General

Health implications of negligence/refusal to accept the practice of family planning

Introduction

A family according to Oxford Advance Learner Dictionary (6^th edition) is made up of father, mother and children. The size of any family is influence by many factors. Family according to Oduntan and Akinsola (1993) is defined as a group of people who are united by the ties of marriage, blood or adoption constituting a single household interacting with each other in their respective position as son and daughter, brother and sister, husband and wife, mother and father, etc. they share, create and maintain a common culture. Family is also a set of relation especially parent and children.

According to the Centre for Health Promotion and Education, (1983), family planning includes the prevention and treatment of sub-fertility and infertility and development, sexually transmitted diseases and problem of abortion. Sweat (1992), family planning as the arrangement spacing and limitation of the children in a family depending on the wishes and social circumstance of parents.

Nambuze (1985) defined family planning as a system adopted by either a husband or the wife or couple to determine when to have a child or on how many children they want to have. According to United Nation International (1994) stated that family planning also help improve the future by allowing parent to better plan their live. Poverty and lack of education limit the opportunities for individuals and family

World Health Organisation (WHO, 1997), define family planning as a way of thinking and living that is adopted voluntarily upon the basic of knowledge, attitude, and responsible decision by individual and couples n order to promote and this contribute effectively to the socio-economic development of country. Delano (1990) explained that family planning is means by which individual or couple space the process of conception, pregnancy and child birth at interval mutually determined by both husband and wife in order to have the desired number of children that they can conveniently maintain.

Derek (1993) defined family planning as a means of helping individual and couples choose the number of children they will have. He added that choice depend on a complicated mixture of social cultural and psychological influence. According to the Catholic religion, God had provided perfectly adequate natural physiological structure to enable man and women to regulate their fertility and that all artificial methods of birth control are immoral.

Traditionally, children are a great importance to the family throughout Africa, because they are perceived by many affirmations of life a sign of strength, a continuity of lineage and economic necessity and Africa men believe that without a male child, they are not men. All these concept of family planning pose a big problem to such people, making women to pass through stress while schooling.

Definition of family planning

World Health Organization (WHO) has defined family planning as a way of thinking and living that is adopted voluntarily upon the basis of knowledge, attitude and responsible decision by individual and couples, in other to promote the health and welfare of family and group and this contribute effectively to socio-economic development of the country. The important components of primary health care programmer are culture bound and the effect of culture on birth control cannot be over emphasized. The above review shows the objective of family planning to an individual and also to the society.

These objectives are to help those who are highly fertile to regulate their fertility rate. Onwuke (1997) listed the objectives of family planning as follow;

To reduce morbidity and mortality rate.
To slow down the population growth rate by encouraging the families to produce children that they can conveniently provide for in terms of feeding, clothing, education and housing.
To provide good health care services with adequate drug at convenience to children.
To reduce unemployment rate and poverty.

To promote family planning, the United Nation Fund for Population Activities (UNFPA) has launched its 4^th country programmer on community family planning/reproductive health in Delta State. The aim was to inverse the awareness level of the people. Cultural, traditional birth control methods are practices, beliefs or customs handed down from one generation to another. Before the advent of modern contraception, ideas and practices of birth control has existed.

Methods of family planning

There are two method of family planning control method which are Birth control also known as source and fertility control are methods or devices used to prevent pregnancy (WHO, 2011).

Natural family planning
Traditional family planning

Natural family planning method

Natural family planning method is a means by which the couple used the daily observation of signs and symptoms of the fertile and infertile phase of the menstrual cycle to their desire to achieve or avoid pregnancy.

Types of natural family planning method

Billing method of ovulation (BMD, Cervical mucus).
Basal body temperature (BBT).
Calendar or Rhythm method
Breast feeding.
Symptom thermal.

All the above method have high failure rate and not that are reliable. Delaro (1990) stated that family planning is the means by which individual or couples space the process of conception, pregnancy and children at intervals actually determine by both husband and wife to have the desired number of children that they can conveniently maintain. Family planning also assists couples who have difficulty in having children. According to Ebon Delaro said that, why do we need family planning?

Family planning is very important for health survival and development of the family. Azikeh, (1989) classified family planning into two;

Traditional method
Modern method

She further classified the traditional method into two groups. A practical method they may directly or indirectly affect fertility but are not practical with the intention of spacing children. The second group deals with practical methods that are available for the purpose of controlling fertility.

Billing method of ovulation (BMO cervical mucus)

The cervical mucus is based on records of the body changes and taking note of quality and characteristics of the cervical mucus that is the colour, texture and quality of the cervical mucus usage. During ovulation the body hormones causes the cervical mucus to become slippery and as clear as the white of an egg. Later the mucus may be absent or become sticky, cloudy and dry. Examine cervical by introducing one finger into the vagina daily, to enable you understand and get used to the technique of observation and recognition of the body change.

Advantages of billing method of ovulation;

It is natural method
Can also be used by an infertile women
Has no side effect
No expenses
Useful in choosing the sex of a child
Approved by some religious groups
Allows couple to understand their bodies and work together to prevent pregnancy.

Disadvantage of billing method of ovulation

There is restricted sexual intercourse
Less effective than some methods
Causes anxiety
May course mental problem
Requires high degree of maturation and good memory

Basal body temperature method (BBT)

The temperature method involves knowing the ovulation period by using temperature chart to determine the probable time of ovulation. A woman can determine time of her ovulation after she has recorded her BBT on chart for 3 or 4 successive months. A drop in (BBT) sometimes precedes ovulation by about 12-24 hours and sustained rise in most times follows for several days until the onset of next menstrual period. (Doring, 1967)

Mechanism of action

Ovulation is detected by identifying a shift in temperature (0.2-0.5) degree centigrade or (0.4-1.0 degree farenheit) from relatively lower level during the follicular phase. This temperature rises under the influence of progesterone, the shift produce by corpus loteum, the characteristics upwards shift does not give any advance that the ovulation has occupied fertile days are over (Doring, 1967).

Calendar method

This method requires a diagram calendar and biro or pencil to be able to use the calendars method, it is very important to have kept a menstrual pattern, be able to guess the ovulation period and use the information to abstain from sexual intercourse during the fertile period.

Method: Plot of beginning of each period on the calendar or diary. The 1^st day of present period to the 1^st day of the next period is a cycle. Keep this record of the next period is a cycle for next 6-12 months to know the safe period from the unsafe (for a woman with 26-29 days regular cycle), subtract 18 from the shortest cycle to determine the 1^st unsafe day (i.e. 26-18=8) and 11 from the longest menstrual cycle. To determine the last unsafe day (i.e. 29-11=18) the safe period is this during the first 7 days and last ten days of the menstrual cycle (Olojoba, 2009).

Breastfeeding

Breast feeding is the act of nourishing the human child/ infant milk from the breast. Breast feeding delays the return of ovulation in the post-partum women provided she is fully breast feeding at least continuing might feeding and not giving any other food or liquids. Breast feeding as a sole means of contraception is most reliable during the first 6 months of post-partum before the return of menses and of the woman is fully breast feeding (Ross, 2001).

Mechanism of action

The act of sucking of a new born baby sends impulses from the areola of the nipple to the argue nerve and then to the interior pituitary gland that immediately secretes the hormones production which stimulate milk production. This process also produces a contraceptive action by decreasing the level of the luteinizing hormone necessary for ovulation. As the body is gradually weaned from breast milk the amount of production of hormones drops thereby reducing the contraceptive effectiveness of breast feeding.

After six month of post partum, many women will begin to ovulate even if their menses have not returned. Abstained if practice properly when breast feeding is 100% effective in preventing pregnancy, (Ross 2001).

Advantages of breastfeeding

Vary effective contraceptive method (90%) during first six months of post partum; in fully breast feeding woman before return of menses.
It is cheaper than buying formula
It helps avoid medical bills
It helps equip the baby fight off diseases and infection
Breastfeeding has been shown to reduced the Highwood of ear infections, and to prevent recurrent ear infections
Breast feeding may also decrease the risk of childhood cancer in children under 15 years of age.

Disadvantage of breastfeeding

Effectiveness decrease with time after birth
Not as effective at any two breast feeding are regularly more than 6 hour from each other
Not as effective once mother menses return
Provided no protection for the mother against required side including HIV.

Indication for the use of breast feeding as a sole method of contraception

Whose menses have returned, who is less than 6 month post partum and who is fully breast feeding.
Breast feeding where over the baby desired at least 6-10 times a day on both breast.
Containing high breast feeding
Not significantly substituting after food or liquid food breast milk meal.

Contra-indication of breastfeeding

Who has resumed her menses? It is likely that client has begin ovulation one menses have resumed.
Where baby is taking other food and liquid
Where baby sleeps throughout the night

Symptoms thermal method: This involves the combination of cervical mucus change and basal body temperature to initiate the fertile period. Sometimes other signs and symptoms of ovulation are also monitored such as breast tenderness, mid cycle pain or spotting addition to calendar calculation.

Traditional family planning

According to Iyama (2003). before the advent of scientific method of family planning, our fore-fathers were at the need for child spacing. Traditional medicine men have prescribed and operate some traditional method of family planning. The modes of action vary from on e herbalist to another and one locality to another. Herbalist may refuse to discuss the mode of action of traditional method of family planning.

Types of traditional family planning methods are;

Arm band: A leather band worn around the woman arm during loiters
Waist band: A form of medicine leather land is worn around the woman waist during coitus.
Scarification mark: Black powered is applied every 3 months on incision on the Mons venires of the woman. The powered is prepared from used burnt menstrual cloth of the woman. The powered is rubbed on the 16^th incision mark on a woman’s venires, it is assumed that this prevent ovulation or minces.
Wooden doll: A wooden doll is expected to be placed under the pillow of the wooden doll will prevent pregnancy.
Ring: A ring mounted with native concoction to be worn every time by the woman.
Locked padlock: A locked padlock with incantation that should remain locked through bit the period the man do not want pregnancy. It is also used for teenagers.
Bark of tree: A specific bark tree steamed and the woman drink periodically.
Specific vegetables: Specifically cooked only for the woman to eat.
Lime Juices: Taken immediately after coitus and used for vaginal douching.
Salt: Used for douching by the woman after coins.
Polygamy: Having more than one wife it is practiced as a means of achieving abstinence.
Water from corpse: Water from dead body is rubbed into specific numbers of scarification marks made in the body of the woman.

Advantages of traditional family planning

It is cheap
The method are accessible to the grassroots
Supports the belief system already held by mans
Does not required change in behaviours
Some methods such as breast feeding and abstinence are effective and beneficial to mother and baby.

Disadvantage of traditional family planning

The mechanism of action are not clearly defined, there is no definite dosage or composition of concoction.
Effectiveness cannot be measured
Some of the article are injurious to the baby e.g. potassium sulphate and blue powder.
Some of the methods are irreversible especially when there is mistake from the operation.
Some methods are executed in unhygienic ways e.g. corpse water.

According to Mark (1977), contraception is a way of preventing unwanted pregnancy without abstaining from sexual intercourse by the use of family planning. He went further to say that it is undoubtedly true that the value individual places on contraception as a way of controlling family size varies from culture to culture as well as within the social classes.

So with the above notes, it can be said confidently that contraception refers to the practices that helps individuals or couples to attain certain standard.

Modern family planning method

This was revolutionized in the sixties by the development and use of synthetic female hormones and mechanical devices which act as contraceptive. Their main action is to prevent the release of the egg to the fallopian tube. (Ross, 2002).

Types of modern family planning

Coitus interruption (withdrawal) method: This involves the man withdrawing from the vagina just before ejaculation. It needs self-control and discipline from the man and sometimes the women. Continuation of intercourse after ejaculation is not possible in view of the residual spermatozoa which can be reintroduced into the vagina. This method costs nothing and is effective if properly carried out.
Barrier method (condom): The condom is a rubber like balloon which is worm over the man erect penis before intercourse to collect the semen and prevent it from entering into the vagina. It acts as a mechanical barrier between the penis and the vagina. And highly effective in preventing pregnancy.
Diaphragms and cervical caps (DUICH CAPS): These are condoms contraceptive barriers but unlike condom, they are used by women. It is made up of soft dome-shaped rubber resembling a cup with flexible rim. It is inserted into the vagina before intercourse and act as a mechanical barrier to the cervix by preventing semen from entering the cervical canal. The addition by spermicidal cream to jelly to a diaphragm before use exchanges it to effectiveness.
Spermicidal: These are chemical substance inserted into the vagina shortly before sexual intercourse to inactive the spermatozoa and also prevent them entering the uterus. Spermicidal may be in form of foams, creams, jellies, tablet or passerines. Apart from having a high failure rate, spermicidal have a very short lasting effect and require a short waiting tome of about 10 minutes between insertion and sexual intercourse.
Intra-uterine contraceptive devices (IUCD): These are plastic or metal devices inserted into the uterus to prevent pregnancy. They are of different types which include the Lipper “Loop” (the coil), copper ‘T’, copper 250, 375, 380 and multi-load. The mode of action of IUCDs is not contrived but it is believed that their presence in the uterus interferes with conception either by immobilizing or inactivating the spermatozoa, interfering with the eggs or acting as a local foreign body to prevent impartation of the ovum. ICUD are very effective and do not interfere with intercourse.
Hormonal contraceptive (PILLS): According to Olojoba (2009) the hormonal conceptive contain two types of hormones namely estrogens and progesterone. They can both be combined or have progesterone only are available as oral contraceptive the types containing progesterone only are given by intramuscular injection (inject-able) implants underneath the skin or as oral pills (mini pills).

Types of hormones contraceptive

Oral contraceptive combine pills (estrogens and progesterone), progesterone (mini pills).
Injectables
Implants

Oral contraceptive

Oral contraceptive consist of two types of female hormones known as oestrogen and progesterone which when taken prevents pregnancy.

Types of oral contraceptive

Combined are available in startled and low dose forms. Progesterone only pills (mini pills).

Mechanism of action of combined oral conceptive (COC)

Suppression of ovulation
Thinking of cervical mullets thereby preventing sperm penetration
Reduction of sperm transport along the genital tract

Advantage of combined oral contraceptive (COC)

Highly effective if used correctly. It is the most effective resistible method.
Client can be discontinues independently
Suitable for young (under 25 years)
Reduces menstrual pain and mid cycle ovulation pain where present
Reduces menstrual flow in heavy bleeders
Regularizes irregular period
Easy to use
Readily available

Disadvantage of combined oral contraceptive (COC)

Has to be taken daily
No protection against SITS/ HIV AIDS
It may lead to mood changes
Expensive

Indication for the use of (COC)

Heavy painful or irregular period
Recurrent ovarian cancer
Premenstrual symptoms, cyclic headaches or cyclic depression
Family history of ovarian cancer
Desire for reversible contraceptive

Contraindications of COC;

Absolute contraindication
Women over 40 years
Suspected pregnancy
Liver disease (jaundices)
Cerebra vascular (stroke)

Side effects of COC

Irregular bleeding
Amenorrhea
Nausea and vomiting
Weight gain
Mild headache spotting between period

Injectable

These are long acting contraceptive containing progesterone only are given by intramuscular injection.

Types

Causes alteration of cervical mucus making it more difficult for sperm to penetrate the cervix causing change in the uterus wall which either inhabits fertilization or prevent implantation.
Slow down transportation of ovum in the fallopian tubes.

The health implication of negligence, refusal of the usage of family planning

The health implication of pregnancy during education married student attainment compared to single student who are neither parents nor married, however strategies have been reported that can help close this gaps. Many drop out from school due to the responsibility of caring for the children as well as their husbands which is one of the consequences of early married and parenting while in school (Bentel, 2000).

Motherhood and fatherhood uniformly places demands on one’s life that were non-existent prior to the birth of a child. The new responsibility is overwhelming from pregnancy stage till birth of the unborn child. Those who lack financial support and experience tends to flop in the process and can be even more daunting as thing seeks support in adult oriented systems (Kast & Carlin, 2010).

Texas Comprehensive Centre staff search two data based (Eric and Education full text) (using google search engine) A variety of search terms were used alone e.g. student parents, school age parents, based child care, pregnancy, student achievement drop-out and graduation. In some of the information revealed the consequences of education parenting pregnancy, parenting and education are both at critical points in their lives, when their life courses can be shaped towards healthy development, stability and productively, or towards lifelong poverty and dependency as concentration to attainment of desires are shortened. (Stephens & Baten, 2003) while Evans (2007) vividly stated that 67% of married student with pregnancy never graduated along side with course mate and the 37% struggle through school and some with involvement in malpractices which may lead to withdraw from school for one year as penal for pregnancy.

However, having access to appropriated resources can reduce this; one year education penalty for pregnancy (Melhado 2007). Education can help to mitigate these negative out comes. In 2008 worker who possessed a high school diploma or its equivalent rejoice over an earned benefit better than school cert holders of which many lament over being drop put as a result of pregnancy while not able to cope with study for economic reasons it pays to stay in school and graduate (Bentel, 2000).

Ways of improving the acceptance and practice of family planning

Williams and Sadler (2001) study found evidence that social support and school-based programs that provide counselling, health care, health teaching and education about prevention of unwanted pregnancy, family planning and how to elevate many of the problem associated with adolescent pregnancy and parenting.

In their study, a 100% success rate was achieved for high school graduation or continuation for married student and in addition Brownson (2009) found that student mother receiving school based child care and support fared better even than unmarried mother without this support although, research shows that pregnancy is the leading factors that limit mothers education attainment, (Zachry 2005) noted that other studies have suggested that these students reasons for leaving school while pregnant have more to do with the school policies and previous school experience from other of being pregnant and lastly express negative perception about education and continuation, a lack of relevance and a negative school environment and stigma.

In contrast, other studies have shown how a supportive and organised school environment can serve as a means of educating the student on the effect of pregnancy in school and the long term effect on educational attainment (Smith & Bathle, 2007).

References

Billing. J. (2007). Love and billing method (9^th ed.). Ibadan: African University Press.

Delano, E. (1993). Guide to family planning. Ibadan: Spectrum Books Limited.

Delano, E. (1990). Family life awareness, (2^nd ed.). Lagos: Golden Publication.

Derek, S. K (1993). A Guild to family planning. Ibadan: Oriental Watchman Publishing House.

Fazior, B. (1990). Guide to family planning practice in Nigeria health care. Ibadan: Eddyson Publishing Coy.

Iyama, J. O. (2003). Human family planning implication for healthy living. Lagos: Ample Press.

Mambuse, J. M. (1985). Family planning principle and practice of community (place): Ibadan: University Press Limited.

Olojoba. A.O. (2009). Family life and sex education. Ughelli: Ama Ohoror Printing Press.

Onzulike, L. (1998). Cultural belief on family planning contraception in Nigeria (2^nd ed). Ibadan: African University Press.

Rich, W. (1994). When behaving means doing, creating links between attitude and behaviour vol. 2 pp 42.

Snyder, M. (1992). Consistency in social behaviour. The Ontario Symposium vol. 2 pp, 165-130.