CHAPTER ONE

INTRODUCTION

1.1     Background of the Study

Family planning is a way of thinking and living that is adopted voluntarily on the basis of knowledge, attitude and responsible decision by individuals and couples in order to promote health and welfare of the family, groups and thus contribute effectively to the social development of the country (WHO, 2011).It involves practices that will enable couples or individuals to determine the number of children they would like to have, when to have them, that is both the timing and spacing and most importantly, those they have the capability or the means with to cater for. (Fumilayo and Kolawole, 2000).

Men are pivotal decision-makers at all household level within the rural communities. The duty of men in the society seems supreme; especially in rural communities they are in charge of the family, they run the world governments, they control religious organizations and they co-ordinate all social systems (Okeke, 2005). Furthermore, they play vital role in pregnancy and delivery and transmission of sexually transmitted infections. Onuoha (2000) stated that African men are mainly responsible for deciding whether their wives will practice family planning and the methods to be adopted. He further stated that the true position is that in traditional African societies, including Nigeria, men are conferred with authority to determine who gets what, how and when in the family. This authority implies that they have the final say on the number of children the family should have, the spacing, maternal health and general level of reproductive health in the family. Thus any family planning programme that excludes men may have minimal impact on the targeted population.

Male involvement in family planning would increase its recognition, acceptance and practice by people especially within the rural communities. This is because in rural communities in Nigeria, including Enugu, men are still the gate keepers in the families who control power and decision making. Their involvement will help to achieve huge success in the numerous campaigns aimed at reducing, population explosion in Africa, arrest the increasing surge of sexually transmitted infections and reduce maternal and infant morbidity and mortality (Onuoha, 2000).

In European countries, statistics show that an average of 65% of men go for family planning yearly. In America about 70% of males go for treatment of sexually related infections like HIV/AIDS yearly due to awareness campaigns about the importance of involving men in family planning (Davidson, 1999).In African countries, for example in South Africa, about 35% of the people that attend family planning and immunization clinics are males. In Togo, it was noted that male involvement in family planning and voluntary health screening and counseling compared with the females is in the ratio of 1:3 (Robert and Brown, 2000).

Despite global recognition of the importance of male involvement in family planning, Nigeria has not developed programmes in family planning that fully involve men. Most family planning programmes in our environment seem to focus on women only, the non- inclusion of men in various family planning programmes by program planners has made men not to know much about family planning and the benefits to their spouses and family especially in rural communities. Yet men can participate in family planning either as users of male methods or as supportive partners of users. (Fumilayo and Kolawole, 2000).

With the above scenario, one wonders what then will be the situation in rural communities in Enugu East Local Government Area where tradition is still highly upheld. Rural communities have typical characteristics such as: they share common interest, bound or tied to tradition and culture, resist change among others. These make men exercise undue authority or control over their wives in family matters such as issues of child bearing and contraceptive use. All these seem to make the acceptance of family planning more difficult in these rural communities (Onuoha, 2000). Therefore, it is very important to get them involved in family planning in order to achieve better success. This will improve health of both themselves and their spouses.

1.2     Statement of Problem

Documented evidence shows that three hundred million pregnancies occur in sub Saharan Africa and eleven million Nigerian women get pregnant yearly. (Ntadom, 2007), while half a million women die from complications related to pregnancy and child birth each year, with 99% of these deaths occurring in developing countries including Nigeria. (Chuwa, 2012). It is estimated that approximately, 200 million couples in developing countries would like to delay or stop child bearing but are not using any method of contraception (World Health Organization (WHO), 2011).

 In Nigeria, couples involvement in family planning is low, for example, a study conducted in Ilorin on couple involvement in family planning showed that only 20% of respondents were using contraceptives (Levy, 2006). Men control pregnancy especially in the rural communities, yet they treat pregnancy and delivery problems as women’s affair and at the same time control the family size without any reference to the health of the mother. Women bear the brunt of the risks associated with reproductive health matters. For example, they are left to bear the entire burden of prevention of unwanted pregnancies, sexually transmitted infections, as well as the use of contraceptives alone. This is particularly the issue in the rural communities. Though males do not carry pregnancy, they are the initiators of the process. Women in rural communities still depend on the consent of their husbands before taking decisions on matters that affect them directly such as adopting family planning methods, frequency of sexual intercourse, family size, etc.

Records from the maternity department in ESUT Teaching Hospital Parklane from January to August (2010), showed that out of 40 referral cases from health centres in rural communities in Enugu East Local Government area, 20 were of high parity, with its associated complications. This high parity was attributed to their husbands’ decision and cultural values. Records in the same hospital showed that family planning attendance by males between 2005 and 2010 was 10% (Records from family planning unit in ESUT Teaching Hospital Park lane, 2011). One wonders what then could be the practice in the rural communities where men’s dominating rights are highly preserved.

Hence, the need to carry out this research work on socio-economic and cultural determinants of use of family planning services in Uruan Local Government Area of Akwa Ibom State.

1.3     Objectives of the Study

The purpose of the study was to find out the socio-economic and cultural determinants of use of family planning sevices in Uruan Local Government Area of Akwa Ibom State. Specifically, the study was set to find out:

1.       The use of Family Planning methods

2.       Family Planning Practices based on level of education and occupation

3.       Family Planning Practices based on cultural affiliation

1.4     Research Questions

The following research questions were posed to guide the study:

1.       What are different Family Planning methods and services used in Uruan LGA

2.       Are Family Planning Practices based on level of education and occupation?

3.       Are Family Planning Practices based on cultural affiliations and beliefs?

1.5     Research Hypotheses

The following null hypotheses were postulated and tested at 0.05 level of significance:

1.       There is no significant difference among the mean scores of couples’ involvement in FPPs based on their levels of education and occupation.

2.       There is no significant difference among the mean scores of couples’ involvement in FPPs based on their cultural affiliations and beliefs.

1.6     Significance of the Study

The results of this study are useful to health educators, curriculum experts, health agencies, FP service providers, counsellors and policy makers. The results of the extent of couples’ involvement in FPPs revealed the degree of males’ participation in FPPs which may have been affecting the success of FP programmes. The results will be useful to health educators and health agencies in planning and implementing FP campaigns for men in order to either sustain or improve their extent of involvement.

The results will be useful to health educators, curriculum experts and FP service providers. The health educators will develop Information, Education and Communication (IEC) materials on FP that will be easily understood by illiterate males. The curriculum experts will develop training manuals that will equip health educators and FP service providers with the skills to communicate FP messages effectively to both literate and illiterate men. The FP service providers will use the results to interpret FP messages in a way illiterate men can understand.

The results will be useful to health agencies and policy makers. The health agencies will utilize the results in organizing FP sensitization programmes for men in occupations recording low levels of involvement in FPPs and in providing FP commodities, such as condom, at little or no cost so that men, in low income occupations, can afford it. The policy makers can also use the results in formulating policies aimed at subsidizing the cost of FP commodities and procedures such as vasectomy and tubal ligation for low income earners.

1.7     Scope of the Study

The study was conducted in Uruan Local Government Area of Akwa Ibom State, and was restricted to married couples residing in the Local Government Area. The study was also concerned with finding out the socio-economic and cultural determinants of the use of Family Planning services. Such factors as level of education, occupation, cultural affiliation and beliefs as they affect the extent of couples’ involvement in the use of Family Planning methods.

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