CHAPTER ONE
INTRODUCTION
Background to the Study
Adewale, Umoh, Iwere and Gbadegesin, (2005) opined that attitude and practice towards modern family planning have attracted much attention in recent times. This is due to increase in unwanted or unplanned pregnancies, induced or criminal abortion, maternal mortality, sexually transmitted diseases, human immune-deficiency virus (HIV) and acquired immune-deficiency syndrome (AIDS) prevalence among women of childbearing age. There is no one universally acceptable definition of attitude. However, Anderson (1981) opined that attitude is a moderately intense emotion that prepares or predisposes individuals to respond consistently in a favourable manner, when confronted with a particular object. Okafor (1991) stated that attitude is concerned with one‟s feeling towards an object, person or thing. Cornachia, Station and Irwin (1999) asserted that an attitude refers to mind-set to action, an internal readiness to behave or act. Simpson and Weiner (2000) defined attitude as a way of feeling, thinking or behaving. Aitken (2000) argued that there is no standard definition of attitude, but in general terms, he perceived the term to imply a learned predisposition or tendency on the part of the individual to respond positively or negatively to some objects or situation.
According to Mann (2002), attitude implies a relatively enduring organization to internalized belief that describes, evaluates and advances actions with respect to an object or situation with each belief having cognitive, affective and behavioural components. He further stated that each one of these beliefs is a predisposition that suitably activates results in some preferential response towards the attitude-object or situation or toward the maintenance or preservation of the attitude itself.
Attitude in the context of the present study is belief, feeling, thinking, ideas or emotion that predisposes an individual to respond when faced with a particular object. For instance, what a widow believes, feels or thinks about modern family planning becomes her attitude towards modern family planning. Practice, on the other hand, is something done habitually or customarily (Webster, 1980). According to Simpson and Weiner (1991), practice is a habitual action-custom. Hornby (2001) opined that practice means to do something regularly as part of one‟s normal behaviour. With regard to the present study therefore, it means using modern family planning methods regularly, as part of ones normal sexual behaviour. Practice of modern family planning may not only be beneficial to women whose husbands are living alone but also to widows of reproductive age.
A widow is defined as a woman whose husband has died and who has not married again (Hornby, 2001). Okafor (2004) viewed a widow as a woman who is married to a man and loses him to death. According to Igbudu and Okoro (2010), a widow of reproductive age is a woman in the age bracket of 15-49 years, whose husband has died and who has not married again. A young widow of reproductive age is a woman aged between 15 and 32 years, whose husband has died and who has not married again. An old widow of reproductive age is a woman aged between 33 and 49 years, whose husband has died and who has not married again.
The Logo widow of reproductive age in the context of the present study, is a woman whose husband has died and who has not married again or inherited by the late husband‟s relation. Widows of reproductive age are chosen for the present study because, they are thought to be sexually active and are more likely to be prone to unwanted pregnancy, illegitimate children, abortion, sexually transmitted infections (STIs), human immune-deficiency virus (HIV) and acquired immune-deficiency syndrome (AIDS) than their married counterparts whose husbands are alive. In addition, widows are usually subsumed within the general categorization of women or ever married women in most studies in family planning, hence the need to study them specially, in the present study.
Furthermore, the researcher’s personal observation of the death of three young widows due to criminal or induced abortion in Logo Local Government Area (LGA), also informed the present study. Besides, a widow was hospitalized for having abortion complications. In addition, five widows who were not even inherited by their late husband‟s relation gave birth to children, two years after the death of their husbands. The situation created a serious social problem as for the paternity of those children in such families. The children were termed illegitimate children in such families, even though they were answering the names of their mother‟s late husbands. OyeAdeniran, Adewole, Umoh, Iwere and Gbadegesin (2006) noted that such children were said to be vulnerable to abuse, neglect and discrimination, especially those with doubtful paternity, who would be regarded as bastards.
There seems to be need for modern family planning among widows of reproductive age. Modern family planning refers to modern contraceptives method other than traditional or natural family planning methods (NSO, 2004). Park (2007) defined modern family planning, as preventive methods that help the woman avoid unwanted pregnancies. They include all temporary and permanent measures to prevent pregnancies resulting from coitus. Modern family planning methods may be broadly grouped into two classes, namely: spacing methods and terminal methods. These methods are further categorized into three sub-categories namely, non-appliance, appliance, and surgical methods. Oreachata (2007) referred to non-appliance methods as non-manipulative methods of family planning such as pills which are taken orally to prevent pregnancy. Non- appliance methods include hormonal methods (oral pills).
Okoye and Okoye (2007) noted that oral pills which are hormone-based contraceptives are the most popular and also the most effective non-appliance methods of family planning in the World. They further observed that the first time to start taking your first package of birth-control pill is the day your period begins. According to Park (2007), appliance methods refer to any contraceptive instrument, drug, preparation or thing designed to, prepared or intended to prevent pregnancy. Spermicides are surface active-agents which attach themselves to spermatozoa and inhibit oxygen uptake and kill sperms. They include among others: foams, creams, suppositories, and soluble films.
Okoye and Okoye viewed male condom as a rubber or processed collagenous tissue sheath that fits over the erect penis and acts as a barrier to the transmission of semen into the vagina and also prevent the transmission of HIV and other sexually transmitted infections. They described female condom as a soft plastic that resembles a diaphragm and condom combination. It consists of a soft, loose-fitting sheath with two flexible rings similar to those of a diaphragm. One of the rings is put into the vagina which serves as internal anchor and the second ring remains outside the vagina to make it possible for the man to find the entrance of the vagina which is now covered by a sheath. It is an effective barrier to sexually transmitted infections (STIs) and semen into the vagina.
The Diaphragm is a vaginal barrier. It is a dome-shaped rubber cap with flexible rim. It is inserted into the vagina, before intercourse, to cover the cervix. The spermicidal could be placed on the dome of the diaphragm, to serve as reinforcement. Diaphragm could be inserted at anytime within the monthly cycle (Okoye & Okoye, 2007). Intra-uterine contraceptive devices (IUCDs) are small plastic or stainless steel or flexible polyethylene nylon device, that can be inserted by a doctor through the cervix, into a woman‟s womb to prevent pregnancy. Almost all brands of IUCDs have one or two strings or threads tied to them. The rings hang out through the opening of the cervix into the vagina. The strings which can be felt by a woman help her to check whether the IUCD is still in place or not. They also aid removal of the device by a health-care provider (Okoye, 2006).
The injectable depoprovera is a contraceptive given every three months as a single injection to women who want to prevent pregnancy. It contains the hormone, progestin, similar to the natural hormone that a woman‟s body produces. The injection, when given, releases the hormone slowly into the woman‟s blood stream up to three months or more. The injection prevents pregnancy by preventing ovulation from occurring, thickening the cervical mucus, thereby making it difficult for the sperm to pass through it, and inducing reduction or thinning of the endometrial lining (inner surface of the womb). By this action, depoprovera can cause amenorrhea (absence of menstruation) on a long use (Okoye & Okoye, 2007). Implant is a subdermal contraceptive capable of preventing a woman from becoming pregnant for five years. The commonly used implant is norplant which consists of six small plastic capsules similar to sticks of matches. The capsules contain 35mg each, of levonorgestrel. Implant is entirely a hospital procedure. The procedure requires a minor incision and the capsules are implanted beneath the skin of the forearm or upper arm. After the insertion, the minor incision is closed with gauze and plaster. No stitches are required and the capsules are not visible on the skin. Both the insertion and removal, require the expertise of a trained health personnel, mainly doctors. Interestingly, return of fertility is almost immediately after the device is removed (Okoye & Okoye, 2007). Abortion simply means termination of pregnancy. World Health Organization, WHO (1971) defined abortion as termination of pregnancy before the embryo or foetus attains the age of viability. Okoye(2006) stated that abortion could be spontaneous or induced. Spontaneous abortion is defined as natural or unaided termination of pregnancy before foetal maturity. Spontaneous abortion is commonly referred to as miscarriage. Induced abortion is defined as artificial or intentional termination of pregnancy, using any of the numerous methods against the laws of the country (Nigeria). This may include the use of drugs, mechanical devices manipulations or instrumentation. This however carries the highest risk of complications and maternal death.
Surgical or terminal methods of family planning on the other hand, are simple or minor surgical operations for permanent contraception. Surgical or terminal methods comprise of male sterilization (Vasectomy) and female sterilization (tubal ligation). The present study was concerned with oral pills, injectables, female condom, male condom, IUCDs, and surgical method. These methods were chosen for the present study because they were the only family planning methods in use in Logo LGA at the time of the study.
There are various demographic factors that influence widows‟ attitude to and practice of modern family planning. The present study was concerned with demographic factors of age, parity, and level of education. Age has been identified by some studies as one of the strong factors that influence attitude to and practice of modern family planning. In a study by Chacko (2001) among married women, in four villages in rural West Bengal, India; it was found that, one of the factors that most influence a woman‟s use of contraception include her age. Specifically, Chizororo and Natshalaga (2003), reported that the younger women liked the female condom more than the older ones. Ngom and Maggwa (2005) postulated that age significantly increases a woman‟s likelihood of using modern contraception. Reports from researchers indicate that parity influences a woman‟s chances of using modern family planning. Chacko (2001) found that the number of living sons a woman has, greatly influences her use of modern contraception. Oyedokun (2007) reported that number of children ever born was also found to be a significant factor that influences women‟s attitude to and practice of contraceptive.
Studies have revealed that level of education has strong influence on attitude to and practice of modern family planning. Kaba (2000) pointed out that educational status of women was found to have an impact on contraceptive use. Those women who have some level of education were found to have better knowledge and tend to use contraceptives. Philippines National Demographic and Health Survey, PNDHS (2000) revealed that women with an elementary school education were more likely than those with more education or with none at all to want no more children and thus tend to use modern contraception. These variables were surveyed and some behaviour-change theories applied, to explain widows, attitude to and practice of modern family planning.
This study was anchored on three theories. These are theory of reasoned action (TRA), theory of planned behaviour (TPB) and self-efficacy theory. The theory of reasoned action (TRA) which suggests that a person‟s behaviour-intention depends on the person‟s attitude about the behaviour and subjective norms, was the theory of anchor for widows‟ attitude to modern family planning. Widows who develop negative attitude to certain methods of family planning are likely not to use such methods, whereas widows who believe that using certain methods of modern family planning protect them against unplanned pregnancies and sexually transmitted infections (STIs) will likely use such methods. Similarly, the theory of planned behaviour (TPB), which states that peoples‟ evaluation of or attitude towards behaviour, are determined by their accessible belief about the behaviour, was another theory of anchor for widows of reproductive age’s attitude to modern family planning. The intention or belief of widows to use modern contraceptives, predicts contraceptive use by them. When a widow intends not to use contraceptives, it translates into non-use of contraceptive. Self-efficacy theory which holds that any change in behaviour must be preceded by a conviction that one can efficiently carry out the desired behaviour was applied to verify the findings regarding Logo widows of reproductive age‟s practice of modern family planning. Logo widows of reproductive age may be more likely to practice modern family planning when they believe that they are capable of executing those practices successfully.
The study was conducted in Logo Local Government Area (LGA) of Benue State. The Local Government located in the North-Eastern part of the State is a typical rural local government. There are two autonomous communities that make up Logo L.G.A. They are Gaambe-Tiev and Ugondo, with five council wards each. The culture of wifeinheritance seems to be fast disappearing in the LGA and widows are left alone to carter for themselves and their children. The task of caring for self and children alone, appears to be cumbersome among widows in the LGA. In an attempt to find helpers, some of them may fall victims of some boyfriends who might not be willing to use any device to protect them from HIV, STIs or unwanted pregnancies. HIV and STIs appear to be on the increase among Logo widows of reproductive age. Unwanted pregnancies, criminal abortion and unwanted children seem to be common among widows of reproductive age in the LGA. It is likely that some widows of reproductive age have died due to criminal abortion while some are being hospitalized as a result of abortion complications. Following from the above characteristics of these widows, the study on attitude to and practice of modern family planning among widows of reproductive age in Logo Local Government Area (LGA), becomes imperative.
Statement of the Problem
Modern family planning methods are considered a first line of defence against unwanted pregnancy, sexually transmitted infections (STIs) and human immunedeficiency virus (HIV). The consistent and correct use of modern family planning methods reduce greatly unwanted pregnancies, STIs and HIV among women of reproductive age in any nation thus enhancing their health. However, it appears that attitude and practice of modern family planning among women of reproductive age in Nigeria is low and it varies by demographic and socio-economic characteristics. This calls for a study to verify what obtains in Logo LGA.
The use of modern family planning methods among widows of reproductive age will reduce unwanted pregnancy, mortality and morbidity associated with abortion among widowss. HIV and STIs incidence among widowss of reproductive age will also be minimized, thus, enhancing their health. Studies have been conducted on attitude to and practice of modern family planning methods among women of reproductive age in many parts of the World including Nigeria. However, none of such studies, to the best knowledge of the researcher, has been conducted in Logo Local Government Area (LGA). Following from this, the need arose to study attitude to and practice of modern family planning methods among widows of reproductive age in Logo Local Government Area of Benue State.This is the major problem of the study.
Purpose of the Study
The purpose of the study was to find out the attitude to and practice of modern family planning methods among widows of reproductive age in Logo Local Government Area (LGA) of Benue State. Specifically, the objectives of the study were to find out the
1. attitude of widows of reproductive age to other women who practice modern family planning;
2. attitude of widows of reproductive age to those who provide modern family planning services;
3. attitude of widows of reproductive age to their possible practice of modern family planning;
4. attitude of widows of reproductive age to modern family planning, based on their age;
5. attitude of widows of reproductive age to modern family planning, based on their parity;
6. attitude of widows of reproductive age to modern family planning, based on their level of education; and
7. practice of non-appliance methods of modern family planning among widows of reproductive age;
8. practice of appliance methods of modern family planning among widows of reproductive age;
9. practice of surgical methods of family planning among widows of reproductive age;
10. practice of modern family planning among widows of reproductive age, based on their age;
11. practice of modern family planning among widows of reproductive age, based on their parity;
12. practice of modern family planning among widows of reproductive age, based on their level of education.
Research Questions
The following research questions were formulated to guide the study.
1. What is the attitude of widows of reproductive age to other women who practice modern family planning?
2. What is the attitude of widows of reproductive age to those who provide modern family planning services?
3. What is the attitude of widows of reproductive age to their possible practice of modern family planning?
4. What is the attitude of young and old widows of reproductive age to modern family planning?
5. What is the attitude of widows of reproductive age to modern family planning based on their parity?
6. What are widows of reproductive age‟s attitude to modern family planning based on their level of education?
7. What are widows of reproductive age‟s practice of non-appliance methods of modern family planning?
8. What are widowss of reproductive age‟s practice of appliance methods of modern family planning?
9. What are widowss of reproductive age‟s practice of surgical methods of family planning?
10. What is the practice of modern family planning by the young and old widows of reproductive age?
11. What are widows of reproductive age‟s practice of modern family planning based on their parity?
12. What are widows of reproductive age‟s practice of modern family planning based on their level of education?
Hypotheses
The present study postulates the following null hypotheses which were tested at .05 level of significance.
Ho1: There is no statistically significant difference between the attitude of young and old widows of reproductive age towards modern family planning methods.
Ho2: There is no statistically significant difference in the attitude of widows of reproductive age to modern family planning methods according to parity status.
Ho3: There is no statistically significant difference in the attitude of widows of reproductive age to modern family planning according to level of education.
Ho4: There is no statistically significant difference between the practice of young and old widows of reproductive age towards modern family planning methods.
Ho5: There is no statistically significant difference in the practice of modern family planning methods by widows of reproductive age according to parity status.
Ho6: There is no statistically significant difference in the practice of modern family planning methods by widows of reproductive age according to level of education.
Significance of the Study
The result of this study may be useful to widows of reproductive age, modern family planning service providers, health educators, counsellors, policy makers, medical doctors, teachers and researchers among others. Specifically, data generated by determining the attitude to other women who practise modern family planning was positive. The findings may be beneficial to Logo widows because it is hoped that it will help them to understand the right attitude to exhibit to other women who practice modern family planning. The result generated on attitude of widows of reproductive age to those who provide modern family planning services, which is positive may enable service providers to determine the need and techniques of persuading widows to maintain their positive attitude towards the modern family planning service providers.
The result generated on the attitude of widows of reproductive age to their possible practice of modern family planning which is negative may enable service providers, health educators and counsellors to develop appropriate health talks to persuade and convince the widows to adopt positive attitude to modern family planning and subsequently use the methods. Furthermore, the result generated on practice of non-appliance method of family planning among widows of reproductive age which revealed low practices may be useful to service providers, health educators and counsellors in their various places of work. The service providers may use the findings during health talk to step up the practice of nonappliance, while health educators may use the results to organize workshops and seminars to give correct and adequate information; in order to encourage positive practices of non-appliance method and discourage negative ones. Counsellors may use the findings to guide counselling of their clients.
Similarly, the results obtained on practice of appliance methods of modern family planning among widows of reproductive age revealed both positive and negative practices. The information may be helpful to women, service providers, health educators and counsellors in their various offices. Other women may also become aware of the prevailing appliance methods in practice and tend to use them. The service providers during health talk may use the information to reinforce the use or practice of the methods and also introduce other appliance methods not used by them. It is hoped that health educators will use the information to organize seminars, conferences, workshops and also compose jingles to enlighten the general public on the benefits of practice of appliance methods while discouraging negative practices of the method. The counsellors may use the findings to counsel for positive action with regard to practice of appliance method. The results generated on the practice of surgical method did not indicate much practice of this method among widows of reproductive age in Logo. Medical doctors may benefit from this finding by using the data to plan for surgical method of family planning. The information on the attitude of young and old widows of reproductive age to modern family planning revealed negative attitude to all the components of modern family planning.
The health educators and service providers may benefit from these information. It is hoped that health educators will use the information and target the age groups that develop negative attitude so as to provide them with correct information that will enable them develop positive attitude to modern family planning even at such ages. The service providers may use the information to give age-appropriate health talk to stimulate positive attitude and discourage negative ones. Findings on practice of modern family planning among the young and old widows will show the extent to which modern family planning methods have been practised by the young and old widows of reproductive age. Health educators may benefit from these findings by using the data to plan and give age-appropriate family planning education to enhance high level practices.
The result on attitudes of widows of reproductive age to modern family planning based on their parity revealed less positive but much negative attitude. Counsellors and health educators may benefit from these findings. Counselors may use the information to advise widows with negative family planning attitudes to develop positive attitude to modern family planning in spite of the number of children they have, while those with positive attitude will be encouraged to maintain them. Health educators may use the information to plan for focus-groups discussion and family visits to encourage those with positive attitude to family planning and persuade those with negative attitude to adopt positive attitudes to family planning.
Policy makers may benefit from the findings by using the information to make policies that will guarantee high level practice of modern family planning, thus limiting the number of children to a woman and allowing freedom of use of modern family planning for all. The results generated on widows‟ attitude to modern family planning, on the basis of their level of education, have helped in exposing the negative and positive attitudes of widows of reproductive age with regard to their level of education. Health educators may benefit immensely from these findings by using the information to plan for family planning education that will be appropriate to individual level of education, to enhance positive attitude and discourage negative ones.
Findings on the widows’ practice of modern family planning, based on their level of education have helped in revealing the extent to which level of education has affected the practice of modern family planning, among widows of reproductive age. Health educators, teachers and researchers may benefit from these findings. Health educators may use the findings to plan and give accurate information on practice of modern family planning based on level of education. Teachers may use the findings by identifying practice-gaps to be filled, based on level of education and will guide students, parents and non-teaching staff, on how to improve upon their practice of family planning. Researchers, it is hoped will use the findings as reference material.
Scope of the Study
The study was delimited to Logo Local Government Area (LGA), comprising ten council wards namely, Mbadyul, Mbagber, Mbater, Mbavuur, Mbayam, Nenzev, Tombu, Turan, Ukemberagya/Tswarev and Yonov. The local government located in the NorthEastern part of Benue State is a typical rural local government which is bounded by Wukari Local Government Area in the North, Katsina Ala Local Government Area in the South, Guma Local Government Area in the West and Ukum Local Government Area in the East. The study was concerned with finding out the attitude of widows of reproductive age to and practice of modern family planning. The study was delimited to such modern methods of family planning as pills, injectables, female condom, male condom, Intrauterine Contraceptive Devices (IUCDs) and surgical methods.The demographic factors of age, parity and level of education as they appear to affect attitude to and practice of modern family planning among widows of reproductive age was explored. The study involved only widows of reproductive age in Logo Local Government Area of Benue State.