CHAPTER ONE

INTRODUCTION

1. BACKGROUND OF STUDY

Unintended pregnancies are a major consequence of contraceptive discontinuation. In 2012, there were ~213 million pregnancies, roughly 40% (85 million) of which were unintended.1 Unintended pregnancies have been linked to many negative health behaviors and outcomes for the mother and child including abortion-related morbidity and mortality, maternal mortality, breastfeeding behaviors, timing of antenatal visits, low birth weight, poor child nutrition and incomplete vaccinations, infant mortality, and depression and anxiety.

Recently, it has been shown that across 36 Demographic and Health Survey (DHS) countries, one-third of unintended pregnancies are the result of contraceptive discontinuation. Women discontinue modern contraceptive spacing methods for a variety of reasons including pregnancy desire, need for a more effective method, and unintended pregnancy due to failure in use adherence or change in access to services, or opposition from their husband or other family members, among other reasons. While any single factor or a combination of factors can influence a woman’s decision making around continued use of a particular contraceptive method, the experience of side effects is one of the leading causes of contraceptive discontinuation worldwide. Approximately one in 10 contraceptive users stops using a method within 12 months of its initiation because of method-related side effects.

Unexpected or unplanned pregnancy poses a major public health challenge in women of reproductive age, especially in developing countries. It has been estimated that of the 210 million pregnancies that occur annually worldwide, about 80 million (38%) are unplanned, and 46 million (22%) end in abortion. More than 200 million women in developing countries would like to delay their next pregnancy or even stop bearing children altogether, but many of them still rely on traditional and less effective methods of contraception or use no method at all. Those who do not use any contraceptive method may lack access or face barriers to using contraception. These barriers include lack of awareness, lack of access, cultural factors, religion, opposition to use by partners or family members, and fear of health risks and side effects of contraceptives.

In Nigeria, unintended intercourse is the primary cause of unwanted pregnancies, and many women with unwanted pregnancies decide to end them by abortion. Since abortion is illegal in Nigeria (unless medically recommended to save a mother’s life) many abortions are carried out in an unsafe environment. The consequences of these clandestine abortions are grave and can be life-threatening, often leading to maternal death.  Abortions account for 20%–40% of maternal deaths in Nigeria.

Many factors contribute to unwanted pregnancy in Nigeria, and a very important factor is the low level of contraceptive use. In addition, a desire to limit family size to enable the family to provide a better education for the children, the increased participation of women in the labor force, and urbanization are other factors leading to the desire of Nigerian women to have a predetermined number of children. Contraceptive prevalence rates have correlated with maternal mortality and it has been shown that countries with low contraceptive prevalence rates are also countries with very high maternal mortality ratios.

Nigeria has one of the highest maternal mortality ratios in sub-Saharan Africa, and ranks as the country with the second highest number of maternal deaths in the world, with illegal and unsafe abortions contributing 20%–40% of about 60,000 maternal deaths that occur yearly in Nigeria. Similarly, the rate of induced abortions is a good indicator of the current state of medical care and family planning in any country. Among Nigerian women of reproductive age, one in seven (14%) have tried to have an abortion, and one in 10 (10%) have actually ended an unwanted pregnancy, suggesting up to 760,000 induced abortions annually. The use of modern contraceptive methods translates into the prevention of unwanted pregnancy and subsequent abortions. If contraceptive use in the population increases among Nigerian men and women who are sexually active, there will be a significant reduction in unwanted pregnancies and abortions leading to reduced maternal mortality. Research in Nigeria indicates that more than 60% of women with an unplanned pregnancy are not using any form of contraception.

The risk of maternal mortality can be lessened using reliable modern contraceptive methods. The contraceptive prevalence in Nigeria has remained very low (15%), while the fertility rate of 5.7 children per woman has not changed.

Although the couple’s awareness of contraceptive methods has been raised, there are still various religious and cultural practices, which constrain the use of these methods in the developing countries. These religious and cultural practices include early marital age of female, desire for large families and male children, and some misconceptions about contraceptive use. An “ideal” contraceptive has been defined as “100% effective, completely safe, and not related to coitus with minimal need for frequent replacement and facilitation of speedy return to fertility after suspension.

Family planning is a feasible effort made by a couple to curtail the number of children they want through the use of contraceptive methods. Despite the growing awareness of the child spacing benefits and its tactical role in reducing maternal and neonatal mortality, the acceptance and utilization of contraceptive methods is still at a low level, particularly in unindustrialized nations. More than 200 million women in the developing countries would like to postpone their subsequent gestation or even stop having offspring. Nonetheless, many of these females still utilize the traditional and less effective methods of contraception or use no method at all.

Contraception methods can be divided into two categories, namely traditional and modern methods. The selection of the appropriate method has been described as one of the six elements regarded as critical to the quality of care in family programs, which will lead to improved initial acceptance and sustained use. Sometimes, the women’s choice, compliance, and consistency of contraceptive use are affected by some reasons beyond benefits, satisfaction, and level of side effects. Up to 50% of the women using contraceptives are not fully satisfied with the methods they use due to their real or anticipated adverse effects, complexity, unknown reliability, and decreased pleasure during sexual intercourse.

The women who are not totally pleased with their chosen contraceptive methods may not fully comply with it. This issue results in error or nonuse of the method, thereby increasing the chances of unplanned conception. Successful use and compliance with family planning methods are strongly associated with the woman’s satisfaction. The frequency of contraceptive use has universally risen as a result of the advancement in the modern contraceptives and the institution of structured family planning programs.

The traditional methods that are currently used by the women in Nigeria for the prevention of postcoital conception include ornaments like waist beads that are rubbed with herb and worn to prevent pregnancy, and also oral and vaginal potions. The percentage of the Nigerian women utilizing contemporary contraceptives increased from 3% in 1990 to 8% in 2003. According to Abiodun and Balogun, awareness about family planning has remained consistently high in Nigeria over the past five years.

In this regard, 97% of the women within the age of 15-49 years have heard about at least one method of contraception. Furthermore, 52% of the women who are presently married have reported to make use of a contraceptive method at one time in their life. In addition, the most common methods among the married women were the injectable contraceptives, pills, and rhythm method. Various reports have used the tolerability of methods to rate continuity or stoppage of contraceptive use; in other words, they estimate the proportion of the mothers, who carry on or halt using a method after six months or one or more years. Lete et al. demonstrated that the avoidance of daily use of contraceptives improved compliance in the typical users. The improvement of the reproductive health in the young women living in the developing countries requires access to safe and effective methods of fertility control. Nonetheless, most of the people rely on traditional rather than modern contraceptives, such as condoms or oral/injectable hormonal methods. In a study conducted by Isah and Nwobodo in Nigeria, the practice rate of family planning was reported to be still at a low level in this community.

Contraceptive effectiveness greatly relies on the intrinsic efficacy of these methods and their accurate utilization. It is not easy to determine the regular effectiveness of the contraceptives. Furthermore, as reported by Adegbola and Ogedengbeeven, faultless application of these methods may not lead to zero failure rate. Women’s choice of various family planning approaches depend on their perceptions concerning the prevention of conception, health care workers, familiarity with various methods of contraception, socioeconomic status, and spouse’s characteristics.

Parkes et al. reported that convenience and usefulness are the factors affecting the selection of contraceptive methods by the women. They also indicated that the presentation of various appropriate methods automatically enhanced the utilization of contraceptives. According to the mentioned study, 88.5% of the females were found to be satisfied with their chosen contraceptive methods.

Spouses' attitudes and decisions influence contraceptive choices; accordingly, the women who infrequently discuss with their partners about the prevention issues are less likely to use contraceptives regularly. In addition, in a study carried out by Hatcher et al., the mainstream of the women stated that they required partner’s consent before using the birth control methods. The frankness and open conversation about contraceptive practice are discountenanced in some cultures. Moreover, the inaccessibility of contraceptives and information inadequacy about family planning escalate the hazard of unintended conception among the women.

Women's satisfaction with family planning services is a significant factor for the sustained use of these methods. According to Bruce, satisfaction with services entails six elements of qualities, including choice of methods, information given to clients, technical

While any single factor or a combination of factors can influence a woman’s decision making around continued use of a particular contraceptive method, the experience of side effects is one of the leading causes of contraceptive discontinuation worldwide. Approximately one in 10 contraceptive users stops using a method within 12 months of its initiation because of method-related side effects.

1. STATEMENT OF THE PROBLEM

Much of the research around side effects of contraceptive devices to date has focused on the physical manifestations of side effects like headaches, moodiness, abdominal pain, and menstrual irregularities. These physical effects alone may be a major contributing factor in women’s decisions to stop using a contraceptive method, but do not provide a complete picture of women’s experiences of side effects in the course of contraceptive devices. Less is known about how side effects influence a woman’s daily activities and lives especially the health of mothers using gashu LGA as a case study.

1. AIMS AND OBJECTIVES

The main aim of the study is an investigation into the side effect of contraceptive devices on mothers’ health in Gashu LGA. Other specific objectives include:

1. to examine the usage of contraceptive devices.
2. to examine the side effect of contraceptive devices on mothers’ health in Gashu LGA.
3. to determine the factors that influence the use of contraceptive devices in Gashu LGA.
   1. RESEARCH QUESTIONS

1. What are contraceptive devices used for?
2. What are the side effects of contraceptive devices on mothers’ health in Gashu LGA?
3. What are the factors that influence the use of contraceptive devices in Gashu LGA?
   1. STATEMENT OF RESEARCH HYPOTHESIS

1. HO: contraceptive devices have no significant effect on mothers’ health in Gashu LGA.
2. HI: contraceptive devices have significant effect on mothers’ health in Gashu LGA.
   1. SIGNIFICANCE OF STUDY

The study will help mothers and young women to understand what contraceptive devices are and what they are used for. Also understanding that an abuse of these contraceptive devices can have a negative effect on their health. In as much as there are positive sides to the use of contraceptive devices, there are also effects and that what the study will research on serving as an enlightening tool to women especially in rural areas like Gashu LGA.

It will help the government of Nigeria and that of gashu LGA to understand the need to create awareness on contraceptive devices in all LGA and the nation at large.

Finally, it will serve as an added knowledge to the use of contraceptive devices and its effects on mothers’ health.

1. SCOPE OF STUDY

The study will cover an investigation into the side effect of contraceptive devices on mothers’ health in Gashu LGA.

1. LIMITATION OF THE STUDY

1. Financial constraint- Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
2. Time constraint- The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.
   1. DEFINITION OF TERMS

Investigation

Investigation refers to the careful search or examination with an intension to discover facts. This may include questioning of witnesses, forensic examination etc. a formal inquiry or systematic study.

Side effect

A secondary, typically undesirable effect of a drug or medical treatment. an unpleasant effect of a drug that happens in addition to the main effect

Contraceptive devices

Birth control, also known as contraception and fertility control, is a method or device used to prevent pregnancy. The most effective methods of birth control are sterilization by means of vasectomy in males and tubal ligation in females, intrauterine devices (IUDs), and implantable birth control.

Mothers

Mother is an English word, not an acronym. It is a noun which specifies a woman who is in relation to a child, to whom she has given birth.

Health

Health is the state of being free from illness or injury. Health, as defined by the World Health Organization (WHO), is "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Health may be defined as the ability to adapt and manage physical, mental and social challenges throughout life.