nigeria, knowledge about contraceptives was found to be 80% and approval, 87%; [11] in a rural population of Northeast Nigeria, the awareness of natural contraceptives ranged from 36.1% to 50.7% and even much lower for modern contraceptives [21]. Across nations the prevalence also varies: in Nigeria (15%), Sierra Leone (8%), Mozambique (16%), Ghana (24%); whereas it was Netherlands (69%), USA & Paraguay (79%) and united Kingdom (82%) [22]. ...
Background: Contraceptives are methods used to prevent pregnancies because of coitus. It is a major determinant of pregnancy and birth rates worldwide. Nigeria, like many other developing countries has a low prevalence rate of contraception, hence, the need to improve awareness and availability of modern contraceptives to reduce the unmet need and avail our women the opportunity to enjoy the numerous benefits derivable from it. Aim: To determine the prevalence, awareness and barriers to contraceptive uptake among the rural women. Materials & Method: It was a cross-sectional study of women of reproductive age in Achi. A multi-stage sampling technique was used to recruit respondents from the communities in the town. A questionnaire administered by the interviewer was used to collect relevant data, which was subsequently analyzed using SPSS version 20.0 computer software for Windows. The result was presented using tables, means and percentages. Result: Four hundred and twenty two (422) women were recruited into the study. Majority of them were 25-29 years (34.6%) whereas the least were 15-19 years (4.33%) of this number, 68.2% had secondary education and majority of them farmers (27.5%). About 40% were orthodox Christians and the rest Catholics and Pentecostals. Also, 316 (74.9%) of the women did not use any contraceptive method giving us a contraceptive prevalence of 25.1%. Two hundred and eight (49.3%) had 3 to 4 surviving children while only 43 (0.2%) had no child. Most the women on contraceptives used injectables,(11.1%), 4.7% used implants and only 0.2% used oral pills. Of the possible reasons for non-acceptance considered majority had fear of carcinogenesis 133(31.5%), followed by husbands’ opposition 110(26.1%) while 19(4.5%) considered contraceptives unhealthy. Conclusion: There is still a low prevalence of contraception in Achi suggesting a high burden of unmet contraceptive needs. Efforts should be channelled towards unravelling the remote and immediate causes of the low prevalence so as to proffer a lasting solution to the problem.
... In the same study, among those not using contraceptives, some identifiable barriers include: desire for more children, partner disapproval and fear of side-effects [20]. In southeast, Nigeria, knowledge about contraceptives was found to be 80% and approval, 87%; [11] in a rural population of Northeast Nigeria, the awareness of natural contraceptives ranged from 36.1% to 50.7% and even much lower for modern contraceptives [21]. Across nations the prevalence also varies: in Nigeria (15%), Sierra Leone (8%), Mozambique (16%), Ghana (24%); whereas it was Netherlands (69%), USA & Paraguay (79%) and united Kingdom (82%) [22]. ...
Background: Contraceptives are methods used to prevent pregnancies because of coitus. It is a major determinant of pregnancy and birth rates worldwide. Nigeria, like many other developing countries has a low prevalence rate of contraception, hence, the need to improve awareness and availability of modern contraceptives to reduce the unmet need and avail our women the opportunity to enjoy the numerous benefits derivable from it.
... Family planning has been de ned, as parents can have as many children as they wish and space their pregnancies apart with family planning [2]. In some countries of the Middle East and North Africa, maternal mortality has not decreased by more than 25% [4]. Three-quarters of maternal deaths occur after childbirth and the rst few weeks after birth [5]. ...
Background
Family planning (FP) is an important strategy in promoting maternal and child health. Although family planning was initiated in Sudan in 1965 and then incorporated into the Primary Health Care System in 1985, the utilization rate remains low, which is among the lowest countries in the region. The study aimed to evaluate the effects of a Community-based Family Planning Education Program on knowledge of family planning methods among Married Women in Aldaroshab and Alkadaro Areas, Khartoum State, Sudan.
Methods
This was a Quasi Community interventional study design. It was conducted in Sudan, Khartoum state, Aldaroshab and Alkadro areas. December, 2020. A Family planning program was invented as an intervention program. The population frame included all married women in age (15–49) years in research areas. The sample size was calculated by computerized method, the sample size 456 mothers. The data was collected by a questionnaire designed to measure mothers‟ knowledge, the questionnaire consisted of 30 questions covering the different aspects of family planning. Respondents were divided into two experimental and control groups randomly. The intervention group were women of Aldroshab area and the control group was women of Alkadro area. The data was collected by the researcher and assistants. A pre-evaluation was done on the knowledge of family planning using a structured questionnaire.
Results
The findings showed that knowledge of women has significantly increased (P = 0.01 < 0.05) from 40–85% after program intervention. The most source of family planning information for women was from the TV/Radio (51%). The study results showed most of the intervention and control groups were illiterate (40%)
Conclusion
The study concluded that a family planning program intervention has significantly increased the mother's knowledge regarding family planning.
... Family planning has been de ned, as parents can have as many children as they wish and space their pregnancies apart with family planning [2]. In some countries of the Middle East and North Africa, maternal mortality has not decreased by more than 25% [4]. Three-quarters of maternal deaths occur after childbirth and the rst few weeks after birth [5]. ...
Background
Family planning (FP) is an important strategy in promoting maternal and child health. Although family planning was initiated in Sudan in 1965 and then incorporated into the Primary Health Care (PHC) in 1985, the utilization rate remains low, which is among the lowest countries in the region. this study aimed to evaluate the effects of a community-based family planning education program on knowledge of family planning methods for married women in Khartoum State, Sudan.
Methods
Quasi-community interventional study design. It was conducted in Khartoum State, Sudan in December, 2020. A Family planning program was invented as an intervention program. The sample size consists of 456 mothers, the participants in the research are between the ages of (15 and 49). The data were collected by a questionnaire designed to measure mothers’ knowledge. The questionnaire consisted of 30 questions covering the different aspects of family planning. The data were collected by the researcher. A pre-evaluation was done on the knowledge by using a structured questionnaire. After that, the health education program for the experimental group was done within 20 educational hours, pre and post-test is done to the evaluated effectiveness of the educational program.
Results
The study results showed most of the intervention and control groups were illiterate 40%, they have little information about family planning methods, the mothers’ knowledge has increased after family planning program intervention from 40–84.7%.
Conclusion
The study concluded that a family planning educational program has significantly increased a mother’s knowledge regarding family planning.
... The results express the need to provide more correct information about natural family planning, including the LAM method during contraception counseling [92]. Among some populations, one consultation is not enough, and women need to be reminded of LAM efficacy and advantages throughout the postpartum period [74]. ...
Lactation is a physiological state of hyperprolactinemia and associated amenorrhea. Despite the fact that exact mechanisms standing behind the hypothalamus–pituitary–ovarian axis during lactation are still not clear, a general overview of events leading to amenorrhea may be suggested. Suckling remains the most important stimulus maintaining suppressive effect on ovaries after pregnancy. Breastfeeding is accompanied by high levels of prolactin, which remain higher than normal until the frequency and duration of daily suckling decreases and allows normal menstrual function resumption. Hyperprolactinemia induces the suppression of hypothalamic Kiss1 neurons that directly control the pulsatile release of GnRH. Disruption in the pulsatile manner of GnRH secretion results in a strongly decreased frequency of corresponding LH pulses. Inadequate LH secretion and lack of pre-ovulatory surge inhibit the progression of the follicular phase of a menstrual cycle and result in anovulation and amenorrhea. The main consequences of lactational amenorrhea are connected with fertility issues and increased bone turnover. Provided the fulfillment of all the established conditions of its use, the lactational amenorrhea method (LAM) efficiently protects against pregnancy. Because of its accessibility and lack of additional associated costs, LAM might be especially beneficial in low-income, developing countries, where modern contraception is hard to obtain. Breastfeeding alone is not equal to the LAM method, and therefore, it is not enough to successfully protect against conception. That is why LAM promotion should primarily focus on conditions under which its use is safe and effective. More studies on larger study groups should be conducted to determine and confirm the impact of behavioral factors, like suckling parameters, on the LAM efficacy. Lactational bone loss is a physiologic mechanism that enables providing a sufficient amount of calcium to the newborn. Despite the decline in bone mass during breastfeeding, it rebuilds after weaning and is not associated with a postmenopausal decrease in BMD and osteoporosis risk. Therefore, it should be a matter of concern only for lactating women with additional risk factors or with low BMD before pregnancy. The review summarizes the effect that breastfeeding exerts on the hypothalamus–pituitary axis as well as fertility and bone turnover aspects of lactational amenorrhea. We discuss the possibility of the use of lactation as contraception, along with this method’s prevalence, efficacy, and influencing factors. We also review the literature on the topic of lactational bone loss: its mechanism, severity, and persistence throughout life.
... Our result shows that majority, 90% of women in Jimma town had a good level of knowledge of natural family planning methods which is contradicted with study stating that majority, 63% of respondents had a moderate level of knowledge of natural family planning methods study stating low level of awareness and low utilization of natural family planning methods among the African population [5, [14][15]. This corroborates the results from other studies that revealed a low level of awareness about natural family planning methods as well as minimal or incorrect knowledge of natural family planning among the general population [16,[17][18]. In line with findings of this study was a research conducted by Ikechebeluet al. [19] in Maiduguri, Nigeria which shows a high level of knowledge among (80%) among study participants, also contradicting this study Wilcox A Jet al reported a high level (95.8%) of awareness of family planning methods among the respondents but a lower knowledge of natural family planning methods by the few who practice family planning [20]. ...
Background: The high fertility rate leading to the rapid growth of country’s population is a major hindrance towards the development of a nation. Sub-Saharan Africa has the highest fertility rate in the world, which is further promoted by the low utilization of contraceptive methods. Yet, many communities claim to have natural methods of family planning that pre-date the introduction of modern contraceptives, implying that contraception is a culturally acceptable norm. Objective: To Evaluate the Knowledge, Attitude and Practice towards Natural family planning among reproductive age women of Jimma town, Oromia, Ethiopia. Methods: Across sectional community based quantitative study was done in Jimma town, among reproductive age group women from February to March; 2020. A total of3 99 sample size is calculated using single population proportion formula with a proportion (P) of 50 %.Systematic random sampling technique issued to draw the study participants among the target population. The data was collected using structured questionnaire adapted from similar and the tools modified to fit the local context. The collected data was tallied and analyzed by using scientific calculator. Results: From the total of 399 respondents who responded the questionnaire Majority, 90% of women in Jimma town had a good level of knowledge of natural family planning methods. A positive attitude towards natural family planning methods was seen in (68%) of the respondents. Conclusion: A fair level of knowledge of natural family planning methods is seen among reproductive women in Jimma town, yet differences in knowledge of specific natural family planning methods exist. Therefore, physicians and other health care providers‟ limited knowledge of and experience with Natural family planning methods inhibits broader use as reproductive age women reported getting information about NFFP methods from health providers and friends, therefore, their level of knowledge will depend largely on the information received.
... From the 1970s to the 1990s, numerous research articles examined the topic of traditional methods (Free & Alexander, 1976;Diller & Hembree, 1977;Logarta-Avila, 1985;Bain, 1989;Maynard-Tucker, 1989;Sheon & Stanton, 1989;Tsui et al., 1991;Mbizvo & Adamchack, 1992;Ringheim, 1993;Bledsoe et al., 1994;Goldberg & Toros, 1994;Rogow & Horowitz, 1995). In the past two decades, the published research on this topic has focused largely on sub-Saharan Africa (SSA): Nigeria (Audu et al., 2006;Garba et al., 2012;Rabiu & Rufa'i, 2018), Ghana (Marston et al., 2017), Burkina Faso (Rossier et al., 2014) and Uganda (Higgins et al., 2014). Exceptions include Iran (Rahnama et al., 2010), Turkey (Ortayli et al., 2005), India (Shahina et al., 2013;Ram et al., 2014) and a multi-country comparison (D'Arcangues, 2001). ...
Traditional contraceptive methods are used by 55 million women in developing countries. This study analysed over 80 national surveys to compare traditional with modern method users, by type, region, socio-demographic characteristics, strength of family planning programmes and discontinuation rates. The advance of modern methods has greatly reduced the share held by traditional methods, but the actual prevalence of their use has declined little. Young, sexually active unmarried women use traditional contraception much more than their married counterparts. Discontinuation rates are somewhat lower for traditional methods than for the resupply methods of the pill, injectable and condom; among users of all of these methods, more than a quarter stop use in the first year to switch to alternative methods. Traditional method use is firmly entrenched in many countries, as the initial method tried, a bridge method to modern contraception and even the primary method where other methods are not easily available.
... Either single or both, unsuccessful fertilization and implantation prompts natural termination of pregnancy, which is termed as contraception (Su et al., 2015;Timeva et al., 2014). Although traditional methods like coitus interruptus, lactational amenorrhea, and rhythm/calendar-based method are available for contraception, mankind has moved towards modern contraceptive methods that are believed to be reliable, and efficient (Audu et al., 2006;Belda et al., 2017). The targets of these contraceptive agents rely on the physiological and functional mechanism of reproductive organs. ...
Background
Azadirachta indica A. Juss. is an Indian medicinal plant with innumerable pharmacological properties. Studies have proven that the phytochemicals from neem possess remarkable contraceptive abilities with limited knowledge on its mechanism of action.
Purpose
The present review aims to summarize the efficiency of A. indica treatment as a contraceptive.
Methods
The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used. Published scientific articles on antifertility, antispermatogenic, antiovulation, hormone altering, contraceptive, and abortifacient activities of A. indica were collected from reputed Journals from 1980 to 2020 using electronic databases. Specific keywords search was completed to collect numerous articles with unique experiment design and significant results. This was followed by the selection of the requisite articles based on the criteria designed by the authors. Data extraction was based on the common research elements included in the articles.
Results
A total of 27 studies were considered for reviewing, which included key pharmacological investigations. In the beginning, authors evaluated a number of publications on the contraceptive properties of A. indica, in which it was revealed that most of the publications were made between 1995 and 1999. All the collected articles were categorised and reviewed as antifertility, antispermatogenic, antiovulation, hormone altering, contraceptive, and abortifacient. Authors also assessed studies based on the plant parts used for pharmacological evaluations including leaves, seeds, stem-bark, and flowers. The article was primarily divided into different sections based on the previous works of authors on phytochemistry and pharmacological review articles.
Conclusion
Although A. indica is not reported with the complete alleviation of reproductive system in both male and female animal models, studies have proven its efficacy as a contraceptive. Extracts and phytochemicals from neem neither reduced the libido nor retarded the growth of secondary sexual characters, thus indicating only a temporary and reversible contraceptive activity. However, there is a dearth for clinical studies to prove the efficacy of A. indica as a herbal contraceptive.
... Also, in Sub-Saharan Africa rural women practiced the lactational amenorrhea method significantly more often than urban residents while the use of LAM method was significantly increased with the number of living children in both religious groups [17]. In a study done in South-Eastern Hungary with the use of postpartum contraceptives, 40.2% of women were relying on lactational amenorrhea [18]. ...
Background: Lactational amenorrhea method (LAM) is a highly effective for preventing subsequent pregnancy by 98% during the first six months postpartum. The
efficiency and effectiveness of LAM are affected by correct use and adherence to its three criteria.
Objectives: This study aims to assess practice of lactational amenorrhea as a method of contraception among women attending El-Walidia Health Care Center, Assiut
City, Assiut Governorate.
Methods: This cross-sectional study was conducted from the first day of November 2017 until the end of April 2018 included 400 married women having at least one
living child less than five years old. Data were collected using structured questionnaire through personal interview of the study population.
Results: More than one third of married women (34.5%) were in the age group from 25 to under 30 years of age. Of the participants in the study, 63 women (15.8%)
were pregnant during use family planning methods, less than half of them used breastfeeding as a contraceptive method. About one third of previously breastfed
women reported practice of LAM before, very few numbers of them (9.2%) use it correctly. High incidence of unintended pregnancy (30.8%) was observed among
past LAM users due to incorrect use. Practicing of LAM was higher in women from rural residence, not working women and women with low educational level.
Conclusion: This study concluded that mothers had more than three children and rural women more practicing LAM. The findings recommend that the health care
providers should encourage mothers to breastfeed their children and give the women good counseling about lactational amenorrhea method.
... However, despite the persistent advocacy urging the use of modern contraceptive methods for family planning, the fertility rates in most sub-Saharan African countries still remain unacceptably high [1,5,6,7], mostly due to poor uptake of contraception because of cultural, economic and political barriers [6,8]. Evidence from the recent Nigeria Demographic and Health Survey indicates that only about 15 percent of sexually active women currently practice effective contraception [6,9], though the figure varies from region to region being higher in the southern part of the country with the prevalence of modern contraceptive use of 12.5% among married women compared to prevalence rate of 5.3% among married women in the northern part of the country. ...
... Conversely, the majority of women start sex before the first menses next to childbirth devoid of contraceptive use [20][21][22]. Even if the Sub-Saharan African region had the highest fertility globally, modern contraceptive utilization is very little because communities are still under traditional methods of family planning which lag introduction of modern contraceptives, while contraception is a culturally acceptable norm [20,[23][24][25]. Actually, postpartum family planning (PPFP) utilization is inconsistent in Sub-Saharan countries, for example, less than 10% in Ethiopia, 15% in Nigeria, 20% in Tanzania, 25% in Kenya, and 40% in Zambia [26]. ...
Background:
Postpartum contraceptive use is defined as the avoidance of short spaced pregnancies and unintended pregnancy through the first 12 months after delivery. In Ethiopia, different studies have been conducted to assess the prevalence of postpartum contraceptive use and associated factors. The findings of these studies were inconsistent and characterized by great variability. Therefore, the aim of this systematic review and meta-analysis was to estimate the pooled prevalence of postpartum contraceptive use and determinants in Ethiopia using the accessible studies.
Methods:
The articles were identified through electronic search of reputable databases (MEDLINE through PubMed, EMBASE, HINARI, Science Direct, and Cochrane Library) and the hand search of reference listed in previous prevalence studies to retrieve more. 18 articles are included based on a comprehensive list of inclusion and exclusion criteria. Two authors independently extracted all necessary data using a standardized data extraction format. STATA 14 statistical software was used to analyze the data. The Cochrane Q and I2 test were used to assess the heterogeneity between the studies. A random effects model was calculated to estimate the pooled prevalence of postpartum contraceptive use. Moreover, the determinants for family planning use were reviewed.
Results:
The pooled prevalence of family planning use among mothers during the postpartum period in Ethiopia was 48.11% (95% CI: 36.96, 59.27). Besides, subgroup analysis revealed that the highest family planning use prevalence among postpartum mothers was observed in Addis Ababa, 65.41 (95% CI: 48.71, 82.11). Resumed sexual activity: 7.91 (95% CI: 4.62, 13.55), antenatal care: 4.98 (95% CI: 2.34, 10.21), secondary school and above level of maternal education: 3.53 (95% CI: 1.67, 7.45), postnatal care: 3.16 (95% CI: 1.7, 5.88), menses resumption: 3.12 (95% CI: 1.52, 6.39), and ≥6 months of postpartum period: 2.78 (95% CI: 1.97, 3.93) have shown a positive association with the use of family planning among mothers in the postpartum epoch.
Conclusions:
In this study, family planning use among mothers of the postpartum period in Ethiopia was significantly low compared to the existing global commendation on postpartum contraceptive use. Resumed sexual activity, antenatal care, secondary and above level of maternal education, postnatal care, menses resumption, and postpartum period ≥ 6 months were found to be significantly associated with postpartum contraceptive use.
... Sub-Saharan Africa has one of the highest fertility rates in the world, which is further promoted by the low utilization of modern contraceptive methods. Yet, many communities claim to have traditional methods of family planning that pre-date the introduction of modern contraceptives, implying that contraception is a culturally acceptable norm (5). ...
Background
The postpartum period is a critical period for addressing widespread unmet needs in family planning and for reducing the risks of closely spaced pregnancies. However, many women do not realize that they are at risk for pregnancy during this period. Therefore, the aim of this study was to assess utilization and associated factors of modern contraceptives during extended post-partum period.
Methods
Institutional based cross-sectional study was conducted from March to April, 2015 in six health institutions among women who gave birth in the last 12 months prior to the study period in Gondar Town, Northwest Ethiopia. A systematic random sampling technique was used to select the study participants. Data were analyzed using SPSS version 20. Bivariate and multivariate logistic regression models were fitted to identify the determinants of postpartum modern contraceptive use. Adjusted odds ratios with 95% confidence intervals were calculated, and p-values <0.05 were considered to indicate statistical significance.
Result
Of the total 404 participants, 45.8% mothers used modern contraceptives during postpartum period. Injectable contraceptive was the most frequently used method. Menstruating [AOR =3.84, 95% CI: (2.33, 6.35)], resumption of sex [AOR= 3.17, 95% CI: (1.80, 5.58)], 37–51 weeks of postpartum period [AOR= 2.48, 95% CI: (1.11, 5.55)], husband approval of contraceptive [AOR= 2.10, 95% CI: (1.16, 3.82)] and current knowledge on FP [AOR= 5.01, 95% CI: (2.23, 11.24)] were factors affecting contraceptive use in postpartum period.
Conclusion
Utilization of modern contraceptive during the postpartum period was significantly decreased placing women at risk for a pregnancy in the extended postpartum period. Menstruating, resumption of sex, variation on postpartum period and husband approval of contraceptive were factors associated with contraceptive use. Strengthening FP counseling service at the ANC clinic and postnatal care would improve contraceptive use during the postpartum period.
... [15] Prolonged breastfeeding, Ngaji yaye as branded among the Kanuris, is a factor that accounts for long birth intervals in tropical Africa. [16] This method of contraceptive is more reliable and efficient than the more conservative less reliable methods like the ornaments (guru; laya etc), spiritual invocations (on things like Padlock) and dried herbs. However, the Nganji Yandeye, dried herbs imported from Saudi Arabia might contain some active contraceptive ingredients but there is the need to identify and purify such active ingredients. ...
... In a North-Eastern Nigeria rural population, the awareness of rhythm method, lactational amenorrhoea method and coitus interruptus was 50.7%, 42.1% and 36.1%, respectively and even lower for modern forms of contraception [12]. Bankers represent a population of highly professional and informed individuals whose choice of career will influence their general attitudes and practices including contraception. ...
Contraception means procedures employed to interfere at one stage or the other with the normal sequence of events in the process of reproduction leading to a failure in conception. It means voluntary techniques adopted to achieve birth control. Its use remains sensitive worldwide. Within the same society, contraception varies amongst people of different socio-cultural, educational, religious, or occupational affiliations. It also varies between urban and rural settlements. Some contraceptive techniques also prevent sexually transmitted infections (STIs). The prevalence of STIs also varies with these same factors. There is very limited literature on contraception exclusively amongst bankers. We sought to investigate the level of awareness and practice of contraception amongst bankers in an urban society in Lagos State, Nigeria.
In this descriptive cross-sectional study, 200 self-administered structured questionnaires were retrieved from bankers from 5 banks selected by simple random sampling in Surulere Local Government Area of Lagos State, Nigeria. Data was subsequently statistically analyzed using SPSS.
The age range was 21-45 years, mean28.8±1.4 years, 51.7% were males (72% single, 27% married, 1% separated) and 48.3% were females (52.4% single, 47.6% married). All (100%) respondents were aware of contraception, 93.3% males and 91.7% females were sexually active, 88.9% males and 84.5% females believe contraception is useful. Most (71.4%) respondents practice contraception, males (81%) being more than females (61.1%), p < 0.05. More (71.4%) females and fewer (37.8%) males believe that contraception prevents pregnancy but not STIs, 28.6% of females and 46.6% of males believe it prevents both pregnancy and STIs, whereas 14% of males and no female believe contraception prevents STIs but not pregnancy.
The awareness of and practice of contraception was very high among the bankers but more male bankers practice contraception whereas more female bankers perceive contraceptives to be for the married only.
... [15] Prolonged breastfeeding, Ngaji yaye as branded among the Kanuris, is a factor that accounts for long birth intervals in tropical Africa. [16] This method of contraceptive is more reliable and efficient than the more conservative less reliable methods like the ornaments (guru; laya etc), spiritual invocations (on things like Padlock) and dried herbs. However, the Nganji Yandeye, dried herbs imported from Saudi Arabia might contain some active contraceptive ingredients but there is the need to identify and purify such active ingredients. ...
ARAŞTIRMA / RESEARCH Effect of the premarital sexual health/reproductive health training on knowledge level and marital adjustment of the newly married women Evlilik öncesi cinsel sağlik/üreme sağlığı eğitiminin yeni evli kadınların bilgi düzeyi ve evlilik uyumuna etkisi Abstract Öz Purpose: This study was conducted in order to determine the effect of the premarital Sexual Health/Reproductive Health Training on the knowledge level, marital adjustment and sexual satisfaction of the newly married woman. Materials and Methods: This study was an experimental study based on the design of pretest-posttest with control group. The study was performed with 149 women.
The report based on secondary data analysis like NFHS analyzes situation of uninted pregnancies and abortions in the State of Bihar, Madhya Pradesh and Orissa in India
This project examines how women who currently use natural family planning (NFP), those who formerly used NFP, and those who have never used NFP compare along demographic, socioeconomic, and attitudinal variables. Bivariate analyses of data from the National Survey of Family Growth 2006–2010 (N = 10,598 female respondents) suggest that current NFP users varied socioeconomically and demographically from former NFP users, but differences were more prominent between current NFP users and never NFP users. In many cases, there was little variation between former NFP users and never NFP users. Current NFP users were less likely to be black and more likely to be Hispanic or other race, married, Catholic or other religion, have a bachelor's degree, and earn higher income than the other two groups. Understanding how current NFP users differ from those who formerly used NFP and those who have never tried NFP provides important clues about which populations to target for promotional efforts.
The objective of the study was to find out factors that affect the intentions of men and women to use family planning methods.
The study was conducted in Mangochi district, the southern region of Malawi in 2006. About 60 Focus group discussions were conducted to identify the attitudes and beliefs of 30 male and 30 female participants regarding family planning methods. The data was then transcribed and analyzed manually identifying central themes and relationships across the cases and narratives.
Most of the respondents knew the different types of family planning methods and reported that health facilities had adequate stock of family planning supplies. However, it was found that most of the women and men were not using any modern family planning methods. Reasons included: family planning methods were perceived side effects, such as prolonged menstruation, men's concerns about impotence and genital sores, weight gain or loss, and subsequent infertility. Traditional family planning methods were mostly used for infertility problems.
Despite knowing about the different types of family planning methods, and awareness of their ready availability in health facilities, use of these methods is low because considerable misinformation still prevails regarding contraceptive methods' side effects.
The lactational amenorrhoea method (LAM) is an effective contraceptive option in developing countries. Post-partum, of the women who accept to apply LAM, many never do. Our aim was to determine the actual use of LAM.
A group of 326 post-partum women who accepted LAM use were recruited. After 6 months, they were asked if they actually had applied the method or not. In a logistic regression analysis, nine socio-demographic and clinical variables were studied as predictors of actual LAM use. An alpha level was set at 0.05.
Overall, of the 326 women, only 61 (18.7%) actually applied LAM. The mean duration of LAM use was 4.3 +/- 0.2 months. The main reason for not applying LAM was that women thought the method was ineffective (66.0%). The variable time of menses resumption emerged as a predictor of LAM use (p = 0.001).
Despite post-partum acceptance, most women did not actually apply LAM. In our setting as well as in other developing countries, regular contacts with a health care provider could improve LAM use.
Context: Women who are breastfeeding need access to family planning information and services to help them choose a contraceptive method that allows them to sustain breastfeeding and that is safe for the breastfeeding child. Methods: Data from an operations research study of all family planning service delivery sites in Senegal were used to assess the management of contraceptive services for lactating women visiting the clinics for the first time. Results: At the time of the site visits, nearly 60% of the women visiting the family planning clinics for the first time were breastfeeding. Although most providers knew the correct advice to give breastfeeding women, 21% of the women were not asked their breastfeeding status during the clinic visit, and more than one-third accepted estrogen-containing contraceptives (which are not recommended for breastfeeding women). Overall, estrogen-containing contraceptives were less likely to have been accepted by breastfeeding women than by women who were not breastfeeding; however, among women known by the provider to be breastfeeding, estrogen-containing methods and progestin-only pills were accepted at the same frequency as among women who were not asked their breastfeeding status. Conclusions: In order to meet the needs of breastfeeding women, providers must have correct information about the appropriate use of all contraceptive methods during lactation. Additionally, the reasons that providers do not ascertain breastfeeding status or give appropriate contraceptive advice to lactating women need to be identified.
The withdrawal method and other traditional methods of contraception are still used in Turkey. Ninety-eight percent of women in Turkey know about modern family planning methods and where to find contraceptives. In fact, only one in every three women uses an effective method. The aim of this descriptive and experimental study was to investigate reasons for using traditional methods and the role of nurses in family planning. The women included in the sample were visited in their homes by nurses and educated for family planning in four sessions. Overall, 53.3% of women were using an effective method. However, 54.3% of women living in the Sirintepe district and 41.6% of women living in the Yenikent district were still using the traditional methods they used before. After the education sessions, the most widely used method was found to be intrauterine device (22.8%) in Sirintepe and condom (25%) in Yenikent. There was a significant difference in family planning methods between these two districts (p < 0.001).
Objective:
To assess physicians' knowledge and practices of modern methods of natural family planning.
Methods:
A questionnaire was mailed to 840 physicians selected randomly from Missouri state licensing records for obstetrics-gynecology, family practice, general practice, and general internal medicine.
Results:
The response rate was 65%. A total of 375 physicians (69% of respondents) saw women for reproductive issues. About half (46%) of physicians reported that they mentioned natural family planning to at least some women when discussing family planning issues. Observing vaginal discharge of cervical mucus was discussed by 40% of physicians in the context of avoiding pregnancy and by 36% of physicians in the context of helping a couple achieve pregnancy. Twenty-two percent of physicians estimated the best possible effectiveness of natural family planning to avoid pregnancy to be greater than 90%, and 35% estimated the actual effectiveness to avoid pregnancy to be greater than 70%. (The threshold rates of 90% best possible effectiveness and 70% actual effectiveness were chosen to be somewhat less than those reported in medical literature.) Physicians who gave higher estimates of effectiveness of natural family planning and physicians who were aware of an instructor in their community were more likely to provide women with relevant information about natural family planning.
Conclusion:
Most physicians, especially those unaware of availability of instructors in their areas, underestimate the effectiveness of natural family planning and do not give information about modern methods to women.
This study examined the effectiveness of lactational amenorrhea in preventing pregnancy during the first 6 months postpartum. Women were recruited during January 1994 to May 1995 from maternity clinics family planning centers and other health care providers. 643 women were screened out of 1425 total women participating in the study. Sample women were recruited from Birmingham England; Dusseldorf Germany; Milan Italy; Merida Mexico; Manila the Philippines; Stockholm Sweden; Washington D.C.; Jakarta Indonesia; Sagamu and Jos Nigeria; and Assiut Egypt. Study participants had to be no more than 3 months postpartum amenorrheic fully or almost fully breast feeding and having sexual intercourse. All women had to agree to accept the lactational amenorrheic method (LAM) for birth control. Women used diaries for recording coital frequency. Women were interviewed at 6 9 and 12 months postpartum. Findings indicate that 324 women (62%) were still using LAM at 6 months. Knowledge of LAM was high. 6-month life table risk of pregnancy based on 2718 woman-months of use was low among women using the method correctly (1.5%). The risk was 1.7% among women who did not adhere to the conditions of use of LAM. 27% of women started contraceptive use 6 months after the birth or after stopping LAM. By 9 months postpartum 68% were using contraception. The desire for spacing of births or stopping of births was 85% at 9 months and 76% at 12 months respectively. 84% were satisfied with LAM. 13% reported problems with LAM. The most problematic report was night feedings and worry about efficacy.
This report presents the findings of an analysis of 1997 Senegal Demographic and Survey data on contraception marriage AIDS and maternal and child health patterns. By 1997 86% of married women and 90% of married men could name at least one contraceptive method. However only 13% of women and 16% of men currently used contraception. The most widely used methods for women were the pill injectable and the IUD. Senegal has a predominantly Muslim population that consists of 43% of Wolof ethnic group 24% Poular 15% Serer 5% Diola and 4% Mandingue. More than 50% of respondents lived in rural areas. 67% of women had no formal education; 13% had a secondary or higher education. Levels of education for men were similar. The median age at marriage among women aged 25-49 years was 17.4 years. 68% of women were married 27% were never married 4% were divorced and 1% were widowed. The Serer and Diola tended to marry later. 64% of men were married. 34% had more than one wife. The practice of polygamy was greater in rural areas. The total fertility rate among women aged 15-49 years was 5.7 lifetime births/woman. Fertility was higher among rural and uneducated women. Married women desired 5.7 children; married men 9.5 children. 23% of married women desired no more children. Infant mortality in the 4 years before the survey was 68/1000. Child mortality was 139/1000. 81% of men and 75% of women knew about sexual transmission of AIDS. Respondents cited the following means of prevention: fidelity condom use sex with one partner and abstinence.
Although the contraceptive prevalence rate of Turkish women approximates that in Western countries almost half rely on withdrawal and other traditional methods. A 1993 survey of 918 married parous women 15-44 years old from the Cobancesme district of Istanbul Turkey found that 90% of nonpregnant women were practicing some form of contraception. 41% of respondents relied on withdrawal 29% were using the IUD and 6% used oral contraceptives. 73% of these women did not begin contraceptive use until after their first birth. 44% selected withdrawal as their first contraceptive method. 14% of withdrawal users subsequently switched to another method primarily because of method failure or fear of pregnancy. Use of modern methods was positively associated with increasing age and length of residence in Istanbul. 49% had used the IUD at some point in their lives and 41% had used the pill. Discontinuation of these methods was largely due to fear of adverse health effects. 81% of women reported at least 1 reproductive health symptom including anemia reproductive tract infection and severe pelvic relaxation. With the exception of an association between IUD use and menstrual disorders no links were detected between individual contraceptive methods and morbidity. These findings suggest that many Turkish women resort to reliance on withdrawal as a "refuge" from the perceived or actual side effects of other methods.
An analysis of data from a 1990 household survey conducted in Greater Freetown, the capital of Sierra Leone, revealed that among women aged 12-49 with at least one child younger than five, 17% were using a contraceptive method and 64% wanted more children. Regression analysis showed that contraceptive use was positively associated with age and with education beyond the primary level, and negatively associated with Islamic religious affiliation. The desire for more children was negatively associated with age and with parity greater than three, and was positively associated with Islamic religious affiliation.
Breastfeeding has important health and contraceptive benefits in developing countries. These benefits are not entirely distinct from one another, because part of the health benefit of lactation derives from its contraceptive effect. Breast milk provides all the nutrients an infant needs during the first few months of life, as well as immunological agents that protect against disease. Breastfeeding improves child survival by decreasing an infant's exposure to contaminated food and water and by lengthening the interval between births, thus preventing premature weaning and sibling competition for food, and reducing nutritional depletion of the mother. These potential benefits are greatest in societies with low contraceptive prevalence, little supplementation of breast milk, low nutritional status of women, and cultural taboos against sexual relations for the duration of breastfeeding.
A one-page family planning questionnaire developed by Nigeria's Federal Office of Statistics can be attached to nationally representative surveys that are routinely conducted to monitor development activities. The module collects data on household composition, source of family planning information, current use of family planning methods and the source of services and supplies. A comparison of data from two of these family planning modules, fielded in December 1992 and December 1993, with results from two earlier national surveys reveals that modern method use among women aged 15-49 went from 4% in 1990 to 9% in 1992, and then rose to 11% in 1993. Such a tool allows program managers to document the expansion of family planning practice between infrequently conducted national fertility surveys.
Bolivias 1994 Demographic and Health Survey documented a 50% increase in contraceptive usage in the five years since the previous survey from 30% in 1989 to 45% in 1994. Of concern however was the lack of reliance on modern methods despite the finding that 75% of contraceptors were attempting to limit rather than postpone childbearing. 22% of all married respondents used rhythm for contraception yet a quarter of these women were unable to identify the fertile period of the menstrual cycle. The IUD the most commonly used modern method was selected by 8% of women in union. The total fertility rate in the three years preceding the survey was 4.8; there were large differentials in this rate however between urban and rural women (6.3 and 3.8 respectively) and the least and most educated women (6.5 and 2.7 respectively). 45% of respondents reported that their current or most recent pregnancy was not wanted; overall 72% of women in union wanted no more children. In 1994 the unmet need for family planning was 24% (18% to limit and 6% to space births) with higher levels among rural women (34%) and the least educated (36%). Had Bolivian women had only wanted births during the survey period the total fertility rate would have been 2.7 compared to 4.8. The 1994 survey also documented a 24% decline in infant and child mortality a 62% decrease in maternal mortality during pregnancy and a 23% drop in childbirth-associated maternal mortality since 1989. 57% of most recent births occurred at home and 43% were attended by a physician.
To assess physicians' knowledge and practices of modern methods of natural family planning.
A questionnaire was mailed to 840 physicians selected randomly from Missouri state licensing records for obstetrics-gynecology, family practice, general practice, and general internal medicine.
The response rate was 65%. A total of 375 physicians (69% of respondents) saw women for reproductive issues. About half (46%) of physicians reported that they mentioned natural family planning to at least some women when discussing family planning issues. Observing vaginal discharge of cervical mucus was discussed by 40% of physicians in the context of avoiding pregnancy and by 36% of physicians in the context of helping a couple achieve pregnancy. Twenty-two percent of physicians estimated the best possible effectiveness of natural family planning to avoid pregnancy to be greater than 90%, and 35% estimated the actual effectiveness to avoid pregnancy to be greater than 70%. (The threshold rates of 90% best possible effectiveness and 70% actual effectiveness were chosen to be somewhat less than those reported in medical literature.) Physicians who gave higher estimates of effectiveness of natural family planning and physicians who were aware of an instructor in their community were more likely to provide women with relevant information about natural family planning.
Most physicians, especially those unaware of availability of instructors in their areas, underestimate the effectiveness of natural family planning and do not give information about modern methods to women.
Contemporary patterns of breastfeeding and postpartum abstinence among the Yoruba of Nigera are examined. Quite extensive periods of postpartum abstinence are still observed by most rural and poorer urban women to prolong breastfeeding and increase child survivorship. Differentials in duration of breastfeeding and abstinence relate to both socioeconomic factors and age, suggesting the likelihood of large future reductions. Implications for family planning prospects and policies are noted.
Previously published estimates of probabilities of method and user failure for all contraceptive methods suffer from a serious methodological error and are biased downward, with the extent of bias unknown. Data from a World Health Organization clinical trial of the ovulation method of periodic abstinence were used to provide the first correctly calculated measures of method and user efficacy and to determine the characteristics that distinguish women who consciously take risks from those who do not. Probabilities of pregnancy during the first year are 3.1 percent during perfect use (method failure) and 86.4 percent during imperfect use (user failure). Thus, if used perfectly, the ovulation method is very effective. However, it is extremely unforgiving of imperfect use. Because perfect compliance is difficult for many couples who desire intercourse when it is forbidden by ovulation method rules, and because the risk of pregnancy during imperfect use is so great, the ovulation method cannot be considered an ideal contraceptive method for the typical couple, who are likely to be less compliant than couples who volunteer for a clinical trial. The probability of an accidental pregnancy is greatest when any of the three most serious rules--no intercourse during mucus days, within three days after the day of peak fecundity or during times of stress--are broken. Those who have a poor attitude toward the rules are more likely to take risks, including serious risks. Those who get away with taking a risk (i.e., do not get pregnant) are very likely to take risks again. Because breaking the most serious rules entails a 28 percent risk of pregnancy per cycle, those likely to take risks should be counseled about the probable consequences.
There has been an increase in interest in natural family planning (NFP) in recent years. The Roman Catholic Church and other groups sympathetic to NFP philosophy have pressured the US Agency for International Development (AID) to increase emphasis on NFP, and AID has responded by increasing funding devoted to NFP from US$0.8 to US$7.8 million from 1981-85. In 1985, AID exempted NFP providers from the requirement of providing direct or referral services for other methods, but repealed the exemption in 1986. Several methods fall under the NFP umbrella: rhythm, the estimation of ovulation time by the counting of days elapsed in relation to menstruation; and the more precise cervical musus; basal body temperature; and sympto-thermal methods. Because NFP requires considerable training, recording, and willingness to abstain, recruitment is difficult and dropout rates high. A 5-country World Health Organization study found that 17% of women dropped out during training, and 36% discontinued during the following year. At the 4th International Congress of the International Federation for Family Life Promotion (IFFLP), it was stressed that data on NFP prevalence classed by type of NFP are lacking. Questions raised included whether populations of countries that have achieved or hope to achieve a low birth rate will be interested in NFP; whether NFP can increase the risks of birth defects through fertilization by "aged gametes;" and whether NFP is capable of helping couples to select the sex of the child. The implications of the contraceptive effects of breastfeeding were reviewed. Some problems arise concerning evaluation of effectiveness: NFP advocates often do not consider couples who "break the rules" as acceptors, and when these couples are excluded from data the method appears much more effective. Traditionalists emphasize the increased quality that NFP brings to a marital relationship. Some participants maintained that rigid moral advocacy would deter many couples.
The family planning aspects of the practice of traditional healers in Ibadan, a large city in south west Nigeria, was investigated by means of a questionnaire survey of 193 traditional healers. The findings revealed that between 13% and 53% agreed with certain cultural beliefs which tend to increase fertility and that their perceptions of ideal child spacing is most commonly 2-3 years. Only 13% think a couple should have a specified number of children; a large proportion think the number should be "as God wills" (42%) or as many as the couple has resources to cope with (42%). Nearly all think that traditional healers and orthodox health professional should work together in the area of family planning. While most of them recommend traditional methods of contraception (such as beads and herbs) to their clients, up to 22% recommend modern family planning methods such as condoms and oral contraceptive pills. The implications of these findings for family planning programmes and the possibility of the involvement of traditional healers in the promotion of modern family planning methods are discussed.
The factors determining the choice of contraception were studied among 230 pregnant women attending the antenatal clinic at Nnewi, Nigeria. There were 174 (52.1%) choices for the natural methods of contraception, 86 (25.7%) for the traditional methods, and 74 (22.2%) for the artificial methods. The most commonly chosen contraceptive methods were rhythm, 95 (28.4%) and Billings, 79 (23.5%), while the least was surgical contraception, 4 (1.2%). The barrier method was not chosen at all.
The most common reason given for choice of contraception was safety, 28.7%, followed by dislike of artificial methods, 25.2%; the no-response rate was 29.1%. Other reasons given were ease of use, 10%; husband's decision, 1.3%; fear of the complications of the artificial methods, 13%; dislike of foreign body, 2.6%; the method most understood, 24.8%; need for further counselling, 7%; and long-lasting, 2.6%.
The most common reason given against the use of the artificial methods of contraception was fear of its complications, 31.9%, followed by preference for the natural methods, 22.3%.
Condom use decreased with increasing age, being highest at 16–20 years, 37.5%, and lowest at 31–35 years, 5.9%. When compared with other parity groups, the grandmultipara group (≥5) used the IUD, 14.3%; injectable contraception, 4.8%; and other traditional methods (breastfeeding and abstinence), 28.5%, and did not use the rhythm method.
Women of the lowest social class most commonly chose other traditional methods, 57.1%, and never chose the Billings method. Women who desired 1 to 3 children most commonly chose the pill, 23.5%, or withdrawal method, 23.5%, while women who desired 4 to 10 children most commonly chose the rhythm and Billings methods.
There was no difference in choice of method of contraception for the various religious denominations, although the artificial methods were less commonly chosen by Catholics, 14.1%, compared with Anglicans, 33%, and other Christian denominations, 33.3%.
The physician was the most common source of information for the choosers of the condom, 18.9%; surgical contraception, 2.7%; and the pill, 8.1%; the nurse for injectable contraception, 4.9%, while the commonest source of information among choosers of the rhythm method was the electronic media, 40.5%; print media, 34.9%; and peer group, 34.4%. Lecture/sex instruction was the commonest source of information among choosers of the Billings, 35.5%, and withdrawal, 22.6%, methods, while the no-response rate on source of information on contraception was highest among choosers of the Billings method.
There is a need to bridge the gap in contraceptive information by redirecting counselling strategies and restructuring family planning programs to dispel negative perceptions and encourage informed choice of effective family planning methods.
To examine the relationship between reading ability and family planning knowledge and practices among Medicaid managed care enrollees.
A total of 406 women age 19-45 years enrolled in TennCare and members of Prudential HealthCare Community Plan in Memphis, Tennessee were interviewed to determine their methods of contraception, desire for additional information about contraceptives, and knowledge about the time in menstrual cycle they are at highest risk for pregnancy. Patient reading ability was assessed by an abbreviated version of the Test of Functional Health Literacy of Adults. The independent associations between reading ability, desire for additional contraceptive information, and knowledge about the highest risk time for pregnancy were assessed with logistic regression.
Almost 10% of the respondents had low reading skills. Women who had used an intrauterine device, douching, rhythm, or levonorgestrel implants as methods of birth control had higher rates of low reading skills than women who used other methods of birth control. Compared with women with good reading skills, women with low reading skills were 2.2 times (95% confidence interval [CI] 1.1, 4.4) more likely to want to know more about birth control methods and 4.4 times (95% CI 2.2, 9.0) more likely to have incorrect knowledge about when they were most likely to get pregnant. These relationships were significant even after controlling for age, race, and marital status.
Health providers and organizations that serve historically underserved populations must understand that some individuals have a low level of reading ability that limits family planning education.
This study investigated the effectiveness of traditional contraceptives commonly used by Yoruba women, and the attitudes of users and non-users towards family planning services and contraceptives in Nigeria. One hundred forty-two married women aged 19 to 40 years were followed for 18 months. Seventy-two of the women were identified as current users of four types of traditional contraceptives (ring, incision, soup, and waistband types), and 70 women did not use any type of contraceptive. The users and non-users were matched on socio-demographic characteristics. Attitudes of the users and non-users towards fertility regulation were investigated using focus group discussions. The study found that 5.6 percent of the users and 34.5 percent of the non-users became pregnant during the follow-up period. Contraceptive failure was experienced by users of the waistband and ring methods. The main barriers to the use of modern contraceptives as described by women were the negative attitudes of men and the fear of side effects.
This study was conducted among Yoruba women and traditional healers with the aim of identifying and describing the practice, preparation, and administration of traditional contraceptives. The data were obtained in 1990 from a random sample of 1,400 women of childbearing age and 42 traditional healers in Nigeria's Oranmiyan area, using questionnaires and in-depth interviews. Findings revealed that knowledge of the traditional contraceptives is nearly universal among the Yoruba population, and the traditional contraceptive prevalence rate is 7.1 percent. The use of traditional contraceptives was significantly more common among uneducated women and among women aged 20 to 29 years old. Findings also revealed the existence of four main varieties of traditional contraceptive devices, the methods of preparation of the traditional contraceptives, varieties of herbal and animal products used, methods of administration, and taboos against usage. The easy accessibility of traditional medical practitioners and the belief that traditional contraceptive devices are devoid of complications, especially among those experienced with modern contraceptive devices, were the main reasons women cited for patronizing the traditional practitioners. The paper concludes with policy implications for family planning programmers in Nigeria.
Opening Paragraph
This article is about the marital sexual relationships (MSR) and the timing of the next child among the Ekiti and Ikale sub-groups of the Yoruba. Contrasts in post-partum sexual practices between the two groups allow us to demonstrate the importance of parents' perception of their child's growth and their observance of prohibitions on sexual intercourse during the wife's lactation as factors shaping their decision to have another child. It is argued that the similarity in birth spacing among the two groups, derived from contrasting attitudes to post-partum abstinence, is evidence of an explicit decision on the timing of the next child. Such a decision takes account of the role of the child's growth and social development as it affects adults in the performance of their daily social and economic routines and goes beyond an unquestioned response to quasi-religious taboos. The implications of the findings for fertility prospects are also discussed.
Many couples worldwide practice rituals, herbal approaches, and similar traditional approaches to regulate fertility, but many of them are ineffective at preventing pregnancy and some may even be harmful. Health providers who are familiar with cultural beliefs about fertility may use nonharmful practices (e.g., rituals or storytelling) to teach couples about the fertile period or modern contraception. In fact, providers gain credibility when they teach family planning in ways that include traditional beliefs. In Nigeria, fertility regulation methods were used before modern contraception was introduced. In both Nigeria and Niger, some customs prohibit premarital sexual intercourse. Others promote sexual abstinence for up to three years to promote proper birth spacing. Even though many beliefs do not prevent pregnancy and cause no harm, they can be used to assure women that they are in control of their own fertility. Such beliefs include avoiding the sun or moon at certain times or wearing charms (e.g., dead spiders, children's teeth, or leopard skin bracelets). Providers should discourage dangerous or counterproductive beliefs, however. For example, the Nigerian belief that intercourse during menstruation turns people into albinos (although it is not harmful) may encourage sex during the fertile period. Some harmful beliefs or practices include douching with hot water, salt, vinegar, lemon, or potassium after sex; eating arsenic or castor oil seeds; and drinking water used to wash dead bodies. A 28-bead necklace is being used to help women keep track of their menstrual cycle and know when the risk of pregnancy is greatest. 11 white beads designate the fertile period, with fluorescent beads indicating the peak days of ovulation. In Brazil, the third most popular family planning method is natural family planning (NFP), indicating a clear demand for NFP; yet many couples use NFP incorrectly. In the Philippines, lime juice is used to prevent bean pods from opening and releasing their seeds. This is used to explain how the pill can prevent the ovary from releasing an egg.
A discrepancy exists between the interest in modern methods of natural family planning (NFP) and their actual use in developed countries. To explore reasons for this discrepancy, we analyzed data from a questionnaire administered to postpartum women in Berlin (n = 223) and Cracow (n = 233). Knowledge of NFP, past use of NFP and expected effects of abstinence on the partnership were independently associated with interest in using NFP, but not the choice to do so among those interested. Desire for future pregnancies, importance of religious belief and location in Cracow were independently associated with the choice to use NFP among those interested. Perceived accuracy of observation to identify the fertile time and acceptance of own body were independently associated with both interest in and choice to use NFP. Frequency of intercourse had no effect on interest. These results suggest that increased access and cultural support would likely lead to a higher prevalence of NFP use in developed countries.
To obtain information from rural women regarding their contraceptive knowledge, practices and utilization of services, a cross-sectional survey of 117,465 eligible women was carried out in the sampled areas of 28 districts from January 1996 to February 1997. From among the current contraceptive users all of IUD, OC and acceptors of a permanent method in the last one-year (14,276) were interviewed in detailed. In addition a systematically selected sample of 17,082 non users were also interviewed. Overall contraceptive prevalence was 45.2% of which 34.2% had used a permanent method. Among the current users, the contraceptive had been availed mainly from either PHC (31.5%) or hospital (42.1%). Around half the women (53.1%) had received counseling and in 20.3% information regarding other methods. Pelvic examination was done in 39.1% Most of the women (>97%) expressed satisfaction with the method, provider and services. Almost all the women (98.8%) were using a contraceptive method with the knowledge of their husband and had his support for continuing the same. There was no concept of using any family planning method for either postponing the first conception after marriage or spacing between the two child births. A large majority of women (70.5%) used a family planning method for the first time only after completing their desired family size. Among the never users, 73.5% mentioned at least one modern method of family planning available in the national programme and 64.3% mentioned the service source where it would be available. Fewer women in most of the districts mentioned spacing methods as compared to female sterilization. The main reason given for not using any family planning method was "family not complete" (34.6%). There is need to promote spacing methods by policy makers and field workers and motivate couples to accept them.
Nurses and other health care professionals often have little knowledge of methods of natural family planning (NFP) and do not readily prescribe natural methods for their patients. One reason for this is that little or no information on NFP is provided in nursing or medical schools. The holistic, informational, and integrative nature of NFP fits well with professional nursing practice. A university online distance education NFP teacher training program, which offers academic credit and includes theory, practice, and the latest developments in fertility monitoring, has been developed for health care professionals. Professional NFP services in the United States need to meet worldwide standards and include documenting and assessing pregnancy outcomes, tailoring NFP services to the client or couple, and simplifying them for ease of use in a standard health care practice.
Too few family planning studies in Nigeria have focused on the men. This community-based study determined the level of knowledge, attitude to and the practice of contraception among married men in a rural community in south west Nigeria. The study also identified socio-demographic and other variables associated with male contraceptive use. Knowledge was high for any family planning and any modern family planning method (90.9% and 73.3%). High level of knowledge alone was however not sufficient enough to promote a high level of use. The men's attitude was generally positive. Nearly half (47.3%) of respondents reported that they made family planning decisions with their spouses, though the larger majority thought it was the wife's responsibility to go for family planning. Among the men, 55.7% had ever used, while 26.7% were current users of any method. High level of formal education and duration of marriage (10 years and longer) were predictive of ever-used of a FP method while having fewer than 5 surviving children negatively affected the use of FP methods. Current users of any family planning method were likely to be men with high formal education and with two or more surviving female children. The condom was the most utilized method but traditional methods of unproven efficacy, some of which were hitherto thought to be used only by women, were also widely used. Current use of contraceptives by males in this rural community is lower than what is generally reported for the country and the southwest region. It could be further improved when child survival is assured and when there is an improvement in the general level of education in the community.
This study uses data from the 1989, 1993, and 1998 Kenya Demographic and Health Surveys to examine trends and determinants of contraceptive method choice in Kenya. The analysis, based on two-level multinomial regression models, shows that, over time, the use of modern contraceptive methods, especially long-term methods, is higher in urban than in rural areas, whereas the pattern is reversed for traditional methods. Use of barrier methods among unmarried women is steadily rising, but the levels remain disappointingly low, particularly in view of the HIV/AIDS epidemic in Kenya. One striking result from this analysis is the dramatic rise in the use of injectables. Of particular program relevance is the notably higher levels of use of injectables among rural women, women whose partners disapprove of family planning, uneducated women, and those less frequently exposed to family planning media messages, compared with their counterparts who have better access to services and greater exposure to family planning information.
Family planning methods: Africa. Ch. 2 Traditional practices Atlanta: Centre for Health Promotion and Education Contra-ceptive knowledge, practices and utilisation of services in the rural areas of India (an ICMR task force study)
- Cdc N Chandhick
- Dhillon Bs
- I Kambo
- Saxena
CDC. 1983. Family planning methods: Africa. Ch. 2 Traditional practices. Atlanta: Centre for Health Promotion and Education. Chandhick N, Dhillon BS, Kambo I, Saxena NC. 2003. Contra-ceptive knowledge, practices and utilisation of services in the rural areas of India (an ICMR task force study). Indian Journal of Medical Science 57:303 – 310.
- Trussell J
Traditional fertility regulation among the Yoruba of southwestern Nigeria. II. A prospective study of use-effectiveness
- M K Junaidu
- L O Olusi
- B Ajuwon
Traditional fertility regulation among the Yoruba of southwestern Nigeria. I. A study of prevalence, attitudes, practice and methods
- M K Junaidu
- B Ajuwon