THE PERCEPTION OF MARRIED WOMEN ON FAMILY PLANNING

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THE PERCEPTION OF MARRIED WOMEN ON FAMILY PLANNING

CHAPTER ONE

INTRODUCTION

1.1. Background

1.1.1. Population growth and family planning

After the Second World War the population growth in developing countries reached historically unprecedented rates. Falling mortality due to medical discoveries and continued or even rising fertility turned this population growth into a second population explosion, the first population explosion took place when the industrial revolution started in England in the late 18th century (Bongaarts, 2009).

The rapid population growth has been identified as a problem by national governments and the international society (UNFPA, 2011a). This phenomenon, which causes for example shortage of cultivated land and unemployment, are claimed to cause increasing poverty (UNFPA, 2011b) and environmental stress (Collins, Sayer, & Whitmore, 1991).

However, the problem of population growth may not only be seen from an economical point of view. The high fertility rates, which account for the rapid population growth, have serious consequences for maternal and infant health. Short intervals pregnancy and many pregnancies and deliveries pose a large burden on maternal health. Inadequate periods to recover strength between each pregnancy, as well as many deliveries, all associated with different levels of risk, are factors that makes high fertility rates a threat to women’s health. Moreover, infant health is also plagued by the short interval between births, because short birth interval is associated with increased risk of pre-term births, low birth weight and infant mortality(Bongaarts, 1987; Norton, 2005; Rutstein, 2005).

During the 1950’s and 1960’s, it has been important for national and international societies to control populations. Since that period the population growth has been treated as a problem, and issues surrounding reproduction, that once were considered the most private to talk about, have become matters of intense public concern(Green halgh, 1995). Family planning is identified as the solution to control fertility rates against the rapid population growth. Subsequently, family planning has been expanded in developing countries by each national government, international organizations and non-governmental organizations (NGOs)(Greene, 2000). In the 1960’s, the organizations related to provide family planning, for instance United Nations Population Fund(UNFPA)and United States Agency for International Development (USAID),were established in response to the problem of the population growth. There has been an emphasis on increasing the use of contraceptives. These organizations, the international society and national governments have regarded long-term methods such as intrauterine device (IUD) as the most effective methods to achieve the demographic goal, which is to reduce fertility rates (Greene, 2000). Between the 1960’s and the 1980’s, declining fertility rate has been diffusing in developing countries, the exception being sub-Saharan Africa (Shapiro & Gebreselassie, 2008).

The role of family planning is important, not only to reduce fertility rates by providing contraceptives, but also to expand the understanding that all women have a right to control their fertility. The main activities of family planning programs are provision of contraceptives and education related to reproductive health, especially to women (Greene, 2000). General school education to women is also supposed to have an effect on fertility rates. Many studies show that educated women get married at a later age than non-educated women, and have better access to contraceptives than non-educated women(Alemayehu, Haider, & Habte, 2010; Bongaarts, 2010; Haile, 2004).

The main hypothesis in demographic studies, which are often based on economic rationalism, is that behaviour related to reproduction is decided by “calculations” conducted by individuals. These calculations are based on the costs and benefits of having children, and have had what Price and Hawkins (2002) call “a positivist and empiricist research methodology” (Price & Hawkins, 2002). The major way of conducting such demographic research has been through large-scale sample studies. Anthropologists have criticized the demographical approach or viewpoint. Many anthropologists have insisted that reproductive behaviour or decisions made in relation to family planning is not only decided by economic factors, but also affected by socio-cultural factors such as fertility preferences or values related to having children. Further, political issues such as national population policy or reproductive health programs, are also influential matters. Subsequently, anthropologists emphasize that it is very important to understand what social, cultural or structural factors that may shape peoples thoughts and behaviours (Price & Hawkins, 2002). In recent years the idea that it is significant to understand the socio-cultural contexts in demographic studies has gradually expanded (Price & Hawkins, 2002).

Some studies have mentioned the importance of the role of men in reproductive health and their influence on the decision-making and behaviour related to reproduction (Dudgeon & Inhorn, 2004; Greene, 2000). As mentioned, many family planning programs have focused mainly on women. Even though men are increasingly being “involved” by reproductive health programmes, the view of men still seem to be that they are peripheral and problematic (Greene, 2000).Short and Kiros (2000) studied fertility preferences and demands for contraception in Imo state(Short & Kiros, 2002).The authors reported a gender difference between husbands and wives in fertility desires; husbands were more pronatalist than their wives(Greene, 2000; Short & Kiros, 2002). Lasee and Becker (1997) studied husband-wife communication related to family planning and the use of contraceptives in Imo state. The authors reported that “the wife’s perception of her husband’s approval of family planning”(Lasee & Becker, 1997)has a significant impact on the current contraceptive use. The result shows that men’s opinion and perception regarding reproduction have a strong impact on women’s perception and their subsequent behaviour. Therefore, it is important to study both gender’s perception related to reproductive, as well as the communication between wife and husband, in order to understand what factors shape their behaviour.

Nigeria is the most populous country in Africa, with more than 88 million people; it also has a high annual rate of population growth (3.5%) and a total fertility rate of 6.0 lifetime births per woman. Additionally, the country has relatively high levels of infant mortality (104 infant deaths per 1,000 live births) and maternal mortality (800 maternal deaths per 100,000 live births). In response to these and other serious demographic and health issues, the Nigerian government put into effect a national population policy in 1989 that called for a reduction in the birthrate through voluntary fertility regulation methods compatible with the nation’s economic and social goals.

During 1992-1993, an information, education and communications campaign was launched to change Nigerians’ attitudes toward family planning, and to thereby increase their contraceptive use. The campaign was based on evidence that family planning messages relayed through the mass media can influence contraceptive behavior. For example, in Nigeria, one-quarter of new clients attending a family planning clinic identified a television campaign as their source of referral. Similarly, a mass media effort in the Philippines promoting sexual responsibility substantially increased requests for contraceptive information among adolescents. Other studies have shown that exposure to a mass media family planning campaign increases contraceptive use.

Several studies have reported changes in Nigerians’ knowledge of and attitudes toward family planning. These studies, however, did not examine the association between attitudes toward contraception and its use. In the 1981-1982 Nigerian Fertility Survey, only 34% of all women reported that they had heard of any family planning method. By 1990, when the Nigerian Demographic and Health Survey was conducted, the proportion of women who knew of any contraceptive methods had increased by about one-third, to 46%, and the proportion of women who knew of specific methods also had grown. Furthermore, 41% of married women who knew of a contraceptive method had discussed family planning with their husbands. Although the majority of them had discussed the topic with their husbands only once or twice, a substantial proportion had done so more often. Seventy-one percent of married women who knew a family planning method said that their husbands also approved of family planning.

This article investigates the association between Nigerians’ attitudes toward family planning and their contraceptive behavior. To ascertain what gains the family planning campaigns in Nigeria have made and what factors motivate contraceptive use, we set out to answer the following question: Do positive attitudes toward family planning affect contraceptive use? The answer will help policymakers and program planners determine what issues need to be stressed in the design of future family planning awareness campaigns in Nigeria.

1.2. Research aims and rationale for the research

1.2.1. Rationale for the research

As shown in the background information, Imo state has a rapid population growth. The educational zone of Imo state government and international organizations have tried to reduce the pace of growth by education in family planning and providing contraceptives. Despite these efforts, there is still a higher fertility rate than what is considered an ideal rateof4.0per woman. In rural areas, where the research place is located andapproximately84% of The educational zone of Imo states live, the population is growing at approximately 2.3%every year (Ringheim et al., 2009). However, existing studies on population growth have mainly been conducted by quantitative methods and there are very few qualitative studies in rural Imo state exploring people’s point of view, and the reasons why the interventions have not worked and what kind of perception and experiences people have.

Based on the existing studies, we can argue that there is a knowledge gap related to this topic in this particular area. As mentioned, few studies on this topic have used qualitative methods, and there is no qualitative research from the rural Oromia regional state. Further, no previous studies, related to fertility, have adequately focused on the socio-cultural background, for example gender role, marriage form, religion, and occupation.

1.2.1 Research aims and sub-objectives

Based on previous studies related to family planning in Imo state, I found a lack of qualitative studies in rural Imo state, an area which has a much higher fertility rate compared to urban areas. Thus I decided to investigate why there are still high fertility rates in rural Imo state.

Some sub-objectives were set as a means to reach the main aim of the study. The sub-objectives were developed drawing upon the results and identified knowledge gap in previous studies, and are as follows:

• To explore what having children means in different peoples’ lives.

• To explore how people make decisions related to family planning (micro-level).

• To explore how a variety of cultural, social and structural factors influence such decisions.

• To explore what kind of contraceptives people know of and prefer to use.

• To explore what kind of needs, both met and unmet, people have in relation to family planning.

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