ASSESSMENT OF HEALTHY TIMING AND SPACING OF PREGNANCY APPROACH IN LONG ACTING REVERSIBLE CONTRACEPTIVES ACCEPTANCE AMONG WOMEN IN YALA LOCAL GOVERNMENT AREA OF CROSS RIVERS STATE

ASSESSMENT OF HEALTHY TIMING AND SPACING OF PREGNANCY APPROACH IN LONG ACTING REVERSIBLE CONTRACEPTIVES ACCEPTANCE AMONG WOMEN IN YALA LOCAL GOVERNMENT AREA OF CROSS RIVERS STATE

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CHAPTER ONE

INTRODUCTION

Background of the Study

Family planning is defined as the use of contraceptive methods to control the number, timing and spacing of births. The use of modern contraception is of great importance in public health, as its advent has resulted in the decline of fertility, the improvement of economic productivity, as well as the health of mother and child (Cleland, 2012). The use of modern contraceptive methods prevents unintended pregnancy, which is associated with many negative health consequences (White, 2007). According to a report released by the Guttmacher Institute and UNFPA in 2012 approximately 54 million unintended pregnancies resulted in 26 million abortions (of which 16 million would have been unsafe); 79,000 maternal deaths and 1.1 million infant deaths which would have been prevented if women of reproductive age used modern contraception. Furthermore, modern contraception reduces unwanted pregnancy among HIV positive women, which in turn reduces the number of infants born with HIV (Macro 2011). Thus, most countries in Sub Saharan Africa are engaged in family planning interventions to ensure that women of reproductive age, namely 15 to 49 years, have access to modern contraceptive methods as a health and development strategy (White, 2007).

Recent scientific findings strongly encourage the use of Long Acting Reversible Contraceptives (LARC) methods, because they are the most efficient and cost effective family planning methods for pregnancy prevention. Long acting reversible methods are cost effective, because of the reduced cost that a couple incurs in a year of protection when compared to short term methods (Hubacher, 2008).

In Nigeria and other Sub-Saharan African countries, modern contraceptive use has been one of the dramatic social transformations of the 21st Century. Despite a challenging socio-economic environment, family planning interventions have led to significant improvements in modern contraceptive use in the country. The challenges include limited financial and human resources and the serious opposition that the Ministry of Health faced from the government, when it introduced family planning services in the country as a strategy to stop the negatives consequences of rapid population growth (Cohen, 2010).

Eventually, the government realized that rapid population growth stifled the economic growth and development of the country as well as negatively affected the health status of, especially women (Cohen 2010). Since then, there has been a remarkable increase in modern contraceptive use among married women of reproductive age (15 to 49 years) from 7.4% in 1992 to 26.1% in 2000; 28.1% in 2004 and 42.2% in 2010  (Gaskiya, 2013). Despite this remarkable improvement in modern contraceptive use, it is still very low when compared to countries like Zimbabwe and South Africa, with contraceptive prevalence of 57% and 60.3%, respectively (MOH, 2010, Sharan, 2010).

The desire to limit and postpone childbearing in many women has increased their risk of unintended pregnancy in settings like Nigeria where the use of modern contraceptive methods is considered relatively low (Combs, 2011). Additionally, incorrect or inconsistent use of short term modern contraceptive methods (pills or condoms) also increases the risk of unintended pregnancy (Frost, 2008). Thus, family planning programs in Nigeria are advocating for the availability and use of highly effective contraceptives such as Long Acting Reversible Contraceptives (LARC) methods, in order to limit the occurrence of unintended pregnancy (Hubacher, 2010). This is highlighted by a cohort study which reported that the risk of pregnancy was 0.27 and 4.55 pregnancies among Long Acting Reversible Contraceptives (LARC) methods and short term users respectively (Winner, 2012). Long Acting Reversible Contraceptives (LARC) methods namely Intra-uterine devices (IUD) and implants are recommended as the best strategy for reducing unintended pregnancy (Philips, 2008). The Ministry of Health in Nigeria has approved the Copper IUD and the Norplant (implants) as the LARC methods available in the country (Solo, 2011).

Despite the record of efficacy, safety, cost effectiveness and user friendliness, there is very low usage of long acting reversible methods (Kluge, 2010). The growing evidence in the literature of the appropriateness of these methods evokes the need for research into factors influencing their use among sexually active women of reproductive age.

Healthy Timing and Spacing of Pregnancy is an developed by the Extending Service Delivery (ESD) Project Funded by USAID’S Bureau for Global Health, that is designed to address unmet needs for Family Planning and increase the use of Reproductive Health and Family Planning (RH/FP) services at the community level, especially among under served population, in order to improve health and socio-economic development. To accomplish its mission, ESD strengthens global learning and application of best practices, increases access to community level Reproductive Health and Family Planning (RH/FP) services; and improve capacity for supporting and sustaining Reproductive Health and Family Planning (RH/FP) (services).

ESD’s Approach to Healthy Timing and Spacing of Pregnancies

·        HTSP is a key RH/FP intervention for both reducing unmet need for FP/spacing AND for reducing maternal and infant mortality and morbidity

·        Global research indicates an association between timing of pregnancies and maternal and child health outcomes

·        HTSP Recommendations for Improved Maternal and Child Health

·        A couple should wait at least two years before considering becoming pregnant again

·        After a miscarriage or abortion, a couple should wait at least 6 months before considering becoming pregnant again

·        A woman’s first pregnancy should not occur before 18 years of age

Statement of the Problem

There is low use of Long Acting Reversible Contraceptives (LARC) methods in developing countries. According to the Nigeria Demographic and Health Survey of 2010, 20.5% of sexually active women are using LARC methods (Macro 2011).  Inability to access these highly effective family planning methods by the majority of sexually active women in reproductive age has tremendous negative consequences. Challenges which culminate from low use of Long Acting Reversible Contraceptives (LARC) methods in Nigeria include rapid population growth among others (Macro, 2011). The government is unable to meet the demands for the social services of its people like education, housing, health and employment with the ever increasing population (FMG, 2012).

Nigeria is characterized by a high rate of unintended pregnancy, which is a result of contraceptive failure, poor use of short term methods (pills, condoms) and non-use of modern contraception (Black, 2010). The 2010 Nigeria Demographic and Health Survey indicates that 39% of pregnancies were unintended (Bradley, 2011). These unintended pregnancies have negative consequences on the health and wellbeing of women and their families (Bradley, 2011). Studies indicate that children born from unintended pregnancies are less likely to be breastfed, more likely to be stunted and have a higher risk of child mortality than children from wanted pregnancies (Gipson,  2009). The quickest way to eliminate these negative health outcomes is through an increase in the use of LARC methods (Combs, 2013). A comparison of maternal and child health indices from Nigeria and developed nations indicates the need for the promotion of long acting reversible contraceptives (Jacob, 2012). For instance, maternal mortality is rare in Sweden, with two deaths per 100 000 live births (Johnson, 2011), whereas in Nigeria maternal mortality is high, at 675 deaths per 100 000 live births ( Macro, 2011).

Therefore, it is imperative to focus on solving the challenge of low LARC use in Nigeria for the country to enjoy better socio economic conditions.

 Purpose of the Study

The purpose of the study is to determine the Assessment of Healthy Timing and Spacing of Pregnancy Approach in Long Acting Reversible Contraceptives acceptance among women in Yala Local Government Area of Cross Rivers State. Specifically, the objectives seek to:

i.                    determine the level of knowledge of Long Acting Reversible Contraceptives acceptance among women.

ii.                 determine the level of acceptance of Long Acting Reversible Contraceptives acceptance among women.

iii.               determine the attitude of women towards Long Acting Reversible Contraceptives acceptance.

Significance of the Study

Increased use of Long Acting Reversible Contraceptives (LARC) methods would help reduce government expenditure on maternal and infant health through the reduction of mortality and morbidities. The savings can be channeled to mitigate other socio-economic challenges in the country.

This study will inform policy on measures which can help increase LARC use, which in turn reduces many sexually reproductive health and economic challenges associated high fertility.

This study will help couples to know different methods of modern family planning

available for their use and benefits of those methods which will help reduce

maternal and child mortality in the area.

It also contributes to the pool of data which are needed to in developmental play by

the government.     

The result will also assist the health care providers with adequate information about problems associated with reproductive health which will serve as basis for health education, counseling and advocacy programmes on reproductive health.

This will help in eradicating ignorance about family planning, prevention of obstetric complications like criminal abortion, sexually transmitted diseases and HIV/AIDS, improvement in maternal and child health, reduction in population, reduction in maternal mortality and morbidity and reduction in poverty and hunger in the community.

The research findings will also provide information that will influence positive behaviour change towards the acceptance of women of child bearing age on the use of modern method of family planning.

The findings of this study will also reveal the acceptance level of modern family planning methods among women of child bearing age in the study area, which will help in creating awareness to couples on how to regulate the size of their family for modern family planning method.

The findings of this study will provide the government with necessary information on how to put strong family planning policies that will help improve maternal and child health services in the area, reduce maternal and child mortality or morbidity, reduce poverty and improve general wellbeing of the people.

Research Questions

i.                    What is the level of knowledge of Long Acting Reversible Contraceptives acceptance among women?

ii.                 What is the level of acceptance of Long Acting Reversible Contraceptives acceptance among women?

iii.               What is the attitude of women towards Long Acting Reversible Contraceptives acceptance?

Scope of the Study

This research is centred on the Assessment of Healthy Timing and Spacing of Pregnancy Approach in Long Acting Reversible Contraceptives Acceptance among women in Yala Local Government Area of Cross Rivers State. It is hoped that the benefits of Healthy Timing and Spacing of Pregnancy Approach in Long Acting Reversible Contraceptives Acceptance would have been known by women in the study area in the course of this research work.


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