FACTORS AFFECTING UTILIZATION OF CONTRACEPTIVES AMONG MARRIED WOMEN IN NORTH GONJA DISTRICT OF GHANA: A QUALITATIVE STUDY

ABSTRACT
In Ghana, fertility rates continue to vary widely; ranging from 2.5 children per woman in the Greater Accra region to 6.8 children in the Northern Region. Moreover, the use of any contraceptive method is highest among women in the Volta Region (32%) and lowest among women in the Northern Region (11%).Using a qualitative explorative descriptive design, this study explores the factors affecting contraceptive utilization among married women in the reproductive age group (15 – 49 years), through in-depth interviews in the North Gonja District. The data collected was analyzed by means of thematic analysis. This included construction of a thematic framework, coding, editing and categorization of available data as well as the creation of sub-themes. The study revealed that there is limited knowledge and a general lack of understanding about contraceptives among the married women who were interviewed. The result also suggested that male domination and social stigma are some of the factors affecting the utilization of contraceptives. In view of this, it is recommended that Ghana should develop some educational and counselling techniques to educate the public to help debunk the social stigma in the community. Besides, the study recommends an effective development and implementation of male-involvement contraceptive initiatives to address men's negative beliefs regarding contraceptive services.

CHAPTER ONE
INTRODUCTION
Background to the Study
Population explosion is the major contemporary issue in this part of the world. The alarming increase in the world population poses certain crucial economic, political and social problems in almost all spheres of life and in all sectors of the human race. In addition to the depletion of environmental resources and the impact of global climate change, most developing countries realize the implication of rapid population growth on the socio- economic status and welfare of the people (Yunus, 2006).

With the human population exceeding 7 billion and the food and energy prices rising, the longstanding question of the adverse consequences of expanding populations in the developing world and rising consumption everywhere is commanding the attention of scientists and policymakers. In addition to the depletion of environmental resources and the impact of global climate change, other potential adverse effects of rapid population growth and high fertility include poor health among women and children, slow economic growth and widespread poverty, and political instability in countries with large numbers of unemployed young people (John, 2012).

Family planning has been defined (WHO, 2015) as allowing people to attain their desired number of children and determine the spacing of pregnancies. It is achieved through the use of contraceptive methods and the (treatment of infertility). Thus, researchers have discovered that the same pill used to prevent pregnancy can actually help a woman conceive. The study found that a two-week intervention treatment using a standard low-dose birth control pill can help time egg harvesting, making the in Vitro Fertilization (IVF) process more convenient for both doctor and patient. While the previous definition focuses on limiting the size of the family, the 2009 Collins English Dictionary (Collins,2009), specifies the use of contraceptives when defining family planning as the control of the number of children in a family and the intervals between them, especially by the use of contraceptives. The Medical Dictionary (Marriam, 2007) on the other hand adds a sense of intention and determination to the two previous definitions by stating that family planning is intended to determine the number and spacing of one‘s children through effective methods of birth control.

The World Health Organization (WHO, 2006), issued a recommendation that, after a live birth, the interval before attempting the next pregnancy should be at least 24 months, and at least six months after a miscarriage or induced abortion, in order to reduce the risk of adverse maternal, perinatal, and infant outcomes (Healthy Timing and spacing of pregnancy) .

Contraceptive use in the United States is virtually universal among women of reproductive age: virtually all women of reproductive age in 2006– 2010 who had ever had sexual intercourse have used at least one contraceptive method at some point in their lifetime (99%, or 53 million women aged 15– 44), including 88% who have used a highly effective, reversible method such as birth control pills, an injectable method, a contraceptive patch, or an intrauterine device (Daniels, Mosher, & Jones, 2013). In 2002, 90% had ever had a partner who used the male condom, 82% had ever used the oral contraceptive pill, and 56% had ever had a partner who used withdrawal (Michael, 2012).

Modern contraceptive methods constitute most contraceptive use. Modern contraceptives method are contraceptives that are based on scientific knowledge of the process of conception. Globally in 2015, 57% of married or in-union women of reproductive age used a modern method of family planning, constituting 90% of contraceptive users. Traditional contraceptive methods are contraceptives which are prescribed or supplied by traditional healers or methods used traditionally in specific cultures without any prescription. When users of traditional methods are counted as having an unmet need for family planning, 18% of married or in-union women worldwide are estimated to have had an unmet need for modern methods in 2015 (United Nations, 2015).

The modern contraceptive prevalence rates (that is, the proportion of women of reproductive age who are using a modern contraceptive method, vary widely across the African region. Among women of reproductive age, Contraceptive Prevalence Rate (CPRs) for modern methods ranges from 1.2% in Somalia to 60.3% in South Africa. Countries in Southern Africa reported the highest levels of contraceptive use, followed by countries in East Africa. With a few exceptions, West and Central African countries report very low rates of family planning use. Some of the lowest contraceptive prevalence rates in the world exist in these two sub regions of Africa (United Nations, 2009).

Sub Saharan African countries by and large are characterized by high fertility and correspondingly high rates of population growth for the foreseeable future. Most countries in the region will grow by 100-300% by 2050 and in total, the population of the region will double over the next 45 years. The main driver of high fertility (5 children per woman) in most countries is a persistent demand for large numbers of children, as expressed by women responding to questions about desired child bearing. Fertility would decline only if women had no undesired childbearing, that is, if greater access to quality family planning services respond to unmet needs (Levin, 2009).

Since the 1960s, alongside efforts to increase levels of education and improve health conditions, the main policy response to rapid population growth has been the implementation of voluntary family planning programs that provide information about and access to contraception. This policy has permitted women and men to control their reproductive lives and avoid unwanted childbearing. The choice of voluntary family planning programs as the principal policy to reduce fertility has been based largely on the documentation of a substantial level of unwanted childbearing and an unsatisfied demand for contraception (John, 2012).

Although there has been a marginal improvements in infrastructure and consumable items needed for family planning services delivery in many parts of Ghana, the Ghana Health Service Survey (GHSS) in 2012 also noted many barriers to the utilization of family planning. According to the GHSS, (2012), these barriers include frequent periods of contraceptives being out of stock at the facility level, limited provider skills, limited use of educational tools, and limited number of methods. Low contraceptive use is attributed to a number of barriers acting at policy, facility, district, community and individual levels (Benefo, 2005). Within individual level, knowledge of family planning services and methods is crucial (Bamikale &Casterline, 2010).

Whereas evidence from a number of researches around the world reveal a near universal knowledge on family planning methods among the women of the reproductive age, this has not translated into increased utilization of these methods in the North Gonja District in the Northern Region of Ghana. Low usage of family planning services and methods has been widely attributed to the negative attitude towards the use of modern contraceptives (Addai.2009). Specifically, approval/disapproval of the modern methods by self and partner, fear of harmful effects on health and low levels of education (Benefo, 2005), have been identified to influence the use of modern family planning methods in Ghana, and for that matter the North Gonja District.

Religions vary widely in their views on the ethics of birth control. Some religious sect accepts Natural Family Planning. Natural Family Planning is the use of calendar or rhythm of a woman‘s menstrual cycle to time sexual intercourse with the aim of preventing conception The Roman Catholic Church accepts only Natural Family Planning and only for serious reasons, while Protestants maintain a wide range of views from allowing none to very lenient. In Islam, contraceptives are allowed if they do not threaten health, although their use is discouraged by some. Hindus may use both natural and artificial contraceptives; however they are against any other contraceptive method that works after fertilization. A common Buddhist view of birth control is that preventing conception is ethically acceptable, while intervening after conception has occurred or may have occurred is not. A number of nations today are experiencing population decline. Growing female participation in the work force and greater numbers of women going into further education has led to many women delaying or deciding against having children, or to not have as many. In Eastern Europe and Russia, natality fell abruptly after the end of the Soviet Union. The World Bank issued a report predicting that between 2007 and 2027 the populations of Georgia and Ukraine will decrease by 17% and 24% respectively (Agyei, 2014).

People‘s control over their sexual lives and choices is in turn shaped by gender-related values and norms defining masculinity and femininity. These culturally-defined gender values and norms evolve through a process of socialisation starting from an early stage of infancy (Agyei, 2014). Studies have suggested that greater gender equality may encourage women‘s autonomy and may facilitate the uptake of contraception because of increased female participation in decision making (Hakim, Mumtaz & Salway, 2003). However, it has not been set as a prerequisite for widespread adoption of contraceptives (Amin & Ahmed, 1998).

Empirical review on the effect of decision-making patterns on contraceptive use often does not distinguish between women participating in decisions and controlling them and account for the effects of common decision-making patterns within the community. This strong effect of normative decision-making patterns within the community is net of individual education and community education, both of which had strong and significant effects. Less traditional gender roles as measured by normative decision-making patterns seem to support more innovative fertility behavior. Community decision-making patterns matter importantly for contraceptive use in this low contraceptive prevalence setting and the need to be assessed elsewhere. Furthermore, women‘s influence is inadequately measured where joint decision-making and wife-dominated decision- making are considered together (Agyei, 2014).When a couple‘s most fundamental assumptions of a faith are dissimilar to those of the health care provider, medical recommendations may be made that are not consistent with the couple‘s religious or cultural values. Health care providers in culturally diverse nations must understand the possible influences of culture and religion on a couple‘s willingness to use contraception, and they should be familiar with a range of contraceptive options in order to address such situations in the most appropriate ways.

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Item Type: Ghanaian Project Material  |  Attribute: 121 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH110 ($20)  |  Delivery: Within 30Mins.
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