Knowledge and use of modern family planning methods by rural women in Zambia

Research Article

                 Knowledge and use of modern family
                 planning methods by rural women in
C Mubita-Ngoma, Msc, RM, RN
Department of Nursing Sciences, School of Medicine, University of Zambia,

M Chongo Kadantu, Bsc RM, RN
Nursing Manager, Siavonga District Health Management Team

ModoTiTcoiitraceptives                 Abstract: Curationis 33 (1): 17-22
Knowledge, Use, Rural women, Zam-     The main aim o f the study was to determine knowledge and use o f modem contrac-
|3ja                                  tive methods among reproductive age group rural women in Zambia. The study is a
                                      descriptive cross-sectional study o f 105 randomly selected rural women. Data was
                                      collected using semi-structured interview schedule and analyzed using EPI Info ver­
                                      sion 6 statistical packages. The findings revealed that 63% o f the respondents were
                                      within the age group 21-35 years, 65% were married and 64% were peasant farmers.
                                      90% of the respondents had heard about modem contraceptives and their main
                                      source o f information was the Health worker (62%). 76% o f the respondents stated
                                      that modem contraceptive methods could be obtained from public health facilities.
                                      56% o f the respondents were currently using modem contraceptive methods and
                                      46% were not using modem contraceptive methods.

                                      Reasons for non use of contraceptive methods were religious beliefs (50%), partner
                                      disapproval (30%) and side effects (20%). The results showed a relationship between
                                      educational level and use of contraceptives (Chi-square 7.83, df = 3, P < 0.05) and
                                      spouse approval or support o f contractive methods and use o f contraceptive (Chi-
                                      square 5.9, d f = 2, P < 0.05). Therefore, efforts to promote modem contraceptive use
                                      among the rural women should be intensified to overcome barriers to contraceptive
                                      use and should involve men.

Correspondence address
Catherine Mubita-Ngoma
Head o f Department
University of Zambia
School o f Medicine
Department o f Nursing Sciences
P.O. Box 50110
Lusaka, Zambia


                                             Curationis M arch 2010
the number and spacing o f their chil­        the face of high AIDS mortality in some
                                              dren and have the information, educa­         countries, the region’s 2008 population
Zambia is among the sub-Saharan Af­
                                              tion and means to do so (Ministry of          of 809 million is projected to increase
rican countries with a high fertility rate
                                              Health 2002: 15). Other specific objec­       to 1.2 billion by 2025 (Haub & Kent,
o f 5.9 births per woman (Central Statis­
                                              tives include slow ing the n ation’s          2008: 9). The major factor underlying
tical Office, 2002:6). It is located in the
                                              population growth rate, initiate, im­         high birth rates is low family planning
southern part o f the sub-Saharan Afri­
                                              prove and sustain measures to arrive          use for instance only 18% o f married
can Region and it is a landlocked coun­
                                              at slowing down the nation’s high             women in sub-Saharan Africa use mod­
try. It shares borders with the Demo­
                                              population growth rate, enhance the           em methods of family planning (Clifton
cratic Republic o f Congo (DRC) and
                                              health and welfare o f all and prevent        et al, 2008: 3). However, there are sub-
Tanzania in the north, Malawi and
                                              premature death and illness, especially       region differences in modem contra­
Mozambique in the east, Zimbabwe and
                                              among high-risk groups o f mothers and        ceptive use, for example, modem con­
Botswana in the south, Namibia in the
                                              children (Ministry of Health 2002:15).        traceptive use is 58% in Southern Af­
south-west and Angola in the west.
                                                                                            rica, 22% in East Africa, 7% and 9% in
Zambia lies between 8 and 18 degrees
                                               The national family planning pro­            Central and Western Africa respec­
south latitude and between 20 and 35
                                              gramme has strived to achieve the             tively (Clifton et al, 2008: 3). It is also
degrees east latitude. The country has
                                              above stated objectives. To help the          estimated that 35 million women in sub-
a population of 10.3 million inhabitants’
                                              national and district levels in planning      Saharan Africa have an unmet need for
(Central Statistical Office, 2002:48) and
                                              and implementation o f the family plan­       family planning (Clifton et al, 2008:2).
the population growth rate in 1990 and
                                              ning component o f their reproductive         They want to delay or stop childbear­
2000 was 2.9% per annum.
                                              health programs, a policy framework           ing but are not using any contracep­
                                              was developed.                                tive method.
The country’s family planning pro­
                                              With regards to knowledge levels, the         C onde - A gudelo and B alizan
gramme came into being in 1970 and
                                              2002 and 2007 Zambia Demographic              (2000:1255) state that, in sub- Saharan
family planning services were first in­
                                              and H ealth Surveys reported high             Africa, rural women tend to use fewer
troduced in the urban areas and ex­
                                              knowledge levels o f modem contra­            contraceptives and have more children
panded to the rural areas very slowly.
                                              ceptive method among the Zambian              than their urban counterparts. In addi­
Family planning was integrated in Ma­
                                              population but despite this, there is still   tion many rural women have gaps in
ternal and Child Health care services in
                                              low utilization of family planning serv­      their knowledge about available con­
1973 and even today it still an integral
                                              ices am ong w om en in Z am bia               traceptive methods and how effective
part o f the country’s reproductive
                                              (N sem ukila, Phiri, D iallo, Banda,          each m ethod prevents p regnancy
health program (M inistry o f Health
                                              Benaya & Kitahara 1998: 26; Central           (Conde - Agudelo & Balizan, 2000:
2002:24). Despite the integration of fam­
                                              Statistic Office, 2002:278).                   1255). Previous studies have shown
ily planning services in the reproduc­
                                                                                            that knowledge o f modem contracep­
tive health program, there has been a
slow decline in fertility level for in­       Literature review                             tive methods is an important determi­
                                                                                            nant of contraceptive use (CSO, 2002:
stance, from 6.5 births per woman in          According to the 2007 World Bank re­
                                                                                            278). Women who are well informed
1992 to 6.1 in 1996 to the current level      port, contraception is a best buy for
                                                                                            about the benefits of family planning
o f 5.9 births per woman. The increase        development. By helping individuals to
                                                                                            tend to use it. However, women’s per­
in contraceptive use over the past dec­       choose when to have children, family
                                                                                            ception that their husbands oppose
ade has also been slow (from 26% in           planning saves lives, it prevents unin­
                                                                                            family planning is a dominant factor
1992 to 34% in 2002). Furthermore,            tended pregnancies, averts maternal
                                                                                            discouraging contraceptive practice in
about one in three o f currently married      and child deaths and prevents abor­
                                                                                            a wide variety o f settings (Joesoef,
women still have an unmet need for            tions
                                                                                            Baughman & Budi, 1988; Khalifa,
family planning (Central Statistics Of­       (Smith, Ashford, Gribble & Clifton,           1988:236; Mbizvo&Adamchak, 1991:
fice, 2002:276).                              2009: 6). Family planning also saves          32;Koblinsky,Timyan&Gay, 1993:10;
                                              public sector resources; for $ 1 a gov­       Grady, 1996: 221; Asturias de Barries,
Zambia developed a national family            ernment spends on family planning             Rods, Nieves, Matula, & Yinger, 1998:
planning policy in 1989 which was             service delivery, $2 to $6 can be saved       15; Elzanary, Sunita, & Casterline, 1999:
adopted as part o f its fourth National       in providing other interventions includ­      23). Another determinant for use or non
Development plan (Ministry of Health          ing basic health and education for            use o f contraceptives is lack o f school­
2002: 15). This policy recognizes the         fewer children, maternal health services      ing (C atrol-M artin 1995:187, Espejo,
effects of rapid population growth on         and improvements in water and sanita­         T sunechiro,        O sis,       D u arte,
Zambia’s socioeconomic development            tion (United Nations Population Divi­         Bahamondese, & De Sousa, 2003:583,
and the need to incorporate population        sion, 2009:4).                                Hamid & Stephenson, 2006:121,Nazar-
concerns into the national development                                                      Beuteelspacher, M onalisa-R oseles,
and planning process (PATH, 2005: 3).         Sub-Saharan Africa has the highest fer­       Salvatierral-Zaba, Zapata-Martelo &
                                              tility o f any world region which is 5.4      Halperin 1999: 134, Unalan, Koc &
The main objective is to ensure that all      births per woman on average (Clifton,         Tezcan, 2003:8). Religious belief is also
couples and individuals have basic            Kaneda & Ashford, 2008:2). Birth rates        one o f the reasons for non use o f mod­
rights to decide freely and responsibly       in the region are so high that even in        ern co n tracep tiv e m ethods ((B a-

                                                      C urationis M arch 2010
Table 3 Use and Reasons for nonuse of modern contraceptive methods                   women whenever an opportunity arises
                                                                                     and most of them have trust in them.
                                                                                     Health workers especially nurses and
 Characteristic                                  Frequency        Percentage         midwives in particular are grass root
                                                                                     w orkers providing health care to
 Use of modern contraceptive methods                                                 populations in the remote parts o f the
        Yes                                      57                     54%          country, therefore they are easily ac­
        No                                       48                     46%          cessible. The current study has also
                                                                                     revealed that knowledge o f m odem
 Contraceptive method in use                                                         methods of contraception and where
       Pill                                                             80%          the methods could be obtain was good,
       Intra Uterine Devise                                             5%           for example, many women could men­
       Condom                                                           10%          tion at least one method o f contracep­
       Injectables                                                      5%           tion and stated that modem contracep­
                                                                                     tive methods could be obtained from a
 Reasons for nonuse                                                                  health facility. However, there is need
       Religious beliefs                        53                      50%          for continued sensitization on the ben­
       Partner disapproves                      31                      30%          efits o f family planning especially
       Fear o f side effects                    21                      20%          among women who are illiterate.

                                                                                     The most popularly known and used
dom, 24% mentioned a pill and 5% men­     who were 21-35 years than women be­
                                                                                     method o f contraceptive among the
tioned inject able contraceptive (Table   tween 36 - 49 years (Chi-square test
                                                                                     respondents was a male condom fol­
2). Only 5% o f the respondents did not   3.38, df = 2, P< 0.05). Among the women
                                                                                     lowed by a pill. These contraceptive
know any modem method of contra­          who were using modem contraceptive
                                                                                     methods were popular among the re­
ception. There was a small difference     m ethods, 80% w ere u sin g a pill
                                                                                     spondents because the methods are
that existed in knowledge o f modem       (Microgynon). The study has shown
                                                                                     readily available and accessible in the
contraceptive m ethods among the          that women who had good knowledge
                                                                                     Government health care facilities than
women in this study. Ninety two per­      about contraceptive m ethods were
                                                                                     other methods of family planning such
cent (92%) o f women in the age group     more likely to use a contraceptive
                                                                                     as injections. In addition, condom use
21-35 years, 89% o f the women in the     method than those with poor knowl­
                                                                                     is currently being promoted by the HIV/
age group 15-20 and 85% of the women      edge.
                                                                                     AIDS program as one of the methods
with the age group 36-49 had hear of a
                                                                                     o f prevention. However, knowledge of
modem method o f family planning.         Forty six percent (46%) o f the women
                                                                                     methods of modem contraceptives is
There was a variation in contraception    were not using any modem contracep­
                                                                                     necessary but it is not sufficient to en­
knowledge levels and education for in­    tive method (Table3) and these were
                                                                                     courage use of methods of contracep­
stance, only 49% o f illiterate women     within the age group 36 - 49 years and
                                                                                     tion. For instance 46% of the women in
knew a method of contraception com­       were illiterate (49%). The reasons for
                                                                                     this study were not using any meth­
pared to 99% o f women with second­       non-use o f modem contraceptive meth­
                                                                                     ods of contraception despite them hav­
ary or higher education and 80% of        ods are illustrated in table 3 and these
                                                                                     ing good knowledge o f modem con­
women with primary school education.      included religious beliefs (50%), Part­
                                                                                     traceptive method.
The most striking differences in knowl­   ner disapprove (30%), and fear o f side
edge of contraceptive method were by      effects (20%).
                                                                                     In this study, women who were younger
source information. Ninety five percent                                              were more likely to use a modem con­
(95%) of women whose source of in­        In this study, women whose spouses
                                                                                     traceptive method than older women.
formation was the Health workers were     approved (68%) of use of modem con­
                                                                                     This could be attributed to the fact that
more knowledgeable about contracep­       traceptive method were more likely to
                                                                                     younger women were more enlighten
tive methods, than those who had the      use modem contraceptive method (Chi-
                                                                                     on family planning than older women.
family as their source of information     square = df = 6, P< 0.05) than those
                                                                                     An association was found between
(48%).                                    whose husbands disapprove (32%).
                                                                                     educational level and use of contracep­
                                                                                     tion. Respondents’ who had second­
Fifty four percent (54%) o f the women    Discussion                                 ary school education were using con­
in this study were currently using a       Knowledge o f family planning is con­     traception than those who have never
modem contraceptive method and the        sidered the first stage toward the adop­   been to school. Education is the most
majority (62%) of the women who were      tion o f a contraceptive method (CSO,      consistent reported determinants o f
currently using contraceptives were       2002:279). This study has revealed that    reproductive health services utilization;
within the age group 21-35 years and      a large num ber o f the respondents        for instance, a Mexican study found
most (62%) of these women had sec­        (90%) had heard about modem contra­        an independent association between
ondary school education (Chi-square       ceptive methods mainly from a Health       lack of any schooling and the use o f
7.83, df = 3, P
Health Survey reported similar findings     cided on the number o f children to          any type o f health problem, especially
that women who were educated were           have. Women had little involvement in        reproductive- tract problems on their
more likely to utilize modem family plan-   the decision. A study o f Sudanese           contraceptives (Koblinsky et al, 1993:
ning methods. A nother study con­           men’s attitudes, knowledge and prac­         10). This reaction results in part from
ducted in Pakistan by Hamid and             tice concerning family planning sug­         poor counseling and information, edu­
Stephenson (2006: 121) confirmed the        gested that men made the decision            cation and communication and from
findings that women who have been to        about contraceptive use and were re­         information women receive about other
school are more likely to use modem         sponsible for obtaining the method           women’s experiences (Koblinsky et al,
contraceptive methods. In a population      (Khalifa, 1988: 236). In Indonesia hus­      1993:10). Therefore health care profes­
based Turkish survey, women with sec­       bands’ approval was the most impor­          sionals need to provide information,
ond level primary school and higher         tant factor in whether or not wives used     education and communication regu­
education were better informed than         contraception as husbands are seen as        larly to the women in order to encour­
wom en with little or no education          the protector and provider for the           age use o f modem contraceptive meth­
(Unalan et al, 2003: 8). Furthermore,       household and the decision m aker            ods.
higher educational level and better         (Joesoefetal 1991; 162).
socio-econom ical status have been                                                       Conclusion
shown to be associated with better          As in most Sub-Saharan cultures, men
                                                                                         A lthough there has been a steady
knowledge about contraception in a          in Zambia tend to dominate a couples’
                                                                                         change in the attitudes o f women re­
study from Brazil (Espejo et al, 2003:      decision about family size and whether
                                                                                         garding family planning as means of
583). This could be due to the fact that    to use contraception. A husband is re­
                                                                                         spacing children and achieving a
educated women are able to articulate       garded as a decision maker in the home
                                                                                         smaller family size, the country is still
their fertility desires.                    and if he opposes contraceptive use
                                                                                         characterized by very high birth rates
                                            by the wife there is nothing a wife can
                                                                                         and low rates of contraceptive use. One
The barriers to modem contraceptive         do otherwise she risks a divorce or be­
                                                                                         of the perplexing findings is that the
use expressed by women in this study        ing beaten. Culturally men usually want
include religious beliefs, spouse ap­       their wives to have more children so as      level of knowledge about contracep­
proval and side effects. Half (50%) of      to earn respect. It is also perceived by     tive methods is good and yet the use
the respondents believed that children      husbands that use o f contraception          o f the methods is still very low. Rigor­
are given and determined by God there­      could encourage infidelity among             ous research is needed to establish the
fore they could not use contraceptive       wives.                                       reasons for slow rate o f adoption of
otherwise they would go against God’s                                                    contraceptive. Efforts to promote con­
will. Although it is difficulty to ascer­   This study has also shown that women         traceptive use among the rural women
tain the importance of religion in an in­   whose spouses approved o f use of            should be intensified. There is need to
dividuals’ decision making process, it      contraceptive methods were more likely       provide accurate information on man­
quite clear from this study that religion   to use the modem methods than those          agement of side effects to these rural
could have a negative influence on the      whose spouses disproves o f modem            women. Improving knowledge about
women’s use o f contraception. This         contractive use. This finding confirms       the side effects o f contraception can
result confirms the findings of a Yemen     results from a study conducted by            increase the uptake of modem contra­
study which identified religious beliefs    Grady (1996: 222) which also found a         ceptives. Men play an important role
as a reason for non use of modem con­       positive association between spouse          in the reproductive decisions of their
traceptive method (Ba-Hubaish, 1999:        approval and contraceptive use. There­       families therefore there is an urgent need
4).                                         fore, it is clear; there is an urgent need   to involve men in reproductive health
                                            to involve men in reproductive health        matters. Lastly, religious leaders hold
Another barrier to contraceptive use        matters because of the role they play        great influence over public opinion,
revealed in this study is unwillingness     in reproductive decision of their fami­      therefore they should be engaged in
for contraception by the spouse or          lies. This information could be used to      reproductive and family planning is­
husband. Husband’s opinion on fam­          design messages targeted at men.             sues so that they support and promote
ily planning can be strong to determine                                                  reductive health and family planning
their wives use o f family planning         The other reason cited by women in           to their congregations.
(Koblinsky, et al, 1993:10). In Zimba­      this study for non use o f contracep­
bwe, a study o f males’ family planning     tion was side- effects o f modem meth­       Acknowledgement
knowledge, attitudes and practices          ods o f contraception. According to
                                                                                         The authors would like to thank the
found that 80.6% o f the sample had         Wasserheit, Harris, Chakraborty, Kay,
                                                                                         Ministry of Health for sponsoring the
used contraception with their partners      Bradford & Mason (1989: 69), one of
                                                                                         study. We would also like to thank the
and 83.5% approved of family planning       the most commonly cited reason for
                                                                                         mothers who participated in this study
in general (Mbizvo & Adamchak, 1991:        discontinuing contraceptive use is the
                                                                                         and Siavonga District Health manage­
31). O f the men who had ever used fam­     perceived side-effects. These could be
                                                                                         ment team for giving us permission to
ily planning, 58.8% said the male part­     side- effects that are regarded as nor­
                                                                                         conduct this research.
ner should have a major say to practice     mal by health care professionals but
family planning; 48.3% said they were       may be o f great personal or cultural
responsible for the decision to use a       importance to women (Koblinsky et al,        References
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                                                     C urationis M arch 2010
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