CHAPTER TWO
2.0 Literature Review
2.1 Introduction
The review of relevant literature is the main topic of this chapter. A literature review covers
theoretical and methodological contributions to a certain issue in addition to the state of
knowledge at the time of writing. It provides information about the state of the art in relation to
the subject you are writing about. It examines the body of work on the chosen subject.
Childbearing and contraceptive uses are among the most important reproductive health decision
that many have to make (Gertner, 2009). Family decision and the attitude are most likely to meet
these decisions based on accurate, relevant information, and are medically appropriate, that is,
when they are informed choices (AUSC International, 1998)
2.2 THEORETICAL AND CONCEPTUAL FRAMEWORK
The theories or behavioural models that ground this study included the socio ecological model
(SEM) in combination with the health belief model (HBM). In the 1970s, Urie Bronfenbrenner
first introduced the SEM as a conceptual model for understanding human development, but it
was later formalized as a theory-based framework for understanding the multilayered and
interactive effects of personal and environmental factors in the 1980s (Kilanowski, 2017).
Similarly, in the 1950s, a group of social psychologists, namely, Hochbaum, Rosenstock, and
others within the United States Public Health Service, developed the HBM to describe people’s
failure for participating in programs to prevent and detect disease (LaMorte, 2019). Overtime,
the application of the HBM expanse to study people's behavioral responses to health-related
conditions. Its relevance has evolved to address multiple P.H. concerns, a wide range of
populations and health behaviors (LaMorte, 2019). The HBM contains several primary
constructs or concepts, which include perceived susceptibility, severity, benefit, barrier, and self-
efficacy. These perceptions prompt individuals to take action to prevent, screen for, or control
illness conditions (Diddana et al., 2018).
Among the 1.9 billion women of reproductive age group (15–49 years) worldwide in 2021, 1.1
billion have a need for family planning; of these, 874 million are using modern contraceptive
methods, and 164 million have an unmet need for contraception .
The proportion of the need for family planning satisfied by modern methods, Sustainable
Development Goals (SDG) indicator 3.7.1, has stagnated globally at around 77% from 2015 to
2022 but increased from 52% to 58% in sub-Saharan Africa.
Only one contraceptive method, condoms, can prevent both a pregnancy and the transmission of
sexually transmitted infections, including HIV.
Use of contraception advances the human right of people to determine the number and spacing of
their children.
In 2022, global contraceptive prevalence of any method was estimated at 65% and of modern
methods at 58.7% for married or in a union women.
2.3 CONCEPT OF FAMILY PLANNING
Family planning is the planning of when to have and use birth techniques to implement such
plans. Other techniques commonly used include sexual education, prevention and management
of sexually transmitted diseases, pre-conception counselling, management and infertility
management (Olaitan, 2009). However, family planning is usually used as a synonym for the use
of birth control. It is most adopted by couples who wish to limit the number of children they
want to have and control the timing of pregnancy, also known as spacing of children (Olaitan,
2009).
Family planning may encompass sterilization, as well as pregnancy termination. It also includes
raising a child with methods that require significant amount of resources namely: time, social,
financial and environmental. Family planning measures are designed to regulate the number and
spacing of children within a family, largely to curb population growth and ensure each family
has access to limited resources. The first attempt to offer family planning services began with
private groups and often aroused strong opposition. Activists, such as Margaret Sanger in the
U.S., Marie Stopes in England and Dhanvanthis Rama Rou in India, eventually succeeded in
establishing clinics for family planning and health care. Today, many countries have established
national policies and encouraged the use of public family services (The United Nations and
World Health Organisation offer technical assistance, 2006).
The concept of informed choice in family planning can be applied to a wide range of sexual and
reproductive health decisions. It focuses on whether to seek, to avoid pregnancy, whether to
space and time one’s childbearing, whether to use contraception, what family methods to be
used, and whether or when to continue or switch methods. The term family planning choice
could also refer to the family decision making (Diaz et al., 1999).
The principles of informed attitude of women of childbearing age focus on the individual;
however, it also influences a range of outside factors such as: social-economic,cultural norms,
gender roles, social networks, religious and local beliefs. To a large extent, these community
norms determine individual childbearing preferences and sexual and reproductive behaviour. It is
usually thought that community and culture affect a person’s attitudes towards family planning,
desire for sex of children, preferences about family size, family pressures to have children and
whether or not family planning accords with customs and religious beliefs.
The proportion of women of reproductive age (aged 15–49 years) who have their need for family
planning satisfied with modern methods (SDG indicator 3.7.1) is 77.5% globally in 2022, an
increase of 10 percentage points since 1990 (67%) (2). Reasons for this slow increase include
limited choice of methods; limited access to services, particularly among young, poorer and
unmarried people; fear or experience of side-effects; cultural or religious opposition; poor quality
of available services; users’ and providers’ bias against some methods; and gender-based barriers
to accessing services. As these barriers are addressed in some regions there have been increases
in demand satisfied with modern methods of contraception. Family planning is of two types,
modern family planning and traditional family planning. In modern family planning, modern
methods are use which are well recommended while traditional family planning have to deal
with the use of traditional medicines as contraceptives.
2.3.1 IMPORTANCE OF FAMILY PLANNING
Family planning is crucial for individual and societal well-being, empowering women to control
their reproductive health, improving maternal and child health outcomes, and promoting
economic and social development. It helps prevent unintended pregnancies, reduces the risk of
complications during childbirth, and allows couples to plan their family size and spacing of
births.
Here are more detailed look at the importance of family planning:
1. Health Benefits:
Reduced Maternal Mortality:
Family planning, particularly birth spacing, significantly reduces the risk of maternal deaths and
complications during pregnancy and childbirth, especially for adolescent mothers.
Improved Child Health:
Spacing pregnancies allows mothers to recover physically and emotionally, leading to healthier
babies.
Reduced Unintended Pregnancies:
Family planning empowers women to choose their desired number of children and the timing of
pregnancies, reducing the likelihood of unintended pregnancies, which can have adverse health
and social consequences.
Prevention of Sexually Transmitted Infections (STIs):
Family planning methods, especially condoms, can protect against the spread of STIs, including
HIV/AIDS.
Reduced Need for Unsafe Abortions:
By preventing unintended pregnancies, family planning lowers the number of unsafe abortions,
which can have serious health risks for women.
2. Empowerment of Women:
Control over Reproductive Health:
Family planning allows women to make informed decisions about their reproductive health and
their future.
Access to Contraception:
Access to a range of contraceptive methods empowers women to choose the option that best suits
their needs and circumstances.
Increased Educational and Economic Opportunities:
When women can plan their families, they can pursue education and economic opportunities,
improving their own futures and those of their families.
3. Economic and Social Benefits:
Reduced Poverty:
By enabling women to plan their families and access educational and economic opportunities,
family planning can help reduce poverty.
Improved Family Well-being:
Couples who can plan their families experience less physical, emotional, and financial strain and
have more time and energy for personal and family development.
Sustainable Population Growth:
Family planning can help promote sustainable population growth, which is important for the
environment and the economy.
Reduced Government Costs:
Smaller families can lead to reduced costs for social services like healthcare
2.3.2 FACTORS INFLUENCING FAMILY PLANNING
Several factors influence family planning decisions, including individual attitudes, cultural
norms, access to resources, and health factors. These factors can affect both the desire to have
children and the choice of contraceptive methods.
Here are more detailed look at some key factors influences family planning:
1. Individual Attitudes and Beliefs:
Education:
Higher levels of education are often associated with greater knowledge about family planning
and a preference for smaller family sizes.
Knowledge and Awareness:
Individuals need accurate information about different family planning methods, their
effectiveness, and potential side effects to make informed choices.
Fertility Preferences:
A couple's desire to have children, either to have a certain number or to space births,
significantly impacts their family planning decisions.
Personal Values and Beliefs:
Religious, cultural, and traditional beliefs can influence attitudes towards contraception and
childbearing.
2. Social and Cultural Influences:
Social Norms:
Community expectations about family size, gender roles, and childbearing can influence
individuals' choices.
Peer Pressure:
Social pressure from friends, family, and community members can discourage or encourage the
use of family planning methods.
Cultural Beliefs and Traditions:
Cultural norms and traditions, often related to fertility and childbirth, can shape perceptions of
family planning.
Gender Roles:
Traditional gender roles can limit women's access to information and control over their
reproductive health, affecting their family planning decisions.
3. Access to Resources and Services:
Healthcare Access:
Access to healthcare facilities, including family planning services, is crucial for making informed
choices and accessing necessary methods.
Affordability:
The cost of family planning services and methods can be a barrier, particularly for low-income
individuals.
Availability and Accessibility:
The availability of different contraceptive methods and their accessibility to individuals in terms
of location and convenience play a role.
Information and Education:
Access to accurate and reliable information about family planning is essential for making
informed decisions.
4. Health Factors:
Health Status:
Health concerns, such as pre-existing conditions or concerns about potential side effects of
contraception, can influence method choices.
Partner Support:
A supportive partner can encourage the use of family planning methods and improve
communication about reproductive health.
Relationship Dynamics:
Power dynamics within the relationship can affect decision-making, especially regarding
contraception.
Others Influential Factors includes:-
1. Economic Factors:
Financial stability, employment status, and income levels can impact access to family planning
services and resources.
2. Environmental Factors:
Environmental conditions, such as food security and climate change, can indirectly influence
fertility preferences and family planning decisions.
3. Age:
Age is a factor, with younger individuals often having different perspectives on family size and
planning than older individuals.
2.3.4 FACTORS INFLUENCING NEGATIVE ATTITUDES OF FAMILY PLANNING
AMONG THE WOMEN
1. Fear of Side Efects: Some women avoid using family planning methods due to fears about
potential side effects, even if these fears are unfounded.
2. Cultural and Religious Beliefs: Cultural norms and religious beliefs can influence women's
views on family planning, leading to opposition or resistance to its use.
3. Lack of Access and Information: Limited access to information and services, particularly in
rural or underserved areas, can contribute to negative attitudes and hinder family planning
practices.
4. Spousal Opposition: In some cases, a woman's spouse's opposition to family planning can also
influence her attitude and usage.
5. Social Pressure: Social pressures from family and community members can also shape a
woman's attitude towards family planning
. 2.3.5 CONSEQUENCES OF NEGATIVE ATTITUDES
1. Unintended Pregnancies: Negative attitudes towards family planning contribute to unintended
pregnancies, which can have serious health consequences for women, such as increased risk of
maternal mortality and complications.
2. Health Risks: Unintended pregnancies can also lead to increased risk of unsafe abortions,
which can be a serious threat to women's health and well-being.
3. Limited Family Planning: Negative attitudes can limit women's ability to control their
reproductive health and make informed decisions about family size and spacing.
Citations:
Women's attitudes towards family planning
are generally positive, with many expressing a desire to use contraceptives and limit or delay
childbearing. However, a significant number still lack adequate knowledge and understanding of
family planning methods, leading to potential barriers in their uptake.
2.3.6 ATTITUDES THAT INFLUENCE WOMEN TOWARDS FAMILY PLANNING
1. Education:
Women with higher levels of education tend to have more favorable attitudes towards family
planning.
2. Pregnancy History:
Women with fewer pregnancies and those who do not want more children in the future are more
likely to have positive attitudes towards family planning.
3. Religious and Cultural Beliefs:
Some religious and cultural beliefs can negatively influence women's attitudes towards family
planning, particularly regarding the use of contraceptives.
4. Husband's Support:
A supportive husband can positively influence a woman's decision to use family planning
methods.
5. Knowledge of Methods:
Awareness of different family planning methods, including how to obtain and use them properly,
is crucial for positive attitudes.
6. Side Effect Concerns:
Concerns about potential side effects of certain contraceptive methods can negatively impact a
woman's willingness to use them.
[Link]:
Limited access to family planning services and information can also contribute to negative
attitudes.
2.3.7 CHALLENGES AND BARRIERS OF WOMEN TOWARDS FAMILY PLANNING
1. Lack of Knowledge:
Many women are not fully aware of available family planning methods and their benefits.
2. Misinformation:
Misinformation and negative rumors about contraceptives can deter women from using them.
3. Cultural Norms:
Cultural beliefs and practices, including the preference for large families, can influence women's
attitudes.
4. Religious Restrictions:
Some religious beliefs may prohibit or restrict the use of certain contraceptive methods.
5. Husband's Opposition:
A lack of support from husbands can also be a barrier to family planning.
In conclusion, while many women in Lagos have a positive attitude towards family planning, it's
crucial to address knowledge gaps, misconceptions, and cultural and religious barriers to ensure
that all women can access and use family planning services effectively.
2.3.8 VARIOUS FAMILY PLANNING METHODS
Family planning methods can be broadly categorized into hormonal, barrier, IUD, sterilization,
natural, and emergency methods. Hormonal methods include pills, injections, and implants,
preventing ovulation or thickening cervical mucus. Barrier methods physically prevent sperm
from reaching the egg, such as condoms, diaphragms, and sponges. IUDs are small devices
inserted into the uterus, releasing hormones or copper to prevent fertilization. Sterilization is a
surgical procedure that permanently prevents pregnancy. Natural methods involve understanding
and managing fertility, like the rhythm method. Emergency contraception is used after
unprotected sex to prevent pregnancy.
1. Hormonal Methods:
* Oral Contraceptive Pills: Taken daily, they contain hormones that prevent ovulation or thicken
cervical mucus.
* Hormonal Implants: Small devices inserted under the skin that release hormones for several
years.
* Hormonal Injections: Shots given every few months that contain hormones to prevent
ovulation.
* Hormonal Patches: Applied to the skin, they release hormones to prevent ovulation.
* Vaginal Rings: Inserted into the vagina and release hormones to prevent ovulation.
* Hormonal IUDs: Devices inserted into the uterus that release hormones.
2. Barrier Methods:
3. Male Condoms:
A thin barrier placed over the penis to prevent sperm from entering the vagina.
4. Female Condoms:
A thin, closed pouch that is placed inside the vagina.
5. Diaphragms and Cervical Caps:
Devices inserted into the vagina to cover the cervix and prevent sperm from entering the uterus.
6. Contraceptive Sponges:
A sponge placed in the vagina to absorb sperm and prevent them from reaching the uterus.
7. IUDs:
* Hormonal IUDs: Inserted into the uterus and release hormones to prevent pregnancy.
* Copper IUDs: Inserted into the uterus and release copper ions to prevent sperm from fertilizing
the egg.
8. Sterilization:
* Vasectomy (Male Sterilization): A surgical procedure that cuts and ties the tubes that carry
sperm from the testicles.
* Tubal Ligation (Female Sterilization): A surgical procedure that cuts and ties the fallopian
tubes.
9. Natural Methods:
* Rhythm Method (Fertility Awareness): Tracking a woman's menstrual cycle to identify fertile
periods and avoid intercourse during those times.
* Lactational Amenorrhea Method (LAM): Exclusive breastfeeding after childbirth to suppress
ovulation.
10. Emergency Contraception:
* Emergency Pills: Taken after unprotected sex to prevent pregnancy
2.3.9 REASONS FOR POOR APPLICATION OF CONTRACEPTIVES
Poor application of contraceptives stems from a complex mix of factors, including limited
access, insufficient knowledge, concerns about side effects, cultural and religious opposition, and
gender-based barriers. Inadequate health services, poor service quality, and lack of
confidentiality can also contribute to the problem, particularly for young people.
Here are more detailed look at the reasons:
1. Access and Availability:
Limited Access:
Lack of access to contraception, whether due to geographic distance, cost, or lack of availability
in certain areas, is a major barrier.
Limited Choice:
If people don't have a variety of methods to choose from, they may be less likely to use any at
all, or may choose a less effective method.
2. Knowledge and Understanding:
Insufficient Knowledge:
Lack of knowledge about different contraceptive methods, how they work, and how to use them
correctly can lead to incorrect or inconsistent use, says a study on Taylor & Francis Online.
Misconceptions:
Misinformation about contraception, its effectiveness, and potential side effects can also hinder
use, notes a study on the National Institutes of Health (NIH) (.gov).
3. Side Effects and Health Concerns:
Fear of Side Effects:
Concerns about potential side effects, like weight gain or mood changes, can deter individuals
from using certain methods.
Health Risks:
In some cases, individuals may not be aware of or have concerns about the potential health risks
associated with certain methods.
4. Societal and Cultural Factors:
Cultural and Religious Opposition:
Cultural norms and religious beliefs can sometimes discourage the use of contraception,
particularly among certain groups.
Gender-Based Barriers:
Gender roles and societal expectations can also play a role, with some individuals feeling
pressure to have children or experiencing opposition from their partners or families.
5. Health Service Issues:
Poor Quality of Services:
Inadequate health services, including lack of confidentiality, judgmental attitudes from health
professionals, and lack of culturally sensitive care, can create barriers.
Inadequate Training of Health Professionals:
Health professionals may not be adequately trained to provide comprehensive and accurate
information on contraception, or to address the concerns of their patients.
6. Other Factors:
Relationship Instability:
Relationship problems and lack of communication can lead to inconsistent contraceptive use.
Lack of Partnership:
In some cases, partners may not be supportive of contraceptive use, which can also lead to
inconsistent use or discontinuation.
Addressing these multifaceted issues requires a comprehensive approach that includes improving
access to services, providing accurate and accessible information, addressing cultural and
religious barriers, and ensuring quality healthcare services.
2.3.10 CONTROL MEASURES OF POOR APPLICATION OF CONTRACEPTIVES
To improve contraceptive application, focus on education, accessibility, and addressing barriers
like cultural or religious beliefs, and side-effect concerns. Providing comprehensive information
about methods, ensuring easy access to services, and addressing fear of side-effects can lead to
better contraceptive use and ultimately, better family planning outcomes.
Here are more detailed look at control measures:
1. Education and Awareness:
Comprehensive Information:
Ensure individuals receive accurate and detailed information about various contraceptive
methods, their effectiveness, potential side effects, and how to use them correctly.
Community Engagement:
Engage community leaders and health workers to promote awareness and address
misconceptions surrounding contraception.
Visual Aids and Resources:
Utilize visuals, brochures, and other resources to make information more accessible and easier to
understand.
2. Accessibility and Affordability:
Expanded Service Networks:
Increase the number and distribution of family planning clinics, particularly in underserved
areas.
Reduced Barriers to Access:
Address issues like long wait times, transportation costs, and lack of insurance coverage that may
hinder access to services.
Affordable Contraception:
Ensure that contraceptive methods are affordable and accessible to all, regardless of income.
3. Addressing Barriers and Concerns:
Cultural and Religious Sensitivity:
Acknowledge and address cultural or religious beliefs that may discourage contraceptive use,
working collaboratively with religious leaders and community representatives.
Addressing Side-Effect Fears:
Provide clear and accurate information about potential side effects and offer support to
individuals experiencing them.
Gender-Based Barriers:
Identify and address gender-based barriers to access, such as power dynamics within
relationships that may prevent women from using contraception.
4. Promoting Partner Involvement:
Male Involvement:
Encourage men to participate in family planning decisions and support their partners'
contraceptive choices.
Shared Responsibility:
Promote the idea that family planning is a shared responsibility between partners.
5. Improving Quality of Care:
Training for Healthcare Providers:
Provide healthcare providers with ongoing training on the latest contraceptive methods and best
practices.
Confidentiality and Respect:
Ensure that individuals receive respectful and confidential care during family planning visits.
Client-Centered Approach:
Focus on individual needs and preferences when recommending contraceptive methods.
6. Addressing Coercion and Abuse:
Protecting from Forced Sex:
Educate individuals about the importance of consent and the potential consequences of coerced
or forced sexual activity.
Access to Support Services:
Ensure access to support services for individuals experiencing coercion or abuse.
By implementing these control measures, it is possible to improve the application of
contraceptives, empower individuals to make informed decisions about their reproductive health,
and ultimately, achieve better family planning outcomes.
CHAPTER THREE
3.0 RESEARCH METHODOLOGY
3.1 RESEARCH DESIGN
In this study, a survey research design is adopted. Survey is chosen based on the objectives of the
study. Survey is defined according to Nworgu (2005) as studies that samples individual units
from an already known population and it is associated with survey data collection techniques,
such as questionnaire construction and methods for improving the number and accuracy of
responses to survey.
3.2 POPULATION OF THE STUDY
The population of this study comprises the women of gwada community, which is in Shiroro
local government Niger state. In gwada, they have primary health care centers, schools, market,
streets, shops, police station, round about and pharmacies. The community is dominated by
Gbagyi language and few others languages that are in gwada for commercial activities. The total
numbers of people are 2,347 including male, female and children and the total population of the
women that are the target population of the research work is 170.
3.3 SAMPLING AND SAMPLING TECHNIQUE
Sample describes the process of selecting a member of individual for Study in such a way that
they will represent the larger group from which they will be selected. A sampling technique is a
method in which sampling can be carry out. The major sampling techniques are sampling or
systematic sampling.
A simple random sampling technique is used in this research work in which one hundred (100)
respondents are selected at random from women to assess the factors influencing the attitude of
women towards family planning.
3.4 INSTRUMENT FOR DATA COLLECTION
Instrument use for the study is a structure self-developed questionnaire items from the review of
the related literatures in chapter two to elicit responses from parents in Gwada community
Shiroro local Government Niger State. The questionnaire is divided into two sections; section A
is for the demographic information of the respondents, while section B is the main questions to
address the research questions. The questionnaire is a four-point rating scale (Likert scale),
starting from strongly agreed (SA), agreed (A), disagreed (d), and strongly disagreed (SD). The
questionnaire is designed in such a way that every question in the questionnaire will be related to
the research questions. Also, the result will be use to answer the research questions.
3.5 VALIDITY OF THE INSTRUMENT
The instrument will be face validated by an expert and the project supervisor in the field of
measurement, evaluation and research.
3.6 RELIABILITY OF THE INSTRUMENTA pilot Study will be conducted to
respondents of whom the instrument will be administered to, in order to determine it degree of
stability. The structured developed questionnaire will undergo a test - retest method of affirm
with the consistency of the data collection.
3.7 METHOD OF DATA COLLECTION
The questionnaires will be administered to women by the researcher, which the questions are
filled by the respondents and eventually return the questionnaires to the researcher.
3.8 METHOD OF DATA ANALYSIS
A simple frequency distribution table method was use to analyze the data based on the format to
answer the research questions of the study, the researcher employed a simple percentage table to
analyze the already collected data.