Journal of Reproductive Health and Contraception

Key Words

Contraception, Family planning, Women, Contraceptive awareness

Introduction

Currently, women in Nigeria have an average of 5.3 children each.1 Since 1990, fertility rate has decreased from 6.0 children per woman to the current average of 5.9 children in women in rural areas and 4.5 children among urban women.1 At these fertility rates, as in several other developing countries, populations will double in less than 20 years, with increasing threat of a global population crisis.2 This makes the deliberate control of fertility imperative and the widespread use of safe adequate contraception crucial.2

Family planning allows people to attain their desired number of children, if any, and to determine the spacing of their pregnancies through the use of contraceptive methods.3 The prevention of unintended pregnancies helps to lower maternal ill-health and the number of pregnancy-related deaths.3 Contraceptive information and services are fundamental to the health and human rights of all individuals.3

In Africa, one in 26 women of reproductive age die from pregnancy related complications, as against one in 9400 in Europe.4Similar unpleasant statistical disparities also exist with fertility and contraceptive use between low-income and high-income countries and have remained an intractable challenge.4 Multiple programs and efforts by various organizations to improve the uptake of contraceptive methods in Africa have yielded only minimal encouraging results.5,6 Current estimates suggests that 54 million unplanned pregnancies, 79,000 maternal deaths and 1.2million childhood mortality could have been prevented with widespread equitable access to effective contraception.7,8

This study assessed the awareness and prevalence rates of contraception among women in Lagos Nigeria.

Materials and Methods

This was a 2-year (January 2015 to December 2017), community-based, descriptive, cross-sectional survey in which 16214 consenting women, in randomly selected communities across the 20 local government areas of Lagos State, had in-depth interview using an interviewer administered, structured questionnaire designed for the study. Enumeration areas were identified by random selection of households and respondents, one woman per household was also selected by stratified random selection.

The data obtained were analyzed using SPSS, version 22 and frequency and proportions were calculated for categorical variables. Tables and bar charts were used for graphical illustration.

Results

Women aged 25-29 years of age (19.5%) and who had completed secondary education (42.2%) accounted for majority of the study respondents (Table 1). Almost 3/4th of the women (73.7%) were aware of contraception with the contraceptive pills being the most acknowledged in 65.9% of women followed by injectables (64%). (Table 2). None of the women indicated awareness of male sterilization (Table 2). Friends, health care workers and radio were the leading sources of information on options of contraceptive methods among the women surveyed (Table 3).

The contraceptive prevalence rate was 30.2% (95% CI: 29.3 - 31.2) (Table 4). The Catholics and Spiritualists each had the highest contraceptive prevalence rate (CPR) of 33.3% (Table 4). Women who had completed secondary education had the highest (40.6%) contraceptive prevalence rate by level of education (Figure 1). Contraceptive use was significantly associated with age (p<0.001), level of education (p<0.001) of respondents but not with religious affiliation (Table 5).

Table 1: Socio-demographic characteristics of the respondents

Table 2: Respondents awareness of contraception

Table 3: Sources of Information on Contraception

Somerespondentsindicatedmultiplesourcesofinformation/knowledgeoncontraception

Figure 1: Contraceptive prevalence by level of education

Table 4: Contraceptive prevalence by religious affiliations

Number of respondents using contraception

Table 5: Relationship between characteristics of respondents and contraceptive prevalence

Islam=reference Married= reference,

Discussion

The 16214 women, who took part in the survey, were fairly evenly distributed in proportions between the ages 20 to 49years and about half (54%) of the respondents had more than the primary level of education. The fact that many (73.7%) of the women in our study were aware of modern contraceptives is encouraging, however, the room for improvement is obvious. This is similar to reports by Adinma et al South-East Nigeria of an overall mean awareness of contraception of 70.9%.9 Arbab et al among Qatari women in a similar survey found that 94.6% of women knew about contraception but only 64.9% were in favour of contraception.10 Megabiaw in Ethiopia also reported that majority (93.1%) of the street women had heard about modern contraceptives.11 Our finding of a relatively lower level of awareness about contraception informs the need to identify and tackle critical barriers to contraceptive awareness. Adefalu et al in North-West Nigeria reported that 82.4% of women were aware of at least one form of contraception.12 Despite the higher awareness rates reported by these studies our finding is more representative of the general population due to our very large sample size.

The contraceptive pills method was the most acknowledged, in 65.9% of women followed by injectables (64%). None of the women indicated awareness of male sterilization. Nsubuga et al in Uganda observed that the most commonly known and used methods, in a related study, were the male condoms and oral pills, but knowledge of the female condom was very low.13 Hoque et al in Botswana found that the condom (95.6%) was the most commonly known method followed by the oral contraceptive pill (86.7%).14 Adefalu et al in Nigeria found that the most popular and least common modern contraceptive methods were the male condom (86.8%) and vasectomy (26.6%) respectively.12 The variation in findings from these studies and ours may be explained by the different types of study population. Both Nsubuga et al and Hoque et al studied university students, a relatively educated population unlike in our study where more than 50% had no form university education.

Friends, health care workers and radio were the leading sources of information on options of contraceptive methods among the women we surveyed. Bankole et al in South-West Ngeria observed that the most frequent sources of contraception information were friends, television and magazines/newspapers, but their most preferred sources were physicians/health worker.15 The peer-to-peer transmission route appears to be important in the dissemination of information about contraceptives.12

The contraceptive prevalence rate of 30.2% found in our study was similar to the contraceptive prevalence of 33.4% noted by Ekweani et al16 in Zaria Nigeria and 34.3% reported by Megabiaw11 in Ethiopia but lower than 46.6% reported by Nsubuga et al13 in Uganda and 43.8% reported by Adefalu et al12 in North-West Nigeria. We observed that prevalence rates were highest among Catholics, Spiritualists and among women who had a minimum of secondary school education. The 2018 National Demographic and Health Survey (NDHS) reported that 28% of sexually active, unmarried women aged 15-49years, use a modern method of contraception.1 Our prevalence rate of 30.2% is similar to the 2018 NDHS report despite the inclusion of married women in our survey. The 2013 NDHS reported a contraceptive prevalence rate of 11%,17 findings from our study buttress the fact that the uptake of modern contraceptive in Nigeria is improving.

Conclusion

The uptake of modern contraception among Nigerian women is increasing. The widespread adoption of proven and effective interventions geared towards increasing contraceptive prevalence rates should continue.

References

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