Knowledge and use of modern family planning methods by rural women in Zambia
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Research Article
Knowledge and use of modern family
planning methods by rural women in
Zambia
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
Email: Catherinengoma@yahoo.com
17
Curationis M arch 2010the number and spacing o f their chil the face of high AIDS mortality in some
Introduction
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-
18
C urationis M arch 2010Table 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, PHealth 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
method; and 53.3% said that they de 1993:9). In addition women may blame ASTURIAS DE BARRIOS, L; RODS,
21
C urationis M arch 2010IM;NIEVES, I; MATULA, J & YINGER, ing sex, contraception, and child bear SMITH, R ASHFORD, L; GRIBBLE,
N 1998: Unmet need for family plan ing. Family planning Perspective. 28(5): J & C LIFTO N , D 2009: Family Plan
ning in a peri urban community of Gua 221-226. ning saves lives. 4th ed. Washington,
temala City. Washington DC. Interna DC; Population Reference Bureau.
tional center for Research on women. HAUB, C & KENT, MM 2008: World
population data sheet. Washington DC: UNALAN,T; KOC, I & TEZCAN, S
BA-HUBAISH, N 1999: How far Population Reference Bureau. 2003: Hacettepe University Institute
Yemenis believe contraception is im o f Population Studies, Turkey Demo
portant. Yemen Health Time, 03-Janu- JOESOEF, MR; BAUGHMAN, AL& graphic and Health survey. Hacettepe
ary 18lh thru 2 4 th, Vol IX. BUDI, U 1991: Husbands’ approval of University of population Studies, Min
http:www.Yemetimes.com/99/iss03/ contraceptive use in Metropolitan In istry o f Health General Directorate of
health.html. Accessed 26,hAugust 2009. donesia; Program Implications. Stud Mother and Child Health and Family
ies in Family Planning 19; 162-168. planning, state planning organization
C ASTERLIN, JB ; SATHAR, ZA & and European Union. Ankara. Turkey.
HAQUE, M. 2001: Obstacles to con HAMID, S & STEPHENSON, D 2006:
traceptive use in Pakistan. Studies in Education and non use o f contracep UNITED NATIONS POPULATION
Family Planning: 32 (2): 95-110. tives among poor women in Pakistan. DIV ISIO N 2009:World Population
International Family Planning Perspec prospects, medium variant projection
CASTROL-MARTIN, T 1995: Wom tives. 21(3). 121-128. series. Washington, DC: United N a
en’s education and fertility: results from tions population Division.
26 Demographic health surveys. Stud KHALIFA, MA1988: Attitudes o f ur
ies in Family Planning. 26 (4): 187-2002. ban Sudanese men towards family plan W O RLD BANK 2007: Why contra
ning. Studies in Family Planning. 19: ception is a Best Buy. Disease Control
CENTRAL STATISTICS O FFIC E 236-243. Priorities Project Policy Brief. Washing
(ZAMBIA) 2002: Zambia Demographic ton DC: DCP2.
Health Survey 2001-2002.Central Sta KOBLINSKY, M, TIMYAN, J & GAY,
tistic Office, Lusaka, Calverton, Mary J 1993: The Health o f women; a global
land, and Micro International. Perspective. West view Press: Boulder.
CENTRAL STATISTICS O FFICE M BIVZO, M T & ADAMCHAK, DJ
(ZAMBIA) 2008: Zambia Demographic 1991: Family planning knowledge, at
Health Survey 2007-2008.Central Sta titu d e s and p ra ctices o f m en in
tistic Office, Lusaka, Calverton, Mary Zimbambwe. Studies in Family Planning.
land, and Micro International. 22:31-38.
C L IF T O N , D; K A N E D A , T & MINISTRY OF HEALTH 2002: Inte
ASHFORD, L 2008: Family Planning grated technical guidelines for frontline
Worldwide. Washington, DC: Popula Health workers. 2nd edition. Lusaka:
tion Reference Bureau. Ministry of Health.
CONDE-AGUDELO, A & BALIZAN NA ZA R-BEU TEELSPACHER, A;
2000: Maternal morbidity and mortal M O N A L IS A -R O S A L E S , D;
ity associated with inter pregnancy in SA L V A T IE R A I - Z A B A , B &
terval, cross sectional study. British ZAPATA-MATRTELO, E; HALPERIN,
Medical Journal. 321:1255-1259. D 1999: Education and non use of con
traceptives am ong poor wom en in
E L Z A N A T Y , F ; SU N IT A , K & Chiapas, Mexico. International Family
CASTERLINE, J 1999: Egypt in depth Planning Perspectives. 25 (3): 132-138.
study on the reasons for non use of
family planning. Cairo: National Popu N S E M U K IL A , G B ; P H IR I, DS;
lation Council. DIALLO, HM; BANDA, SS; BENAYA,
W K & KITAHRA, N 1998: Factors as
E SPEJO , X; TSU N ECH IRO , MA; sociated with maternal m ortality in
O S IS , M J ; D U A R T E , GA ; Zambia: Ministry o f Health, United
BAHAMONDESE, L & DE SOUSA, Nations Population fund, Central Board
M H 2003: Knowledge adequacy on of Health and University o f Zambia.
co n tra cep tiv es am ong w om en in
Campinas, Brazil. Rev Saude Publica. PATH 2005: RHO archives. Family
37:583-590. p lan n in g program issues, h ttp ://
www.rho.org/html/fpp-
GRADY, W 1996: M en’s perceptions progexamples.html. Accessed 6th No
of their role and responsibility regard vember 2007
22
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