Family Planning Final Thesis PDF

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/339201964 family planning final thesis. Thesis · February 2020 DOI: 10.13140/RG.2.2.19053.33769 CITATION...

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/339201964 family planning final thesis. Thesis · February 2020 DOI: 10.13140/RG.2.2.19053.33769 CITATION READS 1 30,416 1 author: Hamze ALI Abdillahi Medical lecturer. 22 PUBLICATIONS 1 CITATION SEE PROFILE All content following this page was uploaded by Hamze ALI Abdillahi on 08 September 2022. The user has requested enhancement of the downloaded file.  CHAPTER ONE INTRODUCTION 1.0. Background of the Problem Family planning (FP) practices, especially use of modern contraceptives, seem to remain a complex problem and challenging among most communities in the contemporary society, despite huge leaps of gains registered in some parts of the world, like the Latin America, (Frost and Dodoo.2009:45, Fahimi and Ashford 2005), since it was launched more than 50 years ago. The meaning of family planning as used in the context of this study, is adapted from World Health Organization (2012) assertion that, ‘Family planning allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births’, and which is recognized by such scholars like Paek et al. (2008), could be ‘achieved through the use of contraceptive methods, which is considered to represent (modern) family planning behavior (Population report 1984) considers family planning as one of the high priority techniques for improving child health, along with growth monitoring, oral rehydration therapy, breast-feeding, immunization, food supplements and female education. Rapid population growth, which often outpaces economic growth and environmental Sustainability, is a reality in most developing countries of sub-Saharan Africa. Since the early 1980s, population growth rates in this region have remained at high levels, and contraceptive Prevalence Levels in many countries have remained under 15% (World Bank, 1993a; LJNDP, 1 992). High rates of maternal and child mortality are often associated with rapid population growth. 1 Early and frequent childbearing means that in 15 women in Africa dies from reasons related to pregnancy, odds over 200 times greater than those faced by women in Canada (Rosen and Conly, 1998). Moreover, one in six African children does not live to sec his or her fiAh birthday (UNDP, 1992). Fertility regulation, through the use of family planning, has been shown to be an effective means of slowing population growth rates, which is essential in order to achieve a sustainable balance between socio-economic development and availability of resources. Furthermore, because family planning helps couples avoid high-risk pregnancies, the World Bank considers it to be one of the most cost-effective programs for preventing maternal and filial deaths (Measham and Rchat, 1988). Definition of Family Planning According to the World Health Organization (WHO), family planning refers to those practices that help individuals or couples avoid unwanted births, bring about wanted births, regulate the intervals between and timing of pregnancies (Le., child spacing), and determine the number of children in a family (WHO Expert Committee, 1971). Family planning is a fertility regulation approach that is adopted voluntarily by individuals and couples, in order to promote both personal and family health and well-king. According to a resolution of the Twenty-six World Health Assembly: Family planning plays important public health roles in regulating fertility (population growth) and reducing mortality, especially maternal mortality. In developing countries, as compared to developed ones, there is still rapid population growth and high mortality rates. In these same countries, contraceptive use is still very low. The greatest problem of our time is the rapid growth of population, especially developing countries where this population growth matters, because it has enormous impact on human life. 2 Promotion of family planning in countries with high birth rates has the potential of reducing poverty and hunger, while at the same time averting 32 percent of all maternal deaths and nearly 10 percent of child mortality. This would contribute substantially to women's empowerment, achievement of universal primary schooling and long term environmental sustainability 10, 27. Hawkins 14 observed that family planning services offer various economic benefits to the household, country and the world at large. First, family planning permits individuals to influence the timing and the number of births, which is likely to save lives of children. Secondly, by reducing unwanted pregnancies, family planning service can reduce injury, illness and death associated with child birth, abortions and sexually transmitted infections (STIs) including HIV/AIDS. Every year almost 515,000 women die from problems linked to pregnancy and child birth, and approximately 30 more develop serious disabling problems. Family planning could prevent many of these deaths and much of this disability. Unintended pregnancy is a worldwide problem that affects women, their families and society. Unintended pregnancy is associated with an increased risk of morbidity for women, and with health behaviors during pregnancy that are associated with adverse effects. For example, women with an unintended pregnancy may delay prenatal care, which may affect the health of the infant. Women of all ages may have unintended pregnancies, but some groups, such as teens, are at a higher risk It requires heavier investment in education, health, and transport merely to maintain these. In order to reduce the population growth rate, as well as the risk of women and children and the poverty level of the society, contraceptives methods have been used as an effective measure in family planning all over the world. We must also step up efforts for family planning, which has a direct impact on maternal health.The need for family planning 3 is growing fast, and it is estimated that the ‘unmet need’ will grow by 40 percent during the next 15 years Family planning in Somaliland in the present day context is nothing new nor is it any surprising concept. People now do not raise their eye brows to hear the word ‘family planning’, rather it has been now accepted as something useful and beneficial by the general public in the urban cities and towns , but even though the control of population in Somaliland is a delicate issue in view of its social, cultural and economic conditions. Family planning was listed as one of the basic elements of primary health care at the Alma Ata Conference in 1978 for which Somalia was a party. It is an indispensable strategy for promoting family health. Planned deliveries promote the health of the mother, child and that of the husband. The mother is given enough time to recover from the effects of pregnancy and birth. There are many methods of contraception, which have been used such as the oral pill, injection, condoms, intra uterine device, sterilization, Norplant, rhythm method, and withdrawal. According to the 2008-09 Somaliland Demographic and Health Survey, the contraceptive prevalence rate (CPR) for Somaliland was estimated 15 percent. Therefore, one way of approaching the problem may be to explore, how perceptions, attitudes and experiences among Ibraahim koodbu women of Somaliland origin influence their family planning practices by examining psychological nuances which may be behind such reconstruction and how it could constrain, but possibly also enhance women’s agency, as this study has attempted. 4 1.1 Statement of problem While many women know about contraception and approve of it in general, not all that approve of contraceptives use it. Some are not currently using contraceptives because they want another child. Others say they or their partners are sterile. While others want to prevent pregnancy but do not want to use contraceptives for a number of reasons that family planning programs should address. Large-scale survey as well as small studies done in Somaliland as well as other countries indicate that women’s family planning and other reproductive health knowledge, attitude and practices are more clearly understood now than before. Nevertheless, the picture is still incomplete and offers only a broad look at a group that is far more complex than survey statistics alone can suggest. More in-depth, quantative and qualitative studies are required to probe such issues such as women’s reproductive decision-making, men’s unmet needs for family planning, the gap between women’s approval and use of contraception and how different groups of women regard reproductive health issues. The purpose of this study therefore is to endeavor to fill in the gap between women’s approval and use of contraception. In Ibraahim Koodbuur district (where this research will be based), although there is some change in the old-age attitudes to family size, Family planning programs have not yet taken hold in the rural areas of the district. The majority of people have not yet grasped the importance of family planning. Contraceptive usage in the district is still very low, estimated at about 2%. Moreover, the majority of these are in urban areas. The reasons for non-usage of contraceptives that were cited by women included fear of side effects, religious 5 1.2 Objectives of the study 1.2.1. General objective To assess level knowledge, attitude, practice of family planning among the women of reproductive age (15-49) at Ibrahim kood buur district Hargeisa city Somaliland 1.2.2. Specific objective ⮚ To determine the methods of contraceptive available to women their use in Ibraahim koodbuur ⮚ To determine women’s knowledge, attitude, and practice of contraception ⮚ To find out the factors related family planning of women reproductive age 1.2.3 Hypothesis ⮚ There is positive relationship between the knowledge, attitude, and practice with family planning 1.4 Scope of study 1.4.1: Geographical This study was engaged and going to take place in Kood Buur district especially people who lives four sub districts, in Hargeisa city capital of Somaliland. In addition to that, data was collected through questionnaire by the study team and the study was specifically determine gap of family planning among women Ibrahim kood buur and how they understanding about family planning, at Ibrahim kod district Hargeisa Somaliland. 6 1.4.2: Time scope The study duration was from April to Jully 2015. 1.5. Significance of the study This study can also be useful for other researcher to gain valuable information regarding issue of interest. It can also be valuable to the organization working in family planning sector to know the factors influencing unmet needs and conduct necessary programs. This study can also provide information to those working in the area of Human immunodeficiency virus (HIV) and Acquired immunodeficiency syndrome (AIDS) to estimate the utilization and hindering factor for use of family planning methods. The main reasons behind the unmet needs are necessary to be known in order to formulate good plans and policies, in Somaliland of reproductive health department. 1.6.Operational definitions In the hypothesis formulated for conducting this study have some key concepts to be explained: Literacy: the ability to read and write Knowledge of family planning : the awareness of keeping family within limits through means such as contraceptives and other medical aids. Empowerment of women : the attitude of taking initiative and leadership in women. Availability of electronic media: access of audio- visual means of communication like TV and radio. Co-operation of husband : A willing attitude of husband in adoption of contraceptive methods for keeping the family size in limits. 7  Attitude towards family planning: the way of feeling about family planning it would be positive or negative. Socio-economic status: the condition which defines the social and economic condition of a person in society. Practice of family planning: A conscious effort of couples to regulate the number and spacing of birth through artificial and natural methods of contraception. Access of family planning centers; Availability of government sponsored mother and child health care centers who provide family planning services. 17. Utility of the study The study would most likely achieve in the positive direction of the following results: To help the policy makers and administrators to make more effective family planning program for the women of Ibrahim koodbuur hargiesa city of Somaliland. Equip the planners and workers extending effective services for mother and child health care centers in the Ibrahim koodbuur of the hergiesa city. Provide a guide line step forwarding towards the awareness among the women of Ibrahim koodbuur regarding care of their reproductive health. Develop source material for better service in Ibrahim koodbuur. Open up grounds for further detailed investigations in the field of family planning for the women of Ibrahim koodbuur of Hargeisa Somaliland. 8  CHAPTER TWO LITERATURE REVIEW 2.0 Introduction Family planning program planners tend to assume that men are opposed to family planning and will, if involve in reproductive decision making, prevent women from regulating their fertility. Available data, however, suggests that the most successful family planning programs target women as well as men and promote communication about contraception between spouses. ( Karra et al 1997). 2.1 Knowledge and Attitudes of Women to Family Planning Machipisa (1997) noted that while approximately 73% of African men approved of family planning, only 22% couples use either a modern or traditional method. There are clearly many checks at the individual, community, institutional, and policy levels to increase both the level of active male involvement in Family Planning and acceptance use of appropriate methods. A study done in Kenya by Fapohunda and Rutenberg (1998) found that family planning awareness was high, but condoms and vasectomy were found to be stigmatized, and family planning was considered women’s responsibility. Men gave Family Planning only limited support because they believed that contraceptive usage had an adverse effect on women’s sexuality. Rondi and Ash fold (1997) found that in Egypt 87% of women approved of the use of family planning with the level of approval not varying much among men of different age groups 9 or education levels, or between rural and urban residence. 18% of married women surveyed reported having used a male method of contraception in the past, but vasectomy was extremely rare even though 60% of the surveyed men indicated desiring to have no more children. Mungai (1996) noted that while African men are largely apathetic to family planning, they are not necessarily uninterested. Many African men want to participate more actively in deciding how many children they should have and when to have them, but they lack sufficient information to do so. In some cases, many men do not know about contraceptives. Even those who are aware have little access to such services because family planning programmes are designed to serve women. In most African countries, family planning services are widely offered in perinatal units of public hospitals where many African men feel uncomfortable visiting. Studies in parts of Africa have shown that there is a strong link between knowledge and use of contraceptives and the level of education as well as economic status; the levels of knowledge and use of contraceptives are lower among the relatively less educated. Surveys have shown that while men in many cases are informed generally about family planning, they do not have detailed knowledge of the operation and use of converse methods. A reason for the men’s superficial knowledge of contraception lies in the way they obtain information: mainly from mass media and informally from relatives and friends. Radio, and Television are frequently the men’s source of information (Adamchak, Mbizo 1991). The mass media’s messages on family planning are mostly of general nature. 10 This may account for their knowledge which is general and lacks detailed information on methods, which is one of the pre-conditions for continuous use of modern family planning methods. Health workers and family planning helpers give a comprehensive counselling and explanation of application, effects and side effects of the various methods. However health facilities and family planning institutions have so far addressed female target groups, men are often excluded from detailed knowledge of the various methods of preventing pregnancy (Riedberger, 1994). In a study carried out in Eastern Uganda by Ebanyat(1990) on the pattern of birth intervals it was noted that an outstanding reason for non-use of contraception among women who knew about contraception was because husbands did not approve of it. Opio (1986) considering the need to involve men in family planning concluded that family planning is a joint responsibility of both women and men and that they should participate themselves. 25.4% of men in peri-urban areas around Kampala had the knowledge about family planning andhad at least ever used a method of contraception. Kabarangira (1996) noted that men’s opposition to family planning was not as wide spread as it was popularly believed. Women have a major role in the decision to use family planning methods and in determining the number of children a couple should have although they do not encourage women to participate in decision making about family size and share responsibility in women’s health. The problem appeared to be lack of communication between couples/ partners which if it was available, men’s consent for family planning use would be favourable. Male knowledge of various family planning methods was as high as was approval and ever use offamily planning and their important factor to prevent frequent and unwanted pregnancies or limit family size for financial reasons. 11  Current usage of family planning was low with one man using a permanent method (vasectomy) and the rest used condoms mainly for prevention of STDS especially AIDS other than for fertility 2.2 Factors Influencing Women Participation in Family Planning. There are various factors that influence male participation in family planning. These include cultural norms and values, religious beliefs, socio-economic factors, psychological factors. These factors can act as barriers to male involvement. 2.2.1 Religious beliefs Religious beliefs have a direct influence on family planning acceptance. For example the Islamic region does not subscribe to tubal ligation in women. For Muslims the Koran provides the infallible rules of conduct fundamental to their way of life. Previously conservative religion leaders represented a force opposing changes in the traditional status of women and large family norms in Egypt. However, the Grand Mufti openly expressed his support for responsible parenthood and family planning in an interview where he said that family planning is compatible with the trading of the Koran and there is no problem in promoting family planning. Among Islamic countries, Egypt is one of the few countries where family planning has been well accepted. The total fertility rate would not have dropped to 3.9 in Egypt without the strong support for family planning by the Grand Mufti. Religious leaders, medical doctors, and mass media specialists recognized that the Koran’s teachings harmonize with family planning, therefore the promotion of family planning has been successful. More people in other Islamic countries will come to practice family planning as they comprehend the Koran’s teachings accurately. Men should 12 definitely participate in family planning since family planning fits in with the Koran (Hata 1994). Membership of a certain religion is less determining for behaviour in family planning than the practiced religiousness. This may be one of the reasons why many Muslims do not practice family planning although the teachings of Islam do not forbid contraception while Catholics employ artificial contraception massively despite the ban by the church (Riedlberger 1994). The Adventists advocate for the idea of the small family, according to which a family should have as many children as they can adequately feed, educate and give religious instruction. Men who behave accordingly attain social prestige. 2.3 Cultural Factors In traditional societies of Africa children mean the reproduction of the lineage. The ancestors determine the maintenance of the tradition by as many descendants as possible. Families with few children refuse themselves the right of the fore bearers in the continuation of the line of descent (Caldwel 1987) Barriers to male participation include the perception of family planning and reproductive health as concerns of women maternal-child health services that do not target men, the limited availability of women contraceptive methods, and societal attitudes unfavourable to explicit support for equality of men and women (Ormel 1997). 2.4 Socio-economic Factors Factors such as education level, social class, urbanization and employment play an indispensable role in contraceptive behavior of men. The compulsion to move to the towns and the dependence upon monetary income associated with that, often changes that attitude of 13 men to family planning because as a rule in an urban environment they are the main provider for the family: An urban environment promotes the use of contraceptives although improved access to support facilities on one hand, and better education possibilities on the other are factors to consider (Kirumira 1991). 2.5 Psychological Factors/rumours The equation of potent with procreation of as many children as possible can also be seen as one reason for lack of sexual responsibility by women. In African countries, it is seen as a sign of poverty, sickness or disability for women who have intercourse with only one sexual relationship (Hawkins 1992). In Bangladesh a pilot distribution project found that most couples who received free condoms did not use them. The reasonwas that they thought that condom use could cause impotence. Population reports 1982). Family planning service providers are trained to counter such norms by reporting the facts. 2.6 Family Planning in Somaliland Somaliland has one of the highest maternal mortality ratios in the world at 1,044 deaths per 100,000 live births (MICS, 2006). According to MICS, 2006, only thirty-two percent of women received antenatal care (ANC) from skilled health personnel; whereas ANC coverage is only 26%, TT coverage stands at 26.3% and pregnant women receiving Vitamin at 4-25%. Although this is low coverage, given the Somali context, it is an opportunity to reach out with preventative services to women. "Somaliland has one of the worst maternal mortality ratios in the world, estimated to be between 10,443 and 14,004 per 100,000 live births," said Ettie Higgins, head of the UN Children's Fund (UNICEF) field office in Hargeisa, capital of Somaliland. 14 "Maternal mortality is the leading cause of death among women of reproductive age; it is caused mainly by haemorrhage, puerperal sepsis, eclampsia and obstructed labour," Higgins said, adding that women in Somaliland had a one in 15 risk of dying of maternal-related causes. 2.7 Summary of the gaps The above mentioned studies are empirical researches conducted in different places around the world. There are some gaps between these studies and the current study of knowledge, attitude, and practice of family planning following are the gaps identified; ✔ All the above mentioned studies were conducted outside Somaliland. So there is Contextual gap need to be fulfilled. ✔ Most of those related studies used secondary data in their researches. They have analyzed already existed data. But current study used primary data. 15  CHAPTER THREE METHODOLOGY 3.0. Study Design This study used a cross sectional survey, descriptive correlational and retrospective research designs. It is cross-sectional survey because questionnaires were distributed to the target respondents at one time. Descriptive-correlation was used to describe variables to be measured and determine the relationship between knowledge, attitude, and practice of family planning in Hargaisa Somaliland. Retrospective design was used because, Respondents were required to show their knowledge, attitude and practice toward research questions by reflecting back how the situation family planning was and how it is now.. 3.2. Study population. The study population was selected all the women resident of Ibrahim kood buur ,(married and unmarried) The study population was 10.000 people. Included women aged 15-49 years. 3.3.0. Sample Size Determination According to the nature of the target population where numbers of target population are 10,000, sample was taken from 10,000. Slovene’s formula was used to determine the sample size 𝑁 𝑁= 1+𝑁(𝑒)2 N = population 16 N =sample size E =level of significance at 0.05 10,000 𝑁= 1+10,000(0.05)2 = 384. 6 385 The target population of this study was 10,000 of women reproductive age (15-49) while the sample picked from it was 386 3.3.1. Sampling technique After free listing, papers bearing the names of the blocks of households were put in a excel and simple random sampling without replacement 10 blocks were selected by the principal investigator. A house hold was the basic sampling unit in each block. Households were selected systematically by standing in the middle of the block, (as identified by the LC guide), and spinning a pencil. The direction where the pencil pointed was taken and every household was included in the study. In each (blocks), 10 households were selected. In each selected household one women aged 15. The questionnaire was filled in by the interviewer. If the eligible person refused to consent to the study, she was excluded from the study. The next household was then considered 3.3.2 Inclusion criteria 1. All women aged 15 years and above. 2. Women are who had stayed in household. 3. Women who consented to the study 3.3.3 Exclusion Criteria. 1. Adult women who were not available at the time of the study 17 3.4 Study Instruments A pre-tested interviewer administered questionnaire with structured and closed ended questions was used for the survey. The questionnaire contained questions on respondents socio-demographic characteristics, knowledge about Family Planning sources of information on family planning, family planning practices and hindrance to participation. Variables 1. Dependant variable was current use of contraceptive method 2. Independent variables These factors that influence use of a contraceptive method by an individual and or a couple. These included: I. Previous use of contraception II. Knowledge of contraceptive methods III. Demographic characteristics like age, education level, marital status, and occupation IV. Sources of information on family planning V. Attitudes towards Family Planning VI. De-motivators and motivators to family planning use. VII. Availability and types of available contraceptives 18 3.5 Validity and Reliability Validity is the accuracy and meaningfulness of inferences, which are based on the research results. According to Mugenda and Mugenda (2003) validity is the degree to which an instrument measures what it is supposed to measure for a particular group. The instrument for this study that is the questionnaire guide was validated by the supervisor. Also a content validity index formula was used to calculate the validity of the instrument. 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑖𝑡𝑒𝑚 𝑑𝑒𝑐𝑙𝑎𝑟𝑒𝑑 𝑡𝑜 𝑏𝑒 𝑣𝑎𝑙𝑖𝑑 27 𝐶𝑉𝐼 = 𝑡𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑖𝑡𝑒𝑚𝑠 = 28 = 0. 96 Since the result of the validity test is above 0.70 the research instrument was considered valid (Kibuka, 2012) To measure reliability of the research instrument, crombach alpha co-efficient was used to test the constructs used to measure variables under study. Reliability of statistic Crobach’s Alpha N of items 0.74 28 The table shows the result of the reliability test using Cronbach's Alpha test. Result of the analysis shows good reliability measure having computed value of 0.74 which is above 0.7 acceptable reliability levels for acceptable research instrument as recommended by Nunnally, (1978). 19  3.6 Data collection Before getting to the field of the study the researcher ensured the following steps; 1) An introduction letter obtained from Addis Ababa university medical college approval to conduct the study from selected women reproductive age in Ibraahim koodbur 2) The respondents were given information about the study and its objectives, and requested to sign the Informed Consent Form. 3) The researcher reproduced more than enough questionnaires for distribution. 3.7. Data Processing and Analysis Quantitative data was entered in a computer and analyzed using the SPSS computer package. Frequency tables and cross tabulations were used to summarize data and tests for association was done by chi-square statistics. Qualitative data from recorded tapes were transcribed and analyzed with the help of a social scientist. 3.8. Ethical Clearance and Research Permission The project proposal, after approval by the Department Of ministry Health, University of Addis Ababa medical college, was sent to the Ethical Clearance Committee in Somaliland and got approved. Permission was sought for from the Regional Health Research and Application Council (Somaliland). An official letter from this Council was written to the Council of the town, before the interview went on the respondents were requested for their 20 consent to participate in the study. The purpose of the study was explained to them and they were assured of its confidentiality 3.9 Limitations of the Study 1. Respondents who refused to consent may have been different from those who accepted to the answer questions. 2. The study only looked at women and did not differentiate between use of FP method away from home or at home. 3. Men were not included in the study so their views about the barriers to women participation in FP were not obtained. 4. Time and internet is also barrier faced 21  CHAPTER FOUR RESULTS Section A demographic Profile This was to gather the background information of the respondents under study. This section is going to determine the demographic characteristics of the respondents in terms of gender, age, education level and years of experience. Q1 (1) age of the respondents Category Frequency Percent 15-19 5 1.7 20-25 81 27.0 40-49 97 32.3 26-39 117 39.0 Total 300 100.0 Figure:1 22 According the age 1.7% of the respondent within the range of age 15-19 years, 27% range 20-25 years, 32.3% the ranges 40-49 years. While highest range 26-39 years, Therefore indicate the highest reproductive age 26 -39. Q1 (2) education level Categories Frequency Percent Un able to read and write 130 43.3 Able to read and write 170 56.7 Total 300 100.0 Figure:2 23  In accordance with data show in table 2 and figure 2 the respondents was unable to read and write 43.3% of the respondents were able to read and write 56.7%.The higher people able read and write Table (3) Q1 (3) what is your current marital status Categories Frequency Percent Divorced 9 3.0 Married 291 97.0 Total 300 100.0 Figure3 24 The majority of respondents were married comprising (97%, n =291) of the participants. 25 Q1 ( 4) monthly income of women reproductive age Table 4 Categories Frequency Percent 700-1000$ 26 8.7 500-700$ 57 19.0 100-500$ 217 72.3 Total 300 100.0 Figure:4 Q1 (6) this graph shows us 72.333% were 100-500$ monthly income. But 19% were 500-700$ per month. Also 8.6667% were respond 700-1000$ per month. 26 What is your current occupation Table5 Categories Frequency Percent Unemployed 1.3 Other (specify) 2.7 Student 3 1.0 House servant 6 2.0 Government employ 35 11.7 Private employ 65 21.7 House wife 188 62.7 Total 300 100.0 figure:5 Q1 (7) this graph shows us 62.667% were house wife , 21.667% were private employment ,11.667% were government employment , 2% were house service, 1% were student. 0.6667% were other specify , 0.3333% were government employ. Figures (6) Q1 ( 6) age at married Categories Frequency Percent 27  25-29 2.7 30-34 3 1.0 20-24 98 32.7 15-19 197 65.7 Total 300 100.0 Figure: 6 Figure 7 and table shows 0.7% respondents were range 25-29 years, 1% of respondents were range 30-34 years, 32.7% respondents were range 20-24 and highest percentage 65.7% respondents were range 15-19. 28 Section B: Contraceptive Information access is essential for increasing people’s knowledge and awareness of what is taking place contraceptive around them, which may eventually affect their perceptions and behavior, It is important to know the persons who are more or less likely to be reached by the media for purposes of planning programmers intended to spread information about health and family planning. Variable Frequency (n) Percentage % Do you have knowledge about family planning No 117 39 Yes 183 61 Did you use FP methods during your last days Yes 108 36 No 192 64 Do you have access of family planning center in your area Yes 182 60.7 No 118 39.3 When do you prefer to have a child Months 12 1 Yearly 285 4 I don’t know 3 95 Have you (your partner) ever used family planning method before Yes 110 36.7 No 178 59.3 I don’t know 6 2 Which the method you/your partner used 8 2.7 Condom pill 30 10 No method 74 24.7 Injection 14 2.3 You approve of family planning Birth limit 157 42 Birth Spacing 131 43.7 Both 12 4 You see the table knowledge of family planning used the Ibraahim koodbuur women of reproductive age (15-49) development of profile regarding knowledge of family planning 29 method was one of the major object of survey 61%, last days did not use a family planning 64%, access family planning center area were 60.7%, Which the method you/your partner used It is evident that over 24.7% of the women use no method of family planning. Injections are used by (2.3%) of the women while pill is used by (10%) of the women. Only (2.7%) of the women use the condom Qualitative Reasons for non Use The reasons why women are not using any family planning method are of great interest to students programe the main reason was side effect, religion of the women. This was followed by responds mentioning that they wanted more children respondent opposed to family planning 30 Section c: Factors effecting family planning 1. If there is relationship between the education level and the knowledge about family planning Do you have knowledge Total Chi-sq p-va about family planning? uare lue 3.041.031 Yes No Education Able to read and 111 59 170 level? write Un able to read and 72 58 130 write Total 183 117 300 Source: Primary data Significance level 0.05 or 5% is less than 000, we reject the null hypothesis, and there is positive relationship between the level of education and the level of knowledge family planning. Finding: if increase the level of knowledge women reproductive age (15-49) also increase the level of knowledge family planning a women reproductive age. 2. Level of source of information and family planning center Do you have access of Total Chi-s p. family planning center quar value in your area? e Yes No What was your Health 114 16 130 73.5 0.00 first source of worker/facilit information about y this service? Mass media 65 91 156 Friends 3 7 10 Neighbors 0 4 4 Source: Primary data The p. value (0.000) is less than the significance of study 0.05 or 5%, we conclude positive relationship between the awareness due to family planning and practice the family planning a women reproductive age (15-49) in Ibraahim Koodbuur 31 32  CHAPTER FIVE DISCUSSION 5.0 Discussion The findings provide a representative information regarding knowledge, attitude, Practice, factors motivating women participation in FP and hindrances to use of FP of adult women living in Ibraahim Koodbur. 5.1- knowledge about family planning Knowledge is a key factor influencing use and attitudes to the family planning practice. If people are well informed about the benefits, methods used and their side effects, they are likely to have a positive attitude and the majority will participate. Surveys have shown that while women reproductive age in many cases are informed generally about family planning, they do not have detailed knowledge of the operation and use of converse methods. A reason for the women’s superficial knowledge of contraception lies in the way they obtain information: mainly from mass media and informally from relatives and friends. Radio and Television are frequently the women’s source of information (Adamchak, Mbizo 1991). This was reflected in the current study with minor differences. In this study the majority of the respondents 64% had heard about family planning. Most knew the correct meaning of family planning. Knowledge of at least one modern method of family planning was 63 %. This level of knowledge was lower than that obtained from males interviewed in 1995 33 5.2 attitudes towards family panning The majority (64.8 %) of the women had a good opinion towards use of family planning methods. A significant percentage of 28.3 % said they had no idea. Furthermore attitude was assessed by the perceived roles women have towards family planning. Most of the roles given were positive towards family planning. However they were biased towards males. This positive attitude should be uterine by the family planning managers to increase on the contraceptive prevalence rate for the area. Both the quantitative survey and the qualitative discussions revealed that some women think that FP is a women’s affair. This attitude needs to be addressed in order to improve on the family planning prevalence.61.1% women felt males have a role to play in family panning. However only 18.8 % acknowledged that males should use family planning methods. The remaining percentage thought the women should facilitate their husband to participate in family planning in terms of discussing with their partners and deciding for them 16.4 %, educating their partners 9.7 % making decision for their husband 1.7 % Some respondents, especially in the interviw discussions and key informants thought that women should discuss with their husband and decide for them. This shows that women are not willing to involve themselves in using family planning methods but are willing to support their husban. This misconception may have stemmed from the way family planning managers were mainly targeting the women. And most of the services were/are being offered in maternal and child health clinics as was established in this study. Other workers like Mungai (1996) have too reported this. 34 There is therefore need to address this concern by having a program that integrates women in family planning. Some respondents suggested starting up women only family planning clinics. Research done in Kenya has also recommended this. 5.3 family planning practices 26% of respondents had ever used any method of family planning. This was similar to that obtained in multi indicator cluster survey (MICS) 2006 of 25%. Although awareness among women about family panning was good, previous use was low. This confirmed previous findings (Semwezi 1988, Bazilaki 1987, Kabalangira 1995 most commonly used was condom. This could have been due to its added advantage of preventing STDs. No respondent had ever used vasectomy probably because most of the respondents were still young. Of those who had ever used 26.9% had stopped using FP due to various reasons the commonest being that they wanted to have more children. 5.4 Factors motivating women to use FP. 26% of the respondents had ever used a method of family planning. The primary motivation for use of contraception was to space childbirth. When participants in the interview study were asked to define family planning, they frequently mentioned birth spacing. Economic motive was the next most frequently cited reason for adopting family panning These include on going experiences, such as school fees, and medical care as well as long time considerations such as inheritance and old age security. This was mentioned by 24.2% of the respondents Among other reasons given for use were wanted to rest (health), dislike for premarital births and having reached the desired family size. 35 When all respondents were asked about the advantages of family planning the majority 28% was to have children when one is ready for them, followed by 25.7 5, economic reasons and health reasons. 5.5 barriers to women participation in FP The key factors that hindered Ibraahim Koodbur women to practice family planning were ignorance low education and the need for more children. Education was statistically significant in participating in family planning. Results showed that the educated are more likely to use family planning methods, hence lack of education was a hindrance to use of family planning methods. According to MICS 2006 the educated people are more likely to listen to radio than the none-educated persons hence getting more information about family planning. With the new government policy of universal primary education and the universal secondary education in the pipeline will go a long way to eradicating this barrier. 36  CHAPTER SIX CONCLUSIONS AND RECOMMENDATIONS 6.0 Conclusion 1) Knowledge about modern FP methods by adult women in Ibraahim koodbur was 64 %. The breast feeding and pill are most known methods. There is significant lack of knowledge about other modern methods of family planning such as foam tablets, jerry, diaphragm, norplant, female and male sterilization. Health personnel are the major sources of information about family planning. 2) The attitude of most adult women in Ibraahim koodbur area was positive to family planning. Most women think have a role to play in family planning but they prefer a passive role of encouraging their partners. Most of them prefer having methods from the same clinic. 3) The prevalence rate of FP among adults women is 26 % which is similar to MICS survey of 2006. The majority of women were not using 4) The commonest motivating factors to women participation to FP were to space children followed by economic reasons. 5) The commonest barriers to women participation in FP was lack of adequate knowledge about methods of family planning this was followed by the desire for more children. 6.1Rrecommendations A. There is a great need for information, communication and education for women about family planning. Women friendly programs should be put in place to address this issue B. Family planning should be included in curriculum of schools right from primary level. 37 View publication stats C. Women motivation projects should be under taken to convince women that family planning is not only for women but men as well. D. Family planning services should be integrated in the rest of the clinics not to be delivered in only MCH clinic. E. Women should be included in the MCH packages F. The government should set up policy about family planning to guide the community and service providers. G. Strategies must be put in place to increase on the child survival rate so that people are certain that the few children they deliver will survive after birth. 38