Contraceptives In Nigeria Research Articles

Prevalence, trends, and determinants of contraception use among women in Nigeria: An analysis of Nigeria demographic and health surveys 2008 to 2018.

Within Africa, maternal mortality remains a concern that can be prevented and addressed. Among the various African countries, Nigeria has one of the highest mortality rates, particularly in a context where the population continues to rise. The relationship between contraceptive usage among married Nigerian women and low socioeconomic development contributes to another concerning public health issue- performing unskilled abortions. This cross-sectional study examines how seven (7) key social determinants of health impact the usage of contraceptive methods among Nigerian women ages 15-24. Data were analyzed and acquired from the Nigerian Demographic and Health Survey (NDHS) and the National Population Commission (NPC) in 2008, 2013, and 2018. Bivariate and multivariable logistic regression analyses illustrate social determinants have a deep effect on access and usage of contraceptives in Nigeria. Results yielded that as factors such as age, education, and socioeconomic status increase, the use of contraceptives increases as well. While autonomy has little to no significance, religion and urbanity present challenges to Nigerian women who are interested in using contraceptives. More so, this study suggests a stronger need for education for Nigerian women at an early age and deepening the understanding of the barriers to contraception use with the help of the community and religious leaders.

Use of a media campaign to improve access to contraception in Nigeria amid the COVID-19 pandemic: a cross-sectional survey

IntroductionThe total lockdown used to curtail COVID-19 infection in Nigeria disrupted access to contraception. Society for Family Health facilitated access to sexual reproductive healthcare information through an Omni-media campaign during...

Effect and cost-effectiveness of human-centred design-based approaches to increase adolescent uptake of modern contraceptives in Nigeria, Ethiopia and Tanzania: Population-based, quasi-experimental studies.

Around half of adolescent pregnancies in low- and middle-income countries are unintended, contributing to millions of unsafe abortions per year. Adolescents 360 (A360), a girl-centred initiative, aimed to increase voluntary uptake of modern contraceptives among adolescents in Nigeria, Ethiopia and Tanzania. We evaluated the effectiveness and cost-effectiveness of A360 in increasing modern contraceptive use in selected geographies. We used before-and-after cross-sectional studies of adolescent girls in four settings. Two Nigerian settings had purposefully selected comparison areas. Baseline and endline household surveys were conducted. The primary study outcome was modern contraceptive prevalence rate (mCPR). Secondary outcomes mapped onto the A360 Theory of Change. Interpretation was aided by a process evaluation along with secular mCPR trends and self-reported A360 exposure data. Incremental design and implementation costs were calculated from implementer systems, site visits, surveys, and interviews. mCPR change was modelled into maternal disability-adjusted life years (DALY) averted to calculate incremental cost-effectiveness ratios. In Oromia, Ethiopia, mCPR increased by 5% points (95% CI 1-10; n = 1,697). In Nigeria, there was no evidence of an effect of A360 on mCPR in Nasarawa (risk ratio: 0·96, 95% CI: 0·76-1·21; n = 5,414) or in Ogun (risk ratio: 1·08, 95% CI: 0·92-1·26; n = 3,230). In Mwanza, Tanzania, mCPR decreased by 9% points (-17 to -0.3; n = 1,973). Incremental cost per DALY averted were $30,855 in Oromia, $111,416 in Nasarawa, $30,114 in Ogun, and $25,579 in Mwanza. Costs per DALY averted were 14-53 times gross domestic product per capita. A360 did not lead to increased adolescent use of modern contraceptives at a population level, except in Oromia, and was not cost-effective. This novel adolescent-centred design approach showed some promise in addressing the reproductive health needs of adolescents, but must be accompanied by efforts to address the contextual drivers of low modern contraceptive use.

Leveraging Responsive Feedback to Redesign a Demand Generation Strategy: Experience From the IntegratE Project in Lagos State, Nigeria.

Use of modern contraceptives in Nigeria is low (12%) despite very high knowledge of modern methods (92%). Knowledge of modern methods of contraception in Lagos and Kaduna is high at nearly 100% and 94%, respectively, yet contraceptive use in Lagos and Kaduna remains low at 29% and 14%, respectively. Demand generation was a key strategy in increasing contraceptive uptake through the involvement of providers in the private sector (community pharmacists and patent and proprietary medicine vendors) in family planning service delivery.We describe how an interpersonal communication strategy was modified using a responsive feedback approach and detail the insights gained in implementing an individual compared with a group interpersonal communication strategy during the implementation of the IntegratE Project in Lagos State, Nigeria. We conducted monthly pause-and-reflect sessions for interpersonal communication agents to pause and reflect on lessons learned and address challenges. Using the responsive feedback approach helped to improve contraceptive uptake by adopting a group strategy. Also, the monthly pause-and-reflect sessions have helped interpersonal communication agents see program implementation as a collective responsibility.

Knowledge, Attitude, and Perception of Nigerians Towards Herbal Contraception: A Questionnaire- Based Study

Aims: With a population of about 222 million, which is expected to rise to 377 million making Nigeria the 3rd largest country in the world by 2050, a well-planned family will improve the quality of life of mother and child.
 Methodology: A non-probability online survey was conducted (October 2021 and November 2021), recruiting 1113 participants across Nigeria. Socio-demographic data and information on contraceptives were obtained, and Pearson’s chi-squared test of independence at a 95% confidence interval (CI) was computed using R 4.2.1.
 Results: Significant associations (P < .001) were found between age, marital status, education, and profession of respondents. About 44.65% were 15-29 years, while 41.2% were 30-34 years. No significant association was observed between the age group, gender, and the need for population control. Females (50.04%), 15-29 years old (66.48%) are more likely to approve of the need for population control. Likewise, females (22.01%), with tertiary education (18.78%) are well-informed about contraceptive use (P < .001). Only 19.38% (n = 184; P < .001) of participants used herbal contraceptives, in the form of liquid mixtures (55.98%), teas (17.93%), pills (12.50%), and powders (10.87%), with 26.63% > 7.61% > 6.52% > 5.98% = 5.98% = 5.98% > 4.89% > 3.80% who took Moringa, Alligator Pepper, Neem Plant, Castor Beans, African Star apple Momordica, Rosary Pea, and Horse-eye Bean respectively as contraceptives. Aged parents (32.07%), friends (31.52%), doctors (15.76%), herbalists (5.98%), pharmacists (5.43%), and nurses (3.80%) played a significant (P < .001) role in recommending these herbs. Furthermore, 76.37% recommended the development of indigenous herbal contraceptives in Nigeria, while 23.63% did not.
 Conclusion: Although participants have expressed a preference for herbal contraceptives, knowledge of them is lacking, which calls for more awareness campaigns and policy formulations for their promotion, development, and adoption in Nigeria.

Sexual autonomy and the use of modern contraceptives in Nigeria: Evidence from the 2018 demographic and health survey.

The objective of the study was to determine the prevalence and relationship between sexual autonomy and modern contraceptive use among Nigerian women. Secondary data analysis of the 2018 Nigerian Demographic and Health Survey was conducted among Nigerian women aged 15-49 years who were married or had a partner. Analysis was conducted using descriptive analysis and univariate and multivariate logistic regression. P < 0.05 was considered statistically significant. Participants that had never heard or seen a family planning awareness message were 59.6%, whereas 55.9% were capable of deciding whether to refuse their husband/partner's sex or not. The prevalence of modern contraceptive use was 12%, and the likelihood of using modern contraceptives increased with the level of education, wealth status, and the number of living children. Sexual autonomy was also a significant predictor of modern contraceptive use (odds ratio = 1.35, 95% confidence interval: 1.25-1.46). There is a very low prevalence of modern contraceptive use among women in Nigeria. Sexual autonomy, poverty, education, and the number of living children play a major role. Thus, women empowerment and girl-child education are critical interventions needed for the best outcomes on contraceptive use in Africa. Male involvement in sexual autonomy is also key since they are major decisionmakers regarding women's issues.

The role of job aids in supporting task sharing family planning services to community pharmacists and patent proprietary medicine vendors in Kaduna and Lagos, Nigeria

BackgroundCPs and PPMVs are an important source of modern contraceptives in Nigeria, yet many lack the requisite knowledge and skills to capably provide these services. This skills gap might be addressed through targeted family planning (FP) training. This study measures family planning knowledge retention of CPs and PPMVs after receiving training in FP counseling and services in Kaduna and Lagos States, in Nigeria.MethodsIn a quasi-experimental longitudinal design without a comparison group, 559 CPs and PPMVs who were enrolled in the IntegratE project between January and December 2019, completed a self-administered questionnaire to assess their knowledge related to the provision of FP counseling, and injectable and implant contraceptive services at three points in time: 1) before the training; 2) immediately after the training; and 3) 9-months after the training in Kaduna and Lagos states, Nigeria. Adjusted multivariate logistic regression analysis was used to assess the effect of provider characteristics and receipt of job aids on FP knowledge retention 9 months after the training. 95% confidence intervals and p-values were used to assess statistical significance.ResultsMajority of study participants were females (60.3%) and between 30 and 49 years old (63.4%). The study revealed the importance of jobs aids as influence on knowledge retention. CPs and PPMVs who reported having the Balanced Counseling Strategy plus (BCS+) counseling cards, were more likely to retain knowledge (AOR: 2.92; 95% CI: 1.01–8.40, p-value = 0.05) at 9 months follow-up. Similarly, in terms of knowledge of injectable contraceptives, CPs and Tier 2 PPMVs who reported receiving the Medical Eligibility Criteria (MEC) Wheel were 2.1 times more likely to retain knowledge of injectable contraceptives 9-months later on (95% CI: 1.14–3.99, p-value = 0.02).ConclusionCommunity Pharmacists and Proprietary Medicine Vendors had good retention of family planning knowledge, especially when combined with job aids. Training and providing them with job aids on FP will therefore support task shifting and task sharing on family planning services provision in Nigeria.

Enhancing Human-Centered Design With Youth-Led Participatory Action Research Approaches for Adolescent Sexual and Reproductive Health Programming.

Existing participatory research approaches have failed to identify innovative methods that overcome the persistent barriers to adolescent sexual and reproductive health service demand and access. Increasingly, programmers have turned to human-centered design (HCD), a problem-solving process that centers the needs, perspectives, and experiences of people, when developing solutions to complex SRH challenges. This article describes the application of a youth-engaged version of HCD as part of Adolescents 360, a transdisciplinary initiative to increase 15- to 19-year-old girls' use of modern contraception in Nigeria, Ethiopia, and Tanzania. Youth-adult design teams (including 111 "youth designers" trained in HCD methods) undertook formative research to inform the design and implementation of interventions. We reflect on the practical implications of using instrumental strategies of HCD with a youth-led participatory approach. Our experience indicates that (1) engaging youth as project partners in transdisciplinary teams requires planned and dedicated financial and human resources; (2) involving youth as action researchers can help identify opportunities to improve program empathy and responsiveness; (3) it is difficult to recruit "extreme users" as project partners because of the high competencies needed in HCD; (4) centering empathy and employing design standards during prototyping can drive decision-making and resolve questions raised by conflicting evidence claims in existing bodies of literature; and (5) testing tangible services and products in real-world settings continues long after the intervention design phase. Youth-adult partnership should continue throughout this iterative and adaptive phase to ensure that the adolescent experience of the intervention remains at the core of intervention delivery.

Women and the COVID-19 Pandemic: Consequences of Disrupted Access to Contraception in Nigeria

The COVID-19 pandemic has disrupted access to sexual and reproductive health services, including family planning, globally. This study sought to assess the effect of the COVID-19 pandemic on access to contraception amongst reproductive age women in Nigeria, and make recommendations that will improve access. A cross-sectional survey of sexually active, reproductive age women on modern methods of contraception was conducted in Nigeria. A structured questionnaire designed using the free software Google Forms^® was utilised for the study. The questionnaire was electronically administered. The data obtained was analysed using SPSS version 24. Ethical approval for this study was obtained from the Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria. One-fourth (73, 24.7%) of the respondents reported difficult access to contraception, citing fear of COVID-19 exposure at the health facility (21, 28.8%) as the most common reason for this difficulty. Forced abstinence from sexual intercourse (28, 38.4%) and unintended pregnancy (21, 28.8%) were the most common consequences of impeded contraceptive access. Women using short-acting methods were significantly more likely than those on long-acting reversible contraception (LARC) to report difficult access to contraception (35.1% vs. 14.6%, P=0.001). The COVID-19 pandemic has disrupted access to contraception in Nigeria, affecting more women on short acting methods than those on LARC, with the potential of increasing unintended pregnancy and abortion rates.

Fertility Preference in Older Women: Effect of Place of Residence and Use of Contraceptives in Nigeria

This paper explores fertility preference and its associated factors among older Nigerian women within the reproductive ages 40 to 49. It considers the impact of proximate factors of place, wealth, education, use of contraceptives, and other associated factors on fertility preference. Using Nigeria Demographic and Health Survey (NDHS 2018) data, responses of 1357women of ages 40-49 years in the couples recode file were considered. Fertility preference is measured by “the desire for another child”. We use descriptive statistics and logistic regression to identify the associating factors and impacts of identified explanatory variables on the desire for another child. Result revealed up to 25% of women within ages 40-49 desire to have another child while 35% uses contraceptives. The desire by older women to have another child is higher in the rural areas than in urban areas while more than 50% with desire for another child have no education and are found practising Islam. Logistic regression result indicates that older women not using contraceptive have higher odd ratio with the desire for another child, those in urban areas have lower odd ratio while women in the Northeast and the Northwest have more than 2.5 chance of desiring for another child than those in the Southwest. This study concludes that the desire for pregnancy at later end of reproductive years must be controlled through women's education and community-based sensitization programs.

‘Our culture prohibits some things’: qualitative inquiry into how sociocultural context influences the scale-up of community-based injectable contraceptives in Nigeria

ObjectivesTo explore how sociocultural factors may support or impede the adoption of community-based distribution of injectable contraceptives in Nigeria.DesignA qualitative study based on inductive thematic analysis was conducted through in-depth...

Health system readiness for innovation scale-up: the experience of community-based distribution of injectable contraceptives in Nigeria

BackgroundFollowing the successful pilot of the community-based distribution of injectable contraceptives (CBDIC) by community health extension workers (CHEWs) in Gombe, northern Nigeria in 2010, there was a policy decision to scale-up the innovation to other parts of the country. However, there is limited understanding of health system factors that may facilitate or impede the successful scale-up of this innovation beyond the pilot site. Thus, this study assessed the health system readiness to deliver CBDIC in Nigeria and how this may influence the scale-up process.MethodsThis study was conducted in two Local Government Areas in Gombe State in September 2016. Seven key informant interviews were held with purposively sampled senior officials of the ministries of health at the federal and state levels as well as NGO program managers. Also, 10 in-depth interviews were carried out with health workers. All transcripts were analyzed using the thematic framework analysis approach.ResultThe availability of a policy framework that supports task-shifting and task-sharing, as well as application of evidence from the pilot programme and capacity building programmes for health workers provided a favourable environment for scale-up. Health system challenges for the scale-up process included insufficient community health workers, resistance to the task-shifting policy from professional health groups (who should support the CHEWs), limited funding and poor logistics management which affected commodity distribution and availability. However, there were also a number of health worker innovations which kept the scale-up going. Health workers sometimes used personal resources to make up for logistics failures and poor funding. They often modify the process in order to adapt to the realities on the ground.ConclusionThis study shows health system weaknesses that may undermine scale-up of CBDIC. The study also highlights what happens when scale-up is narrowly focused on the intervention without considering system context, capacity and readiness. However, agency and discretionary decision-making among frontline health workers facilitated the process of scaling up, although the sustainability of this is questionable. Benefits observed during the pilot may not be realised on a larger scale if health system challenges are not addressed.

Challenges and opportunities in evaluating programmes incorporating human-centred design: lessons learnt from the evaluation of Adolescents 360.

Adolescents 360 (A360) is a four-year initiative (2016-2020) to increase 15-19-year-old girls' use of modern contraception in Nigeria, Ethiopia and Tanzania. The innovative A360 approach is led by human-centred design (HCD), combined with social marketing, developmental neuroscience, public health, sociocultural anthropology and youth engagement 'lenses', and aims to create context-specific, youth-driven solutions that respond to the needs of adolescent girls. The A360 external evaluation includes a process evaluation, quasi-experimental outcome evaluation, and a cost-effectiveness study. We reflect on evaluation opportunities and challenges associated with measuring the application and impact of this novel HCD-led design approach. For the process evaluation, participant observations were key to capturing the depth of the fast-paced, highly-iterative HCD process, and to understand decision-making within the design process. The evaluation team had to be flexible and align closely with the work plan of the implementers. The HCD process meant that key information such as intervention components, settings, and eligible populations were unclear and changed over outcome evaluation and cost-effectiveness protocol development. This resulted in a more time-consuming and resource-intensive study design process. As much time and resources went into the creation of a new design approach, separating one-off "creation" costs versus those costs associated with actually implementing the programme was challenging. Opportunities included the potential to inform programmatic decision-making in real-time to ensure that interventions adequately met the contextualized needs in targeted areas. Robust evaluation of interventions designed using HCD, a promising and increasingly popular approach, is warranted yet challenging. Future HCD-based initiatives should consider a phased evaluation, focusing initially on programme theory refinement and process evaluation, and then, when the intervention program details are clearer, following with outcome evaluation and cost-effectiveness analysis. A phased approach would delay the availability of evaluation findings but would allow for a more appropriate and tailored evaluation design.

The Use of Contraceptives in Nigeria: Benefits, Challenges and Probable Solutions

This work examines the decision-making processes among couples, and explained the benefit, challenges and probable solutions to the use of contraception in Nigeria. This work is predicated on the premise that contraceptive decision-making is a complex process that involves an array of factors and structural forces that operate and intersect at different levels to influence decision-making on one hand and the dearth of legal framework to regulate the proper and correct use of contraceptives in Nigerian Reproductive Health Law on the other hand. The use of doctrinal research was employed by sourcing materials from internet, journals, and textbooks as well as statutory laws. This paper found that making informed choices on the methods of contraception posed a huge challenge which is a direct consequence of lack of quality contraceptive services or sufficient access to health facilities, misinformation and a dire absence of knowledge in some instances. This paper concluded that in order to make improvements to women’s reproductive lives, the society should have health awareness on the use of contraceptives and its benefits and promulgate a robust, comprehensive and specific regulation for the controlled use of contraceptives in Nigeria. Keywords : Contraceptives, Benefits, Prospects, Challenges, Solutions, Reproductive Health, Nigeria. DOI : 10.7176/JLPG/86-09 Publication date :June 30 th 2019

Challenges and opportunities in evaluating programmes incorporating human-centred design: lessons learnt from the evaluation of Adolescents 360.

Adolescents 360 (A360) is a four-year initiative (2016-2020) to increase 15-19-year-old girls' use of modern contraception in Nigeria, Ethiopia and Tanzania. The innovative A360 approach is led by human-centred design (HCD), combined with social marketing, developmental neuroscience, public health, sociocultural anthropology and youth engagement 'lenses', and aims to create context-specific, youth-driven solutions that respond to the needs of adolescent girls. The A360 external evaluation includes a process evaluation, quasi-experimental outcome evaluation, and a cost-effectiveness study. We reflect on evaluation opportunities and challenges associated with measuring the application and impact of this novel HCD-led design approach. For the process evaluation, participant observations were key to capturing the depth of the fast-paced, highly-iterative HCD process, and to understand decision-making within the design process. The evaluation team had to be flexible and align closely with the work plan of the implementers. The HCD process meant that key information such as intervention components, settings, and eligible populations were unclear and changed over outcome evaluation and cost-effectiveness protocol development. This resulted in a more time-consuming and resource-intensive study design process. As much time and resources went into the creation of a new design approach, separating one-off "creation" costs versus those costs associated with actually implementing the programme was challenging. Opportunities included the potential to inform programmatic decision-making in real-time to ensure that interventions adequately met the contextualized needs in targeted areas. Robust evaluation of interventions designed using HCD, a promising and increasingly popular approach, is warranted yet challenging. Future HCD-based initiatives should consider a phased evaluation, focusing initially on programme theory refinement and process evaluation, and then, when the intervention program details are clearer, following with outcome evaluation and cost-effectiveness analysis. A phased approach would delay the availability of evaluation findings but would allow for a more appropriate and tailored evaluation design.

Household composition and experiences of food insecurity in Nigeria: the role of social capital, education, and time use

The relationship between family structure and economic wellbeing has been widely documented. However, recent demographic shifts necessitate further exploration of the interrelationships between household composition and socioeconomic resources in relation to food insecurity. The Nigerian General Household Survey data was used to analyze three mechanisms - social capital, education and time use - by which the number of children and the presence of a disabled older adult in the household related to household food insecurity. A significantly higher risk of severe food insecurity occurred among households with children and those with a disabled elderly person. Financial support from friends, relatives, and moneylenders was associated with higher, rather than lower, risks of food insecurity. Time spent collecting cooking fuel significantly modified the relationship between number of children and food insecurity. The greater the time spent fetching cooking fuel, the smaller the gap in food security status between households with no children and those having children. These findings call for interventions aimed at combating poverty and hunger, targeting specifically households with children and those with elderly disabled persons. Further, they show the importance of reducing the amount of time it takes for households to access fuel for cooking. Also, addressing the unmet need for contraception in Nigeria may help to reduce the rate of unplanned childbearing, thereby improving household food security.

Harm elimination project for unsafe abortion in Nigeria: An operations research

Context: The harm elimination model is designed to improve access to pre- and postabortion care including free contraception and address the challenges posed by unsafe abortion to the sexual and reproductive health of the women recruited for the study. Aims: To determine the impact of the “Harm Elimination Project For Unsafe Abortion in Nigeria” (HELPUSAN) model on the rate of decision to keep the pregnancy by women seeking termination of pregnancy and the determinants of this decision. Subjects and Methods: Over the 6-month period of this pilot survey, all women presenting for abortion were offered preabortion and postabortion counseling and services according to the study protocol. The study did not offer abortion services based on the abortion law in Nigeria. The clients were followed up for 6 weeks and assessed on decision to continue the pregnancy or not. Results: Of 105 attendees, 12.4% declined enrolment, 59.8%had induced abortion, and 45.8% had spontaneous abortion. Among those who presented for postabortion care following induced abortion, the main method used for inducing the abortion process was drugs (80.5%). A total of 90 (97.8%) of the participants were confirmed to be pregnant of which 52 (57.8%) were viable. Also, of the 52 participants with viable pregnancies, 19 (36.5%) decided to retain their pregnancies, while 33 (63.5%) decided not to retain their pregnancies. Conclusion: Almost 40% of clients presenting as pre abortion clients decided to retain the pregnancy. This work also once again highlights the high unmet need for contraception in Nigeria.

Maternal grand multiparity and intention to use modern contraceptives in Nigeria

BackgroundGrand multiparity and low contraceptive prevalence are dominant among Nigerian women. These elevate the risk of unintended pregnancies, high-risk fertility and adverse maternal and child health outcomes among women in the country, particularly grand multiparous women. Studies have examined predictors of intention to use modern contraceptives among women of reproductive age. However, these studies did not ascertain the extent to which grand multiparity is associated with intention to use modern contraceptives. This study examined association between grand multiparity and intention to use modern contraceptives in Nigeria.MethodsThe study pooled data from 2003 to 2013 Nigeria Demographic and Health Surveys. The weighted sample size analysed was 34,302 women. The outcome variable was intention to use contraceptive. The main explanatory variable was parity with specific attention to grand multiparity. Unadjusted multinomial logistic regression coefficients were used to examine association between specific explanatory or control variables and intention to use contraceptives while the adjusted multinomial logistic regression was applied to further examine associated factors of intention to use contraceptives relative to being uncertain about future contraceptive use. Four multinomial logistic regression models were fitted using Stata 14.ResultsMore than half of respondents do not intend to use contraceptives, while less than one-fifth of respondents intend to use contraceptives in the future. Across the four fitted models, the relative risks of intention to use compared with being uncertain about future contraceptive use were significantly lower among grand multiparous women. Results further revealed pregnancy termination, fertility planning status, exposure to mass media family planning messages, knowledge of modern contraceptives, ideal family size, remarriage, household power relations, and maternal education as other key factors influencing expected risk of intention to use contraceptives relative to being uncertain about future contraceptive use.ConclusionMaternal grand multiparity is significantly associated with intention to use contraceptives among women in Nigeria. The development of a specific population and health programme to target grand multiparous women is imperative in the country. Such programme could be integrated into existing national family planning programme through specific contraceptive education, counselling and information for high parous women.

Maternal health care visits as predictors of contraceptive use among childbearing women in a medically underserved state in Nigeria

BackgroundHealth care visits during pregnancy, childbirth and after childbirth may be crucial in expanding the uptake of contraceptive care in resource-poor settings. However, little is known about how health care visits influence the uptake of modern contraception in Nigeria. The focus of this paper was to examine how health care visits influence the use of contraceptives among parous women in a medically underserved setting.MethodsThe study adopted a descriptive survey design. Data was collected from 411 women who gave birth between 2010 and 2015 selected through a two-stage cluster random sampling technique. Health care visits for antenatal care services, childbirth, postnatal care and modern contraceptive were dichotomised (yes, no). Descriptive analyses were performed, and percentages, frequencies and means were reported. Multiple logistic regressions were computed, and odds ratios and 95% confidence intervals were calculated.ResultsKnowledge of all contraceptive methods was lowest among women who reside in rural areas. Health care visits for antenatal care (UOR 4.5; 95% CI 2.0–10.5), childbirth (UOR2.1; 95% CI 1.4–3.2) and postnatal care services (UOR 2.3; 95% CI 1.5–3.5) independently predict ever use of any contraceptive methods. Likewise, health care visits for antenatal care (UOR 5.6; 95% CI 2.1–14.8), childbirth (UOR 2.3; 95% CI 1.5–3.6) and postnatal care services (UOR 2.8; 95% CI 1.8–4.5) were independent predictors of current use of modern contraceptive methods. In the adjusted model, health care visits for antenatal care services (AOR 3.2; 95% CI 1.1–8.8) were significantly associated with the use of modern contraceptive methods.ConclusionHealth care visits significantly predict the use of modern contraceptive methods. Expanding access to health care services would potentially increase contraceptive use among childbearing women in the medically underserved settings.

Determinants of contraceptive use among women attending antenatal care at federal teaching hospital Abakaliki, Nigeria

Background: Contraception is of immense relevance in reproductive health. It is also one of the effective strategies towards improving maternal health. This study was designed to determine the awareness and use of contraceptives among women attending antenatal care at Federal Teaching Hospital Abakaliki, Nigeria.Method: A descriptive cross sectional study design was used. Systematic random sampling technique was used to select 415 women receiving antenatal care at the facility. Information was obtained using a pre-tested, interviewer- administered questionnaire. Data analysis was done using Statistical Package for Social Sciences statistical software version 22 and level of statistical significance was determined by a p-value <0.05.Results: The mean age of the respondents was 29.3±4.5 years. Majority of respondents, (288) 69.4% had attained tertiary education. Majority, (350)84.3% were aware of contraception and the male condom, (292)70.4% and the pill, (244) 58.8% were the most known methods. Source of information on contraception were mostly from television, (201)48.4% and health workers, (186)44.8%. Use of contraceptives was low among the respondents, (99)23.9% and the male condom, (52) 52.5% and natural method, (28)28.3% were the common methods used. Contraceptives were obtained mainly from pharmacy shops/patent medicine vendors, (50)50.5% and public health facilities, (21) 21.2%. Majority of those who used contraceptives had the support of their husbands, (94) 94.9% and majority also (83)83.8% were satisfied with the methods used. Predictors of contraceptive use among the respondents included being unmarried, (AOR=3.6; 95% CI: 1.3- 10.5), Nullipara, (AOR=0.09; 95% CI: 0.02-0.3) and having 1-4 children, (AOR=0.1; 95% CI: 0.05-0.4).Conclusion: Awareness of contraception was high, however utilization was low among the respondents in the study area. There may be the need for increased public enlightenment on the use of contraceptives. Health workers will have a role to play through counselling of clients. Changing the preference of the people for large family sizes may increase the use of contraceptives in Nigeria and there should be greater emphasis on female education.Keywords: Determinants, contraceptive, antenatal care, tertiary hospital, Nigeria