Negligence of family planning among women of child bearing age and its health implications

Introduction

According to Centre for Health Promotion and Education (2003) a family is a group of people who are related by blood, birth or marriage. It is usually made up of parents and children. Many African parents consider many children to be a source of investment, perhaps because of the need to have many hands for work in the farm or in cattle rearing.

The pattern in the traditional African family has led many parents to having many children so that they will live to survive them and give them a befitting burial when they die. Family planning can be done in the hospital and any health facility. It involves men and women, girls and boys of reproductive age

The World Health Organisation (2000) enumerated the various methods of family planning which include the following.

National family planning
Traditional family planning
Modern family planning

National family planning is a method used by women of childbearing age daily in observation of their signs and symptoms of the fertile and infertile phase of their menstrual cycle before intercourse.
Traditional family planning is a method used by people of reproductive age that is men, women, girls and boys used in having and prevention of pregnancies introduced by herbalist which varies from one locality to another. Some of the method are arm band, rings, waist band, wooden doll, concoctions etc.
Modern family planning also known as hormonal contraceptive is a method used also by women of reproductive age in preventive of pregnancies which are inform of contraceptive made up of mostly oestrogen and progesterone. There are different types of contraceptives examples include pills, depo-provera, nonristerant implant such as I.U.C.D (Intrauterine contraceptive Device).

Many women of childbearing age in developing countries are obviously known for neglecting the use of family planning methods because of their cultural beliefs and practices in which children are seen as riches and children are also needed to help them in their place of work mostly in the farm, domestic work and other duties. These children are born even when they cannot take good care of them considering the economic status. Also they belief that children are a sign of strength, continuity of lineage and that a family without a male child in particular is considered dead.

Conceptual framework

Different scholars defined family planning in different ways. In the view of Henry (2006), family planning is the control of birth rate, fertility rate or population growth including both programme of controlling fertility and helping those who have problem of infertility. Barbara (2004), defined family planning as the arrangement, spacing and limitation of children in a family depending upon the wishes and social circumstance of the parents.

Dorling (2009), defined family planning as the deliberate limitation or spacing of births using the different methods of contraception. According to Nigerian Demographic and Health Survey (2007), Family planning methods can help ensure healthiest family, spacing of pregnancy, hence regulating fertility and as fertility falls, so do infant, child and maternal morbidity and mortality.

In another view, Ekpeyong (2012), stated that family planning has greater role to play in Nigeria in reducing high mortality and morbidity rate among women and infant, while The Centre for Reproductive Rights (2008), noted, several women die every year in the community from preventable pregnancy related diseases towards the non-use of family planning service. Peter (2008), stated that, family planning had received little attention and this has contributed to low contraceptive prevalence rate, high total fertility rate and high need for family planning services especially into research area in the country. Oyebudi (2008), noted that, family planning was one of the most cost effective interventions that could reduce maternal and child mortality to as much 30% and 20% respectively.

The women Advocates Resources and Documentation Centre and Centre for Reproductive Right (2008), urge the Nigerian government to back its community to reducing maternal deaths with the necessary actions such as improving access to information within the health care system, improving access to family planning services including a full range of contraceptive methods. The Centre for Reproductive Right (2008), stated that, lack of access to contraceptives has fuelled unwanted pregnancies and unsafe abortion. Mangaldes (2009) stated that, the work effort of the organized industrial sector to decrease birth rate is through the scope of family planning.

Methods of family planning

Ochiti (2003) stated different methods of family planning (birth control) in which a parent can use for birth control. Different parents have different reasons for wanting to limit the size of their family, some young parents prevents many decide to delay having any child until they have worked and saved enough so that they can afford to care for them well. There are different ways of carrying out family planning which are explained below:

The condom
The diaphragm
Contraceptive foam
Withdrawal or pulling out (lotus interruptus)
Emergency contraception
Rhythm method
Mucus method
Combined methods
Injections
Implants

The condom: The condom also called prophylactic rubber or sheath is a narrow rubber or latex bag that the man wears to prevent pregnancy. It is also the only effective method of controlling child birth and preventing HIV/AIDS and other sexually transmitted diseases, but it is not a complete safeguard. The condom should be put on when the penis is stiff and leave space at the tip for sperm. Roll the condom from the penis. The man should hold on to the condom when he pulls out penis from his partner. Condoms are sometimes given away fee at health clinics. David (1993) stated it is best to use condom only once, but a washed and reused condom is better than none. Before using it, fill it with water to make sure it does not leak.
The diaphragm: The diaphragm is a shallow cup made of soft rubber. A women wears it is her vagina while having sex. It should be left in for at least 6 hours afterward it is fairly sure method especially if used together with a contraceptive cream or jelly (Ochili, 2005). WHO (2005) stated that health worker or midwife should help fix the diaphragm, as different women read different sizes. Check the diaphragm regularly for notes and cracks by holding it up to the light and get a new one. After use wash it in warm soapy water, rinse and dry, keep it in a clean dry place.
Contraceptive foam: Contraceptive foam comes in a tube or can the women put it in to her vagina with a special applicator. It must be applied not longer than one hour before having sex, and left in for at least six hours afterward. The applicator should be repeated each time before the couple has sex even if this is several times in one night. It is fairly sure method if used correctly (Cardy, 2005)
Withdrawal or pulling out (lottus interruptus): David (1993) discussed this method, as a method in which in the man pull his penis out from the women before the sperm comes out. This method is perhaps better than none, but may be distributing to the couple and does not always work, because some sperm often lookout ahead of time and can cause pregnancy and some men do not pull out in time especially if they have been drinking.
Emergency contraception: Emergency contraception after unprotected sex is possible using pills, if they are taken within three (3) days (72 hours).
Rhythm method: This method is not very sure to prevent pregnancy, but it has the advantage of not causing anything. It is more likely to work for women whose period comes very regularly, more less once every 28 days. Also, the husband and wife must be willing to pass one week out of each month without having sex the regular way. Usually a woman has a chance of becoming pregnant only during 8 days of her monthly cycle her fertile day. These 8 days come midway between her period beginning 10 days after the first day of menstrual bleeding. To avoid getting pregnant, a woman should not have sex with her man during theses 8 days. During the rest of the month, she is not likely to get pregnant (Okoye, 2007)
Mucus method: This is a variation of the rhythm method. A woman finds out when she could become pregnant by checking the mucus in her vagina every day. It works fairly well for some couples but not for others. In general it cannot be considered a very same way of preventing pregnancy, but, it costs nothing and has no risk rather than those that come with pregnancy itself. However, it is more difficult to do if the woman has a vaginal infection with a lot of discharge, or her periods are not regular. Every day, except during her period, the woman should examine the mucus from her vagina. Take a little mucus out of your vagina with a clean finger and dry to make it stretch between your thumb and forefinger. As long as the mucus is sticky like paste- not slipping or shimmy-you probable cannot become pregnant, and can continue to have sexual relation. When the mucus begin to get slipping or shimmy, like raw egg, or if it have sex when the mucus is slipping or stretches, or until 4 days after it has stopped being slipping or stretchy and has become sticky again. The mucus will usually become slipping during a few days midway between your periods. These are the same days you would not have sex with your man if you were using the rhythm method. To be sure, use the mucus and rhythm method together. Some people accept ‘natural method’ as against ‘artificial method’ which use pills or rubber goods. An increasing number of religions and community leaders are realising how important it is for the health and well-being of everyone, that easy and sure method of birth control are made wide known (Dickey, 2004).
Combined methods: If you want to be more certain not to become pregnant, it often helps to use two methods at the same time. The rhythm or mucus methods combined with the use of a condom, diaphragm foam or spong is smear than any of these methods alone. Likewise, if a man uses condoms and the woman a diaphragm or foam, the chance of pregnancy is very low.
Injections: There are special injections to prevent pregnancy. Depo-provera is one. An injection is usually given in every 3 months side effects and precautions are similar to those for birth control pills. After a woman stops getting injections, it can take a year or more for her to become pregnant for woman with sickle cell disease it is safe and effective (Cardy, 2005).
Implants: With this method, six small tubes are put under the skin. If left there, it can prevent pregnancy for up to five years. Menstrual bleeding may be heavy during the first year. Return to the clinic if this happens. Injections and implants are useful who have trouble remembering to take pills or who run into problem using other kinds of birth control (Okereke, 2004).

Methods for those who never want to have more children

Sterilization for those who never want to have more children, there are fairly safe, simple operations for both men and women. In many countries these operations are free.

For men: The operation is called a vasectomy. It can be done simply and quickly in a doctor’s office or a health centre, usually without putting the man to sleep. Small cuts are made have so that the tubes from mans testicles can be cut and tied. The testicles are not removed. The operation has no effect on the man’s sexual ability or pleasure. His fluids come just the same, but have no sperm in it.

For women: The operation is called a tubal ligation which means to tie the tubes. One method is to make a small cut in the lower belly so that the tubes coming from the ovaries, or egg-makers, can be cut and tied. It can usually be done in a doctor’s office or health centre without putting the woman to sleep. There is a higher risk of infection in the operation for woman than man.

This operation has no effect on the woman’s menstrual periods or sexual ability, and may make having sex more pleasant because she does not have to worry about pregnancy.

Importance of family planning

The Population Media Centre (2005) also noted that when women are empowered to control the spacing of their birth, they can avoid the stress to their bodies that these pregnancies cause.

According to United Nations Population Fund (UNFPA) (2005), the freedom to choose to have many children and when, is a fundamental human right. Better occurs to safe and affordable contraceptive method is a key to achieving the Millennium Development Goals (MDGs). They noted also that, family planning has proven benefits in terms of gender quality, maternal health, child survival and preventing HIV. Family planning they said can also reduce poverty and promote economic growth by improving family well being raising female reproductivity and lower fertility. It is one of the result and most cost-effective investment any country can make towards a better quality of life.

Angeles (1998) stated that, a woman exposed to family planning through her fertility life span predicated to have four children compared with five children in the absence of family planning. According to Sola (2011), noted that, in 1998 the Nigeria government adopted a population policy, one of the major strategies in the policy is aimed at expanding access to family planning services so that by 2011 contraceptive use would reach 44 percent. Rhonda (1999), stated that, family planning service increase survival improves the health of millions of people and helps achieve national goals. He, also said, family planning could prevent as many as one in every three maternal deaths by allowing women to delay motherhood, space birth, and unintended pregnancies and abortions and stop childbearing when they have reach their desired family size. Reduce newborn, infant and child death significantly.

WHO (2005) estimated that, 536000 maternal deaths occur annually world-wide of which more than 99 percent occur in the developing countries. And if women had only the number of pregnancies they wanted, at the interval they wanted, maternal mortality would drop by about one third.

Akinso (2011) stated that, Nigerian women need access to family planning services that would not only enable them freedom to control the number and spacing of their children but also overall quality of life. The National Demographic Health Survey (2008) stated that only 10-11 percent of Nigerians use any form of modern family planning method. This portends serious danger. As studies carried out in Nigeria shows that large percentage of Nigerians youths are sexually active.

Osotimelim (2011) stated that, Nigeria has one of the highest maternal mortality rate in the world and this has large been attributed to inadequate use of contraceptives for child spacing. Indeed statistics depicting the maternal and child health status in Nigeria are not cheering.

Negligence of family planning on health

According to Population Media Centre (2005), the negligence of not using family planning are grave and diverse which can result to over population on leading to the degradation on the environment and increased civil conflict, exacerbated by the fight over scarce resources. They went further to say that, this population lead to growing communities of young people of reproductive ages many of whom care. This then lead to health problems during child birth.

Population Media Centre (2005) in support of WHO stated that, 529,000 women die from pregnancy related causes and more than 10 million women a year suffer severe or long-lasting illness or disabilities.

Family Planning Policy Maker (1999) assume that, lower fertility lead to a greater opportunity of women to advance their education, seek employment, exercise leadership in public affairs and generally increase the quality of their lives.

Moses (1989), draws attention to the triple roles of women which he said are responsibility for reproductive work (child bearing and child rearing productive work (income generation) and community managements (local support activities) which calls for family planning services.

Health implications of family planning

WHO (2005) stated that when a mother has child after child, without much space between, she often becomes weak. She breast feeds her children for a shorter time. Her babies are more likely to die. Also after many pregnancies the danger is greater that she will die in child birth. Leaving many motherless children-therefore, many couples now choose to allow two or more years to pass between pregnancy, and avoid having a very large number of children, when the children grow up there may not be enough land for all of them to grow the food their families need.

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