CHAPTER ONE

 INTRODUCTION

1.1 Background of Study

Contraception is the intentional use of temporary, long-term or permanent methods to prevent pregnancy as a result of sexual intercourse by inhibiting viable sperm from coming into contact with a mature ovum or by preventing a fertilized ovum from implanting successfully in the endometrium. Contraceptive methods are either modern methods or traditional methods. The modern methods include combined oral contraceptives (CoCs /pill), progestin only pills (PoPs / minipill), combined injectable contraceptives (CiCs/ monthly injectables), progestin only injectable contraceptives (POICs), copper Intrauterine device (IUD), levonorgestrel IUD, male and female condoms, male and female sterilization, lactation amenorrhoea method (LAM) and emergency contraception. Traditional methods are coitus interruptus (withdrawal) and fertility awareness methods (FAM or natural family planning or periodic abstinence).

Contraception plays a vital role in preventing pregnancy-related health risks. Women’s health and well-being are affected negatively by occurrence of unintended pregnancies. Reduction of unintended pregnancies proportionately reduces the rate of unsafe abortions. Contraception allows for delaying and spacing of pregnancies in young women who are at an increased risk of health problems and maternal mortality from early child bearing while it prevents high risk pregnancies in older women. Limiting the size of families is also made possible by use of contraception. This contribute to achievement of millennium development goal (MDG) 5 in improving maternal health (2,3). Closely spaced and ill-timed pregnancies and births which contribute significantly to infant mortality can be prevented by use of contraception since it allows for the spacing of pregnancies. Reduction in infant mortality contributes to the achievement of MDG 4 (2,4).

In Nigeria, awareness of contraception is almost universal. Ninety-five per cent of women and 97% of men aged between 15 to 49 years know at least one modern method of contraception. The contraceptive prevalence rate in Nigeria is 46% of which 39.4% use modern methods of contraception while 6.1% use traditional methods. The level of contraceptive use in all sexually active women in Nigeria is 51.1% (5). The prevalence of unintended pregnancies, which include both mistimed and unwanted pregnancies, in married Nigerian women was at 43% in 2008-2009

The main cause of unintended pregnancy is contraceptive failure and non-use of contraceptives  Hormonal contraceptives exert their contraceptive action by interfering with the feedback mechanism that regulates the release of progesterone and oestrogen consequently interfering with either ovulation, fertilization, implantation or all the three processes. Hormonal contraceptives include combined oral contraceptives (CoCs), combined injectable contraceptives (CiCs), contraceptive patch, combined vaginal ring, progestin only pills (PoPs), implants, Progestin only injectable contraceptives (PoICs) and Progestin IUD. CoCs, CiCs, patch and vaginal ring contain both a progestin and an oestrogen in varying amounts while PoPs, implants, PoICs and Progestin IUDs contain a progestin only. The Progestin IUD is more than 99% effective as compared to the pills, injectables, patch and ring which are about 91% effective in preventing pregnancy. CoCs and PoPs are administered orally on a daily basis with emphasis on strict timing for the PoPs. CiCs and vaginal ring are administered monthly while the patch is applied weekly. Implants are effective for 3-5 years, PoICs for 12-13weeks and Progestin IUD for 5 years (2,7–9).

1.2 Problem statement

The awareness of contraception in women is 95% according to KDHS 2008-09. This is not commensurate to the prevalence of contraception use in sexually active women which is 51.1%. It is therefore not surprising that the prevalence of unintended pregnancy in married women is at 43% due to the gap between contraceptive knowledge and contraceptive use.

Unintended pregnancies are mainly caused by contraceptive failure and non-use of contraceptives. The consequences of unintended pregnancies affect the woman, the family and the society at large. One of the consequences of unintended pregnancies is unsafe abortion which could lead to maternal morbidity and mortality. There could also be risky maternal behaviour such as alcohol intake, cigarette smoking and illicit drug use which have negative effects on the developing foetus. The woman may also not seek for antenatal care leading to poor birth outcomes such as low birth weight, prematurity and still births. After birth, the mother may not breastfeed the child leading to morbidity and mortality, malnutrition and impaired child development. Postpartum depression could develop leading to child abuse. As all these happen, marital and family instability could be present aggravating the poor mental health of the woman. Unintended pregnancies reduce the chances of attaining formal education in colleges and universities especially in teenage women. This leads to decreased chances of being part of the paid workforce and consequently reduced economic stability. Unplanned pregnancies and birth reduce earnings both in the short and long term. Heightened conflict and decreased satisfaction in relationships may arise from unintended pregnancies; relationships are more likely to dissolve after an unintended pregnancy. Individuals who experience unintended pregnancy are more likely to experience depression, anxiety and lower levels of happiness.

Improvement of contraceptive use and counselling on contraceptive use could play a major role in prevention of unintended pregnancies and their negative effects.

1.3 Purpose of the study

Unintended pregnancies are mainly due to non-use of contraceptives and contraceptive failure which is either user failure or method failure. Appropriate contraceptive use averts the occurrence of unintended pregnancies. This study therefore sought to find out the awareness of contraceptive use, the copying strategies type of hormonal contraceptives used, level of knowledge on the correct use and the prevalence of side effects among hormonal contraceptive users and the management of side effect of contraceptive use

1.4 Objectives

1.4.1 Broad objective

To assess the awareness and copying strategies of management of side effect of contraceptives in Community Health Center in Aluu local government area.

1.4.2 Specific objectives

1.      To determine the prevalence of contraceptive use among women in their reproductive age at Community Health Center in Aluu local government area.

2.      To find out the type of coping strategies used by women in their reproductive age at Community Health Center in Aluu local government area between 1st May 2018 and 30th June 2018.

3.      To assess the level of knowledge on the correct use of hormonal contraceptives among women of child bearing age at Community Health Center in Aluu local government in Anambra state.

4.      To find out the prevalence and management of side effects of contraceptive use among women of child bearing age  at Community Health Center in Aluu local government area.

1.5 Research questions

1.      What proportion of women in their reproductive age at Community Health Center in Aluu LGA that used contraceptives?

2.      Which types of coping strategy were the women at Community Health Center between 1st May 2018 and 30th June 2018 using?

3.      Did the women at Community Health Center know how to use the hormonal contraceptives correctly?

4.      What was the prevalence and management of side effects of hormonal contraceptives at Community Health Center in Aluu LGA?

1.6 Significance of the study

The study sought to establish whether hormonal contraceptive users understood the instructions of use and therefore used the contraceptives appropriately. It also sought to find out the most prevalent side effects which would hinder corred consistent use of hormonal contraceptives. Appropriate and consistent use of hormonal contraceptives ensures that contraception is achieved and occurrence of unintended pregnancies is prevented. 

The study will assist reproductive health workers especially nurses to formulate strategies to improve quality of counselling during initiation and continued use of hormonal contraceptive methods. Improved counselling will assist hormonal contraceptive users to use the contraceptives correctly and consistently therefore preventing unintended pregnancies.

In addition, the study will serve as a reference for the prevalence of hormonal contraceptive use, pattern of hormonal contraceptive use, level of knowledge on the correct use of hormonal contraceptives and prevalence and management of side effects of hormonal contraceptives in the study area.

1.7 Limitations

Some of the women were not able to identify the coping strateiges, they were on leading to exclusion. Response bias and interviewer bias might have occurred. Contraception is a personal, private and sensitive issue therefore some of the women might have responded in the negative concerning the use of the same to conceal potentially embarrassing information. Participants who used hormonal contraceptives were interviewed on how they used the contraceptives. The PI asked the questions on the knowledge of correct use of hormonal contraceptives and as the participant gave her responses spontaneously, the PI indicated their response by ticking the corresponding option. This might have led to the interviewer interpreting the responses in their own understanding despite the questions being close-ended to minimise interviewer bias.

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