Attitude of mothers towards utilization of modern contraceptives

Introduction

In 2011, world population stood at seven billion (7 billion) (World Population Data Sheet, 2011). We cannot dismiss as presumptuous the adverse effects of uncontrolled reproduction on women and such risk factors as child birth before 18 years or after 35 years of age where in rich developed nations of the world, population growth rate has diminished as mothers and fathers have chosen to have fewer children. In developing nations like Nigeria, the growth rate remains high as any few couples limit the number of their children.

The sad reality is that people that are less able to care for their children are having more children than those who have the means to support them (Shuaib & Oghodoh, 2010). There is a growing concern among individuals and nations alike to limit the family size and population respectively (Timothy, Nelson & Tom, 2011). There is the need for adequate nutrition, housing and better quality to life. Some people fear that when young people are educated about sexuality providing them with family planning information will lead to irresponsibility and promiscuity. On the other hand, women of child bearing age are reluctant to seek information or help from their family or professional settings. They therefore, do not get the information they need (Olugbenga-Bello, Abodunrin & Adeomi, 2011).

Infant mortality and illness rates depend primarily on the health and nutrition of the pregnant mother and secondly on the nutrition and hygienic care given to each child. We must and therefore make sure that both the quality and quantity of life increase at the same rate as technological and scientific advances. Because of this, we consider family planning to be preventive measure (Kebede, 2006). The purpose of which is to decrease the risk of illness and death. Both for mothers and children. It is also the aim of family planning to give parents, the chance to dedicate more time and resources towards the education of their children (Raul, 2010).

The historical perspective of this problem originated from a past occurrence that took place hundreds of years ago leading to misconception of the term “family planning”. Non-adherence to family planning methods and techniques has lead to morbidity rate regular occurrences of sexually transmitted disease i.e. HIV/AIDs in the community.

To achieve the objective of during a quality life, women must be assisted through counselling, persuasion, health education and family life education which include family planning. This is not a job that the government cannot do, it requires joint effort of the all the society.

Conceptual framework

Contraception also known as birth control refers to the methods that have been historically used to prevent pregnancy. Planning and provision of birth control is called family planning. In some cultures, abortion had none of the stigma which it has today, making birth control less important abortion was in practice as a means of birth control.

Birth control and abortion was well documented in Mesopotamia and accent Egypt where honey, acacia leaves and lint are placed in the vagina to block sperm. The Indians in the 7^th century BC, documented both coitus reservatus and coitus obstructus which prevents the release of semon during intercourse. In the same century, it was documented that oil and quick-silver are heated together for one day and taken orally by women who no longer want to bear children.

Birth control became a contested political issue in Britain during the 19^th century. The economist Thomas Malthus argued in an essay on the principle of population that population growth generally expanded in times and in regions of plenty until the size of the population relates to the primary source called distress. In contrast, the birth control movement advocated for contraception so as to permit sexual intercourse as desired without the risk of pregnancy. Margaret Sanger founded the first birth control league in America in 1921.

The late 20^th Century, Gregory Pincus and John Rock with help from the planned parenthood federation of America developed the first birth control pills in the 1950s. Medical abortion became an alternative to surgical abortion with the availability of prostaglandin analogs in the 1970s and the availability of mifepristone in the 1980s.

The availability of contraception in Ireland republic was illegal in the Irish Free State from 1935 until 1980 when it was legalized with strong restrictions latter loosened. In Italy, women gained the right to access birth control information in 1970s.

Types of birth control methods

Birth control methods available today can be divided into several categories.

• Hormonal methods
• Behavioural methods
• Barrier methods
• Withdrawal methods
• Abstinence
• Lactation
• Fertility awareness
• Intrauterine devices
• Dural protection method
• Emergency methods

Concept of family planning

Family planning has several definitions Basavanthappa (2008) defined it as a way of living and thinking 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 socio-economic development of a country.

Family planning is a practice that is being carried out to achieve specific goals, these includes:

• Reinforcing people’s rights to determine the number and spacing of their children.
• Preventing unintended pregnancy, family planning prevents death of mothers and children.
• Reducing the need for abortion especially unsafe abortion
• Preventing the transmission of HIV and other sexually transmitted infections.

Family planning allows people to attain their desired number of children and determine the spacing of pregnancies. It is achieved through the use of contraceptives and the treatment of infertility.

Scope of family planning

The WHO Expert Committee has stated that family planning includes:

• The proper spacing and limitations of births
• Advice on sterility
• Education for parenthood
• Sex education
• Screaming for pathological conditions related to the reproductive system e.g. cervical cancer
• Genetic counselling
• Premarital consultations and examination
• Carrying out pregnancy tests
• Marriage counselling
• The preparation of couple for the arrival of their first child
• Provide the services for unmarried mothers, teaching homes, economics and nutrition
• Providing adoption services

 Objectives of family planning

Expert committee of WHO defined family planning as practices that help individuals or people to gain certain aims. These includes:

• To avoid unwanted births
• To bring about wanted births
• To regulate the intervals between pregnancies
• To control the time at which births occur in relation to the ages of the parents
• To determine the number of children in the family.

Rationale for contraceptive use

According to Dawn(2007) about 50% of all pregnancies are unintended, 42% of unintended pregnancies end in abortion and it is estimated that one-third of women will have had an abortion by the time they are 45. Women who choose not to utilize birth control methods and are sexually active for one year have an 85% chance to becoming pregnant in the year.

Birth control has been around for as long as people have associated sex with pregnancy. Early forms of birth control consists of the pull-out methods, douching and the rhythm method. Nowadays, there are dozens of ways for women to control their fertility from the pill to the patch, to the ring.

1. Clearer skin: Birth control pills are great way to treat teenage or adult acine. Acine is often caused by hormonal imbalance, birth control pills help regulate the imbalance and eliminate the origin of acne.
2. More college educated women: Birth control helps plan their families so they can focus on their education and their career. Before the landmark Grisworlds V. Connecticut decision in 1960, which established the right to marital privacy, only 35% of college students were women. Today women represent at least 57% of students on most college campuses.
3. Fewer mood swings and temper trantrums: All variations of modern birth control contain some amount of estrogen. Certain pills have higher dose which can reduce severe mood swings and blocking that same women get before their monthly periods, usually referred to as premenstrual dysphoric disorder or PMDD.
4. Teaches responsibility: It is not a stretch to assume that those who seek to make safe, informed choices about their sexual and reproductive health will also be more likely to get tested for STDs and diseases.
5. Promotes an active, healthy sex life: Contraceptives, when used effectively can take the worry out of sex meaning that women and their partners can enjoy the pure act of sex without the consequences of pregnancy or STDs.
6. Fewer abortions: In countries, where women have limited access to contraception, abortion rates are higher in countries where it is not easier to obtain contraceptives. When contraception was banned by an executive order in manila-the capital of Philippines-the rate of abortion increased by more than 10%.
7. Fewer miscarriages: Studies show that short periods between pregnancies have been associated with increased risk of higher mortality for children under age 5, low birth weight, pre-term births, still-births, miscarriages and maternal death. Birth control let women space out their pregnancies resulting in healthier babies.

Birth control methods

1. Hormonal contraceptives:

They are available in a number of different forms, including oral pills, implants under the skin injections, patches and a vaginal ring. There are currently available only for women, although hormonal contraceptives for men have and are being clinically tested. There are two types of oral birth control pills, the combined oral contraceptive pills (which contain both estrogen and progesterol and the progestogen only pills (sometimes called minipills) if either is taken during pregnancy, they do not increase the risk of miscarriage nor cause birth defects. Both types of birth control pills prevent fertilization mainly by inhibiting availation and thickening cervical mecous. Their effectiveness depends on the user remembering to take the pills. They may also change the lining of the uterus and thus decrease implantation.

Combined hormonal contraceptives are associated with a slightly increased risk of verous and arterial blood clots. Venous blood clots on average,  increase from 2.8 to 8.9 per 10,000 women years which is still less than that associated with pregnancy. Due to this risk, they are not recommended in women over 35years of age who continue to smoke. The effect on sexual desire is varied with increased or decrease in some but with no effect in most combined oral contraceptives reduce the risk of ovarian cancer and endometrial cancer and do not change the risk of breast cancer. They often reduce menstrual bleeding and painful menstruation cramps. The lower doses of estrogen released from the vaginal ring may reduce the risk of breast tenderness, nausea and headache associated with higher dose of estrogen products.

Progestin only, injections and intrauterine devices are not associated with an increased risk of blood clots and may be used by women with previous blood clots in their veins. In those with a history of arterial blood clots, non-hormonal birth control or a progestin-only method other than the injectable version should be used. Progestin-only pills may improve menstrual symptoms can be used by breast-feeding women as they do not affect milk production. Irregular bleeding may occur with progestin-only methods, with some users reporting no periods. The progestins, drospirenone, and desogestrel minimize the androgenic side effects but increase the risk of blood clots and are thus not first line. The perfect use first year failure rate of the injectable progestin; depo provera is 0.2%, the typical use first failure rate is 6%.

2. Barrier contraceptives:

Barrier contraceptives are devices that attempt to prevent pregnancy by physically preventing sperm from entering the uterus. They include mate condoms, female condoms, cervical caps, diaphragms and contraceptive sponges with spermicide.

Globally, condoms are the most common methods of birth control. Male condoms are put on a man’s erect penis and physically block ejaculated sperm from entering the body of a sexual partner, modern condoms are most from latex, but some are made from other materials such as polyurethane or lamb’s intestine. Female condoms are also available most often made of nitrile  latex or polyurethane. Male condoms have the advantage of being inexpensive, easy to use and few adverse effect making condoms available to teenagers does not appear to affect the age of onset of sexual activity or its frequency. In Japan, about 80% of couples who are using birth control, use condoms while in Germany, this number is about 25% and in the united states, it is 18%.

Male condoms and the diaphragm with spermicide  have typically use first-year failure rates of 18% and 12%, respectively. With the diaphragm condoms have the additional benefit of helping to prevent the spread of some sexually transmitted infections such as HIV/AIDS. Contraceptive sponges combine a barrier with a spermicide. Like diaphragms, they are inserted vaginally before intercourse and must be placed over the cervix to be effective typically failure rates during the first year depend on whether or not a woman has previously given birth, being 24% in these who have and 12% in these who have not. The sponge can be inserted up to 24hours before intercourse and must be left in place for at least six hours afterwards. Allergic reactions and more severe adverse effects such as toxic shock syndrome have been reported.

• Behavioural methods:

Involve regulating the timing or method of intercourse to prevent introduction of sperm into the female reproductive tract either altogether or when an egg may be present if used perfectly, the first-year failure rate may be  around 3.4%, however if used poorly first-year failure rates may approach 85%.

3. Withdrawal method:

The withdrawal (also known as coitus interuptus0 is the practice of ending intercourse (pulling out) before ejaculation. The main risk of the manoeuvre correctly in a timely manner. First-year failure rates vary from 4% with perfect usage to 22% with typical usage. It is not considered birth control by some medical professionals.

There is little data regarding the sperm content of pre-ejaculatory fluid. While some tentative research did not find sperm, one trail found sperm present in 10 out of 27 volunteers. The withdrawal method is used as birth control by about 3% of couples.

4. Abstinence:

Though some group advocate total sexual abstinence by which they mean the avoidance of all sexual activity, in the context of birth control, the term usually means abstinence from vaginal intercourse. Abstinence is 100% effective in preventing pregnancy, however not anyone who intends to be abstinent refrains from all sexual activity and in many populations. There is a significant risk of pregnancy from non-consensual sex.

Abstinence-only sex education does compared with comprehensive sex education, some authorities recommend that those using abstinence as a primary method have backup methods, available (such as condoms or emergency contraceptive pills). Deliberate non sex without vaginal sex are also sometimes considered birth control. While this generally avoids pregnancy, pregnancy can still occur with intercural sex and other forms of penis near-vagina sex (genital rubbing and the penis exiting from oral intercourse where sperm can be deposited near the entrance to the vagina and can travel along the vagina’s lubricating fluid.

5. Lactation:

The lactation amenorrhea method involves the use of a woman’s natural post partum infertility which occurs after delivery and may be extended by breast feeding. This usually requires the prescence of no periods, exclusively breastfeeding the infant, and a child younger than six months. The World Health Organization states that if breastfeeding is the infants only source of nutrition the failure rates is 2% in the six months following delivery. Six uncontrolled studies of lactational amenorrhea method users found failure rates at six months post partum between 0% and 7.5% failure rates increase to 4-7% at one year and 13% at 2years. Feeding formula, pumping instead of nursing, the use of a pacifier and feeding solids all increase its failure rate. In those who are exclusively breastfeeding about 10% begin having periods before three months and 20% before six months. In those who are not breastfeeding, fertility may return four weeks after delivery.

• Fertility awareness:

Fertility awareness methods involve determine the most fertility days of the menstrual cycle and avoiding unprotected intercourse. Techniques for determining fertility include monitoring basal temperature cervical secretions or the day of the cycle. They have typical first year failure rates of 24%, perfect use first year failure rates depend on which method on which these estimates are based, however is poor as the majority of people in trails stop their use early. Globally they are used by about 3.6% of couples if based on birth basal body temperature and another primary sign, the method is referred to as symptom-thermal. Over all first year failure rates of < 2% to 20% have been reported in clinical studies of the symptom-thermal method.

• Intrauterine devices:

The current intrauterine devices are small devices often “T” shaped often containing either copper of levonorgestrel which are inserted into the uterus. They are one form of long acting reversible contraception which are the most effective types of reversible birth control. Failure rates with the copper IUDs is about 0.8% while the levonorgestrel IUD has a failure rate of 0.2% in the first year of use. Among types of birth control, they along with birth control implants result in their greatest satisfaction among users. As of 2007, IUDs are the most widely used form of reversible contraception with more than 180 million users worldwide.

Evidence supports effectiveness and safety in adolescents and those who affect breastfeeding and can be inserted immediately after delivery. They may also be used immediately after an abortion. Once removed, even after long term use, fertility returns to normal immediately.

While copper IUDs may increase menstrual bleeding and result in more painful cramps, hormonal IUDs may reduce menstrual bleeding or stop menstrual bleeding or stop menstruation altogether. Cramping can be treated with NSAIDs. Other potential complications include expulsion (2-5%) and rarely perforation of the uterus (less than 0.7%). A previous model of the intrauterine device (the Dalkon shield) was associated with an increased risk of pelvic inflammatory disease, however the risk is not affected with current models in those without sexually transmitted infections around the time of insertion.

6. Dual protection method:

Dual protection is the use of methods that prevent both sexually transmitted infections and pregnancy. This can be with condoms either alone or along with another birth control method or by the avoidance of penetrative sex. If pregnancy is a high concern using two methods at the same time is reasonable, and two forms of birth control is recommended in those taking the anti-acne drug isotretinion, due to the high risk of birth defects if taken during pregnancy.

7. Emergency contraceptive method:

Are medications (sometimes misleadingly referred to as “Morning-after pill” or devices used after unprotected sexual intercourse with the hope of preventing pregnancy. They work primarily by preventing ovulation or fertilization. They are unlikely to affect implantation, but this has not been completely excluded. A number of options exist including high dose birth control pills, levonorgestrel, mifepristone, illipristal and IUDs. Levonorgestrel pills, when used within 3days, decrease sex or condom failure after a single episode of unprotected sex or condom failure by 70% (resulting in a pregnancy rate of 2.2%). Ulipristal when used within 5days, decrease the chance of pregnancy by about 85% (pregnancy rate 1.4%) and might be a little more effective than levonorgestrel.

Mifepristone is also effective than levonorgestrel while copper IUDs are the most effective methods. IUDs can be inserted up to five days after intercourse and prevent about 99% of pregnancies after an episode of unprotected sex (pregnancy rate of 0.1 to 0.2%). This makes them the most effective form of emergency contraceptives in those who are overweight or obese levonorgestrel is less effective and an IUD or ulipristral is recommended.

Providing emergency contraceptive pills to women in adverse does not affect rate of sexually transmitted infection, condoms use, pregnancy rate or sexual risk-taking behaviour. All methods have minimal side effects.

Cultural attitude towards family planning

In some community tradition demands that payment of bride price signifies the wife’s obligation to bear children. This deeply ingrained expectation about a woman’s duty to reproduce creates apprehension in men that their wife or wives may be unfaithful if they use contraception. Arranged marriages, which generally occur at a young age, limits female autonomy and therefore often result in a culture in which females do not feel in control of their reproductive health.

According to a 2005 study by Caldwell, large families are seen as usually favourable and infertility is viewed negatively, causing women to use birth control meanly to increase birth intervals instead of limiting family size. The possibility that women may act independently is also regarded as a threat to the strong patriarchal tradition. Physical abuse and reprisals from the extended family pose substantial threat to women. Violence against women was considered justified by 51% of female and 43% of male respondents if the wife used a contraceptive method without the husband’s knowledge. Women feared that their husband’s disapproval of family planning could lead to withholding of affection or sex or even divorce.

In areas with communal grazing areas or “tribal tenure”, large families are desirable because more children means more productive capability and therefore higher status and more wealth for the father, according to Boserup. Additionally, having more children decreases the mothers workload. However, most people in Africa today live in urban areas or agricultural communities with private land ownership. In these communities, having a family that is larger than one can support is viewed negatively. Private landowners do not rely on financial support from children in old age or in crises because they can that sell their land. Despite these changes, Borserup suggest that large families are still seen as symbols of wealth and higher social status by men.

Benefits of family planning

Contraceptive use in developing countries is estimated to have decreased the number of maternal deaths by 40% and child control were met. There are some benefits from birth control use:

• Improving child survey by lengthening the time between pregnancies.
• Decrease pregnancy rates amongst teenagers.
• Improving economic growth.
• Decrease the spread of sexually transmitted infections.
• Provision of improving job opportunities for women.
• Creates an avenue for raising healthy and fit children.
• Improving maternal and infant health.

References

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