ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE (KAP) OF FAMILY PLANNING AMONG RURAL WOMEN IN KOGI STATE, NIGERIA
The purpose of this study was to assess knowledge, attitude and practice (KAP) of family planning among rural women in Kogi state, Nigeria. Ex-post facto research design was used for this study and the sample size consisted of 384 respondents. To achieve this purpose, a researcher developed questionnaire was used as instrument for data collection. The population of the study comprised of 72,844 women of reproductive age. The instrument was vetted by five jurors from the Departments of Physical and Health Education and Nursing Sciences. Three hundred and eighty four (384) copies of questionnaire were distributed to the respondents. Three hundred and seventy nine (379; 98.7%) were adequately filled and retrieved from respondents. Five (5; 1.3%) copies of questionnaire were not filled correctly and therefore, those were not used. A multi-stage sampling
procedure was employed which comprised of; stratified, simple random, purposive, proportionate sampling procedure. The data collected was analyzed using descriptive statistics of frequencies and percentages, mean and standard deviation. To test the formulated hypotheses, one sample t-test was used. All the formulated null hypotheses were tested at 0.05 alpha level of significance. The results of the study revealed that rural women in Kogi state, Nigeria have significant knowledge of family planning with a t-value of 3.201 (p-value of 0.021). The findings further showed that rural women in Kogi state do not have significant attitude towards family planning with t-value of 1.291 and p-value of 0.18, finally the results of the study revealed that rural women in Kogi State do not significantly practice family planning with a (p-value of 1.05). On the basis of the research findings, the following conclusions are drawn; that rural women in Kogi State were knowledgeable about family planning, that rural women in Kogi state do not have positive attitude and practice of family planning. The following recommendations were made based on the conclusions. Federal, state and local government health units should encourage women in sustaining their knowledge of family planning through community mobilization and enlighten programmes. The health directorate in collaboration with the family planning unit should roll out more programmes such as organizing workshops, seminars, to educate married couples on the benefits of family planning practices. This will bridge the gap between knowledge and practice of family planning.
TABLE OF CONTENTS
Title page – – – – – – – – – i
Approval Page – – – – – – – – ii
Declaration – – – – – – – – – iii
Certification – – – – – – – – – iv
Acknowledgements – – – – – – – – v
Dedication – – – – – – – – – vii
Abstract- – – – – – – – – – viii
Table of Contents – – – – – – – – ix
List of Acronyms – – – – – – – – xiii
List of Tables – – – – – – – – – xvi
Operational/Definition of Terms- – – – – – – xv
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study – – – – – – 1
1.2 Statement of the Problem – – – – – – 7
1.3 Purpose of the Study – – – – – – – 9
1.4 Research Questions – – – – – – – 9
1.5 Significance of the Study – – – – – – 9
1.6 Research Hypotheses – – – – – – – 10
1.7 Basic Assumption – – – – – – – 10
1.8 Delimitation of the Study – – – – – – 11
CHAPTER TWO: REVIEW OF RELATED LITERATURE
2.1 Introduction – – – – – – – – 12
2.2 Conceptual Framework – – – – – – – 13
2.2.1 Concept of Knowledge, Attitude and Practice — – – – 20
2.2.2 Knowledge of Family Planning among Rural Women – – – 22
2.2.3 Attitude of Rural Women toward Family Planning – – – 24
2.2.4 Practice of Family Planning among Rural Women – – – 26
2.2.5 Benefits of Family Planning – – – – – – 27
2.2.6 Obstacles to Family Planning Practices – – – – – 29
2.2.7 Population Policy: A Focus of Family Planning – – – 29
2.2.8 Family Planning Methods – – – – – – 31
2.2.9 Contraceptives Practices and Factors that Influence Practice – – 38
2.2.10 Importance of Family Planning Practices – – – – 40
2.2.11 Female Education and Family Planning – – – – 41
2.2.12 Level of Education and Family Planning – – – – 42
2.2.13 Income Level of Rural Women and Family Planning – – – 44
2.2.14 Religion Perspective on Family Planning- – – – – 45
2.3 Theoretical Framework – – – – – – – 46
2.4 Empirical Studies – – – – – – – – 55
Summary – – – – – – – – – 66
CHAPTER THREE: RESEARCH METHODOLOGY
3.1 Introduction – – – – – – – – 68
3.2 Research Design – – – – – – – — 68
3.3 Population of the Study – – – – – – – 68
3.4 Sample and Sampling Procedures – – – – – 69
3.5 Instrumentation – – – – – – – – 71
3.6 Validation of the Instrument – – – – – – 72
3.7 Procedures for Data Collection – – – – – – 72
3.8 Pilot Study and Reliability – – – – – – – 73
3.9 Procedures for Data Analysis – – – – – — 74
CHAPTER FOUR: RESULT AND DISCUSSION
4.1 Introduction – – – – – – – – 75
4.2 Results – – – – – – – – – 76
4.2.1 Answering of Research Questions – – – – – 78
4.3 Hypotheses Testing – – – – – – – – 81
4.4 Discussion – – – – – – – – – 83
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Summary – – – – – – – – – 87
5.2 Summary of Major Findings – – – – – – 88
5.3 Conclusion – – – – – – – – 88
1.1 Background to the Study
The act of giving birth is the most serious labour in the world (Ademowore, 2011). The explosive increase in the nation‟s population emanating from indiscriminate child-bearing, apart from a small number of privileged and conscientious countries that have succeeded in reducing the population growth, each pregnancy and birth remains a risk fatal experience for hundreds of millions of women worldwide.
Family planning is a means by which individuals or couples space the process of conception, pregnancy and childbirth in intervals, mutually determined by both husband and wife in order to have desired number of children that they can conveniently cater for their needs (Delano, 2010).
According to Ahmed (2014), Family Planning is the factor that may be considered by a couple in a committed relationship and each individual involved in deciding if and when to have children. Though, rarely articulated, family planning may involve consideration of the number of children a couple wish to have as well as the age at which they wish to have them. Family Planning are obviously influenced by external factors such as marital situation, career considerations, financial position, any disabilities that may affect their ability to have children and raise them, beside many other considerations.
World Health Organization (2011), describe family planning as a way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitudes, and responsible decisions by individuals and couples, in order to promote the health and welfare
of the family group and thus contribute effectively to the social development of a country. The World Health Organization (WHO) (2012) estimates that 287,000 material deaths occurred in 2010, sub-Saharan Africa (56%) and southern Asia (29%) accounted for the global burden of maternal deaths.
National Demography Health Survey (2012), reported in Nigeria on maternal mortality rate, revealed that, 600,000 women died in agony every year. It is not an exaggeration to say that the issue of maternal mortality, fast in its conspiracy of silence in scale and severity, the most neglected tragedy of our time. Also 585,000 women die during pregnancy and child birth, and result from often pregnancy and child bearing.
Family planning is sometimes used as a synonym for the use of birth control; however, it often includes a wide variety of methods, and practices that are for birth control. It is most usually applied to a female-male couple who wish to limit the number of children they have and/or to control the timing of pregnancy (also known as child-spacing). Family planning may encompass sterilization, as well as abortion. The pervasive problem presently is population rapid growth, especially in developing countries where this population growth matters, because it has enormous impact on the human life. It will not be wrong to say that the most urgent conflict facing the contemporary world today is not between the states of ideologies but between the pace of growth of the human race and the disproportionate increase in the production of resources, necessary to support mankind in peace, prosperity and dignity (Sehgal, 2014).
Odimegwu (2011) Opined that, rapid growth of population is not caused by any single reason, but it is obvious that how crucial the demographic factor can be in the
political stability and the socio-economic development of a country. It has now universally recognized that a massive population size, its rapid growth rate, and its controlled transfer of population from rural areas to the cities can create pressure on the resources of a country, adversely affecting its economic prosperity. There is convincing evidence that poverty incidence is always higher among larger households.
Indeed, Orbeta (2010); figured out an enduring positive association between family size and poverty incidence and severity. Studies by Orbeta (2010) also showed how a large family size creates the conditions leading to greater poverty through its negative impact on household saving, labour force participation. Earnings of parents, as well as on the human capital investment in children. Besides, it is stated that uncontrolled population growth is recognized as the single most important impediment to national development. Although population growth is not the only problem dividing rich and poor countries, it is one important variable that has widened the gap in growth in per capital income between developed and developing nations. Advocates of birth control see it as a means to prevent the personal and social pressures that result from rapid population growth (Encyclopedia, 2013). Family planning services are defined as “Educational, comprehensive medical or social activities which enable individuals, including minors, to determine freely the number and spacing of their children and to select the means by which this may be achieved (Maisamari, 2010).
Generally, it is because of this over population of the family has resulted to unhealthy, the unemployed, the ill-educated and the under-fed, which has no small measures aggravated crime rate as the populace are left with no better option, than involving themselves in various notorious and corrupt practiced earn a timing. With the recognition
and consideration of the consequence of population explosion it is obvious that family planning remains the only acceptable and practicable option for the reduction of incessant population growth. Family planning is the process of choosing the number of children in a family and the length of time between their births. It involves adoption of contraceptive devices to prevent unwanted pregnancies and thereby determining the number and spacing of children in the family (Encarta, 2010). Also family planning practices is therefore, the various ways of controlling births which may not conform to the approved standard either as a result of ignorance or apathy, couples ignorance and wrong perception of family planning, has created a rat-race situation where survival is for the fittest; (Agbakuribe, 2011).
Despite the recent increase in contraceptive use, Nigeria is still characterized by high levels of fertility and a considerable unmet need for contraception. The total fertility rate in Nigeria is 6.0 births per women and considerably higher in the rural areas than in the urban areas. Hence, men should be actively involved at the knowledge level (the concept of family planning), the supportive level (being supportive for other to use contraception) and the “acceptor” level, (as contraceptive user). Their decision-making role should be taken into account in order to promote family planning. Research indicates that accepting pregnancy, knowledge on different methods choice, and the understanding of the side effects of different methods are among the factors related to family planning.
Knowledge of family planning is a key variable in any discussion of fertility regulation and in the evaluation of family planning program. Acquiring knowledge about family planning is an important step toward gaining access to and then using suitable contraceptive methods in a timely and effective manner. Information of knowledge of family planning will help the couples to avoid or delay pregnancy; (Umar, 2012).
Knowledge is facts, information and skills acquired through experiences or Knowledge of family planning – this consisted of knowledge of modern contraceptives source of information about family planning, sex education ins school and sexual transmitted diseases STDs the alarming rate of indiscriminate child bearing emanated from lack of knowledge of family planning (Chingpaye, 2013).
In a study conducted by Dangat (2013) in Hai district, Northern Tanzania among married women attending antenatal clinic, 65% of the Tanzanian population is under the age of 24 and almost 20% of the population is aged 15-24 years, important group faces many significant health challenges, such as early sexual debut, early pregnancies, risky behaviours and sexual transmitted infections. The objective of this study was to assess knowledge, attitudes and practices on family planning services among adolescents in secondary schools in Hai district in northern Tanzania. A cross sectorial study was conducted between April and June 2011 among 36 randomly selected students into secondary schools using a self administered pre-tested questionnaire, median age of participants was 17 years (15-19 years0. Two-thirds (67-4%) of the respondents had adequate level of knowledge on family planning services (FPS) and the most popular source of information was the radio (65.8%). Being in a lower class (X2 = 8.6; P<0.02) and FPS most 71.2% (225/316) respondents reported that FPS should not be used adolescents and mentioned several reasons against it used. Less than 6% (18/316) of all respondents had used FP I their lifetime, with 44.4% (8/316) in the past month 33.3% (6/318) in the past year, and 22.3% (4/18) in the past 5 years. In conclusion, most secondary school students in Hai Districts do not practice family planning services despite of adequate level of knowledge on FPS. Interventions to improve
utilization of FPS among secondary school students address barriers to low utilization of Family Planning Services in this study.
Attitude towards family planning is any strong belief, feeling, approval or disapproval toward people and situations. Attitude are learned tendency to evaluate things in a certain way. This can include evaluation of people issues, objects or events. Such evaluations are often positive or negative. (Paul, 2010).
Study conducted by Dauda and Oberiri (2016) in Taraba state, Nigeria, on the perception of married women aged 18-45 or the practice of family planning in Ardo Kola local government of Taraba state of Nigeria. This study adopted the survey research design method with questionnaire as the instrument used for data collection. The research deployed multi-stage sampling techniques to select 5 wards out of the 12 wards in Ardo-kola, Jauro-ginu Lamido-Borno, Mallam and then sets questionnaire were distributed to 400 respondents gthat were randomly selected from the 5 wards. Data collected were analyzed using simple percentages, frequencies and micro soft excel chart analysis. The study reveals among other things that married women in Ardo-Kola LGA are aware of family planning/method but do not practice family planning because their husband are not favourably disposed to the practice. The study recommends that husbands in Ardo-Kola should be enlightened properly by healthcare providers on the benefits derivable from family planning, and the attendant socio-economic and health problems where the practice is ignored.
Practice of family planning – Are the extent to which people are making use of whatever health services that are available. Knowledge and positive attitude can be seen but the practice is not found; which means that not having knowledge and the positive attitude
and knowledge matters. (Becher, 2014). A survey of 600 Atyap (Kataf) women aged between 15-49 by Avong (2009) in the study, perception and attitude towards Nigeria population policy, family planning programme and family planning in Kaduna State”. Discovered that most of the respondents (98%) knew one form of modern method of family planning or the other but nearly all of them do not practice these modern methods of family planning due to fear of risk factors such as sterility, cancer, high blood pressure (HBP), weight increase, or weight loss, or fear of untimely death. A 34 year old undergraduate woman was reported to have made such remarks after been interviewed.
Contraceptive almost killed me if I were not educated. I`m sure I would have died (34 year old undergraduate women). The ascertain above corroborated what Hellandendu (2013) said in the study of violence against females. The research observed of artificial fertility regulation techniques are perpetuated by economic; political and gender structure in contemporary societies most of which work to the detriment of women. This is so because most of the artificial contraceptives are directed towards women which have detrimental health effects. Therefore, this study was to assess knowledge, attitude and practice of family planning among rural women in Kogi state, Nigeria.
1.2 Statement of the Problem
There is no doubt that Nigeria is one of the most populous country in Africa. The researcher observed that the problem of many children per family contributes to poverty, unhealthy, under-fed and ill-educated. The researcher observed that frequent birth by the mothers had been associated to a serious health problem to the mothers and their children; the health of the mothers is in coma due to frequent discharge of blood which is not regained
before the conception of another pregnancy; and this accounted for thousands of deaths of women in Kogi state. Fertility in the country remains high with a total fertility of 6.0 births per women and considerably higher in the rural areas than in the Urban (Population Bureau, 2012).
Maternal mortality is high due to the short interval of pregnancy which amounted to births related cases, this trends has causes pre-term birth (birth within 37 weeks of pregnancy) low birth weight (child birth less than 2,500grams) and infant morbidity in the rural area for instance in Kogi state. The weaned children are in a serious health condition because the period for normal breast feeding is lacking, thereby resulting to low immunity that prone to contagious diseases.
In spite of the importance of population growth to the society, couples, cultural resistance to child-spacing has brought about numerous social problems like indiscriminate child bearing, unwanted pregnancies, high rate of infant morbidity, drop-out from schools, and the low standard of living which has been on the increase with poverty also contributing to the incidence where families continue to reproduce uncontrollably because, of the believe that. It is a taboo to regulate fertility; these ugly threat has been observed by the researcher in Kogi state; Nigeria.
National Demographic Health Survey (NDHS) (2012), estimated on maternal mortality rate that 600,000 women died every year out of 585,000 women died during pregnancy and child birth, to break this vicious threats in our various rural areas. This study is out to assess knowledge, attitude and practice (KAP) of family planning among rural
women in Kogi State, Nigeria. This is to know whether the rural women have knowledge about family planning, their attitude and practice towards family planning.
1.3 Purpose of the Study
The main purpose of this study was to assess the knowledge, attitude, and practice (KAP) of family planning among rural women in Kogi State, Nigeria. The specific purposes of the study are to assess:
- the knowledge on family planning among rural women of Kogi State, Nigeria.
- the attitude of rural women towards family planning in Kogi state, Nigeria.
- the practice of family planning among rural women in Kogi State, Nigeria.
1.4 Research Questions
The study is proposed to answer the following research questions:
- what is the knowledge of rural women about family planning in Kogi State?
- what is the attitude of rural women towards family planning in Kogi State?
- what is the practice of family planning among the rural women in Kogi State?
1.5 Significance of the Study
The result of this study will be beneficial to:
The health educators in planning awareness program for the client, thereby creating enlighten to the client in making decision that are related to family planning methods.
Findings of this study will enable the client to benefit from the awareness programs that are provided by the health educators in areas that are related to family planning methods.
Findings of this study will sensitize the policy makers in creating policies that would support family planning practices.
Findings of this study will help tremendously in reducing mortality and morbidity through the awareness program on issues or family planning and unwanted pregnancies.
Findings of this study would contribute to the body of knowledge for Researchers and other educational purposes.
1.6 Research Hypotheses
On the basis of the research questions, the following hypotheses were formulated for the purpose of this study:
The knowledge, attitude and practice of family planning among rural women in Kogi state of Nigeria are not significant.
Sub – Hypotheses
1.6.1 There is no significant knowledge of family planning among rural women in Kogi State, Nigeria.
1.6.2 There is no significant attitude towards family planning among rural women in Kogi State, Nigeria.
1.7 Basic Assumptions
On the basis of available research evidence the following assumptions were made for the purpose of the study.
- Knowledge of rural women towards family planning is low in Kogi State, Nigeria.
- That attitude of rural women towards family planning is positive.
- Practice of family planning services among rural women in Kogi State is in poor conditions.
1.8 Delimitation of the Study
This study is delimited to “Assessment of knowledge, attitude and practice (KAP) of family planning among rural women of reproductive age 15-49, in Kogi State, Nigeria. Also, delimited to the following variables;
- Knowledge of family planning among rural women in Kogi state Nigeria.
- Attitude of rural women towards family planning.
- Practices of family planning among rural women.