|Year : 2018 | Volume
| Issue : 4 | Page : 189-195
The role of traditional contraceptive methods in family planning among women attending primary health care centers in Kano
Ayyuba Rabiu1, Asma'u Ahmad Rufa'i2
1 Department of Obstetrics and Gynaecology, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
2 Community Health and Research Initiative, Nassarawa GRA, Kano, Nigeria
|Date of Web Publication||24-Dec-2018|
Dr. Ayyuba Rabiu
Department of Obstetrics and Gynaecology, Bayero University Kano/Aminu Kano Teaching Hospital, Kano
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Traditional contraceptive methods (TCMs) have been used by our ancestors for a long time in child spacing before the advent of the modern contraceptive methods but even with the introduction of the modern methods some women prefer and are still using TCMs. Aim: The aim of this study was to assess the utilization of traditional contraceptives in child spacing and its association with family size among women of child-bearing age attending primary healthcare centers in Kano. Materials and Methods: This was a cross-sectional study among 400 women attending primary healthcare centers in Kano. Their sociodemographic characteristics, number of children, knowledge, and use of traditional contraceptives were recorded on a pretested questionnaire. Results: The mean age ± standard deviation (SD) was 29.1 ± 6.22 years. The mean number of children (±SD) was 3.9 ± 2.27. A total number of 280 (70.0%) participants knew about TCMs, but only 147 (36.8%) used these methods and among those that used TCMs, herbal medicine was the most used method (n = 67, 45.6%). There was no statistically significant difference between the mean number of children of the respondents who used traditional contraceptives and those who did not (t = 0.382, df = 398, P = 0.703, 95% confidence interval:−0.374–0.555). Educational status was significantly associated with the use of traditional contraceptives (χ2 = 8.327, P = 0.005). Conclusion: There was more knowledge of traditional than modern contraceptive methods. Herbal medicine was the most commonly used method. There was poor utilization of the modern contraceptive methods and fair utilization of the TCMs. The study showed no clear benefit of traditional contraceptive usage over its nonuse in reducing family size.
| Abstract in French|| |
Contexte: Les méthodes contraceptives traditionnelles (MTC) ont longtemps été utilisées par nos ancêtres dans l'espacement des naissances avant l'avènement des méthodes contraceptives modernes, mais même avec l'introduction des méthodes modernes certaines femmes préfèrent et utilisent encore les MTC. But: Le but de cette étude est d'évaluer l'utilisation des contraceptifs traditionnels dans l'espacement des naissances et son association avec la taille de la famille parmi les femmes en âge de procréer fréquentant les centres de soins de santé primaires à Kano. Matériels et méthodes: Il s'agissait d'une étude transversale parmi 400 femmes fréquentant les centres de soins de santé primaires à Kano. Leurs caractéristiques sociodémographiques, le nombre d'enfants, la connaissance et l'utilisation de les contraceptifs traditionnels ont été enregistrés sur un questionnaire pré-testé. Résultats: L'âge moyen ± écart type (ET) était de 29,1 ± 6,22 ans. Le nombre moyen d'enfants (± écart-type) était de 3,9 ± 2,27. Un chiffre de 280 (70,0%) connaissait les MTC, mais seulement 147 (36,8%) utilisaient ces méthodes et parmi celles qui utilisaient des MTC, la phytothérapie était la méthode la plus utilisée (n = 67, 45,6%). Il n'y avait pas de différence statistiquement significative entre le nombre moyen d'enfants des répondants qui ont utilisé des contraceptifs traditionnels et ceux qui ne l'ont pas fait (t = 0,382, df = 398, P = 0,703, Intervalle de confiance de 95%: -0,374-0,555). Le statut éducatif était significativement associé à l'utilisation des contraceptifs traditionnels (χ2 = 8,327, P = 0,005). Conclusion: Il y avait plus de connaissance des méthodes contraceptives traditionnelles que modernes. La phytothérapie était la plus méthode couramment utilisée. Les méthodes modernes de contraception et l'utilisation équitable des MTC ont été mal utilisées. L'étude a montré pas de bénéfice clair de l'utilisation traditionnelle de la contraception par rapport à sa non-utilisation pour réduire la taille de la famille.
Mots-clés: Planification familiale, rôle, méthodes contraceptives traditionnelles
Keywords: Family planning, role, traditional contraceptive methods
|How to cite this article:|
Rabiu A, Rufa'i AA. The role of traditional contraceptive methods in family planning among women attending primary health care centers in Kano. Ann Afr Med 2018;17:189-95
|How to cite this URL:|
Rabiu A, Rufa'i AA. The role of traditional contraceptive methods in family planning among women attending primary health care centers in Kano. Ann Afr Med [serial online] 2018 [cited 2019 Mar 25];17:189-95. Available from: http://www.annalsafrmed.org/text.asp?2018/17/4/189/248396
| Introduction|| |
Nigeria is Africa's most populous country, with a current population of approximately 193 million people which is equivalent to 2.55% of the total world population. The current total fertility rate in Nigeria is estimated to be 5.46 per woman.
Family planning/child spacing is defined as a conscious effort by a couple to limit or space the number of children they want to have through the use of contraceptive methods. It is a way of living that is adopted voluntarily on the basis of knowledge, attitude, and responsible decision-making by individuals or couples to pin the number, timing, and spacing of the children they want, with intention of promoting the health and welfare of the family group, and contribution toward the advancement of the society. Basically, there are two major methods of family planning; the traditional and modern methods.
Attempts to control increase in population started from the early men. Evidence from medical history indicates that our forefathers did space their children through traditional means, and the traditional methods of family planning had been handed down from generation to generation. In developing nations like Nigeria, children are valued as they not only demonstrate the masculinity of the men but equally provide the extra useful hands in communities where agriculture is the major source of income. In addition, aged parents and extended family relations depend on their children for care at old age hence reluctance to limit birth.
Before the introduction of modern methods, Africans had methods of fertility regulation. Nigerian culture includes many myths, rituals, and the use of herbs in attempts to regulate women's fertility. Although many of these traditional methods of family planning have no harmful effects on a woman's health, some however, do have dangerous or counterproductive effects. In addition, the complete effectiveness of many of the traditional methods remains doubtful.
The traditional methods of contraception include the lactational amenorrhea method, coitus interruptus (withdrawal method), calendar method or rhythm method, cervical mucus method and abstinence. Other form of traditional contraceptive methods (TCMs) can be customs or beliefs which include some rituals and use of traditional medicine and herbs.
The overall contraceptive prevalence among women in Nigeria is 16%, with the NorthWest having 4.3%, and the TCM used by women in Nigeria is 5%.
Elsewhere, a demographic health survey data in Ouagadougou showed that traditional methods are not very popular; only 6.1% of women in union are reported to use a traditional method across Sub-Saharan Africa, compared to 15.7% for modern methods. Worldwide, estimates show that 9 out of 10 contraceptive users rely on a modern method. In Sub-Saharan Africa, however, smaller, more localized studies have tended to show a different picture of traditional method use.
The benefits of child spacing are numerous; they include: preventing pregnancy-related health risks in women, reducing infant mortality, helping to prevent HIV/AIDS, empowering people and enhancing education, reducing adolescent pregnancies, slowing population growth, reducing rates of unintended pregnancies, and reducing the need for unsafe abortion.
Promotion of family planning and ensuring access to preferred contraceptive methods for women and couples is essential to securing the well-being and autonomy of women, while supporting the health and development of communities.
Knowledge about modern contraception is getting higher in the North with increased awareness and interventions from various organizations and health workers, but still misconceptions about modern contraceptives are abundant. Examples of modern contraceptive methods commonly used in this community include female and male sterilization, oral hormonal pills, intrauterine device, male condom, injectables, implant, vaginal barrier methods, female condom, and emergency contraception. Although many studies have been conducted on family planning methods, little is known about the utilization and determining factors of TCMs among women of child-bearing age groups in the study area. As women's contraceptive choice and practice are a key element of quality care in family planning service program, knowing utilization status and its determinants is crucial. Findings from this study would aim to contribute to the understanding whether the TCMs have a role in child spacing and why women in this community prefer these methods.
| Materials and Methods|| |
It was a cross-sectional study conducted from March 1 to July 31, 2017, at primary health centers (PHC) in Tarauni local government area of Kano State. Ethical approval was obtained from Kano State Primary Health Care Agency, Tarauni Local Government before the study was carried-out. Four PHC were selected by systematic sampling methods of which 100 consenting women of child-bearing age (15–49 years) were also selected randomly using balloting from each of the selected PHC. Women below the age of 15 years and above 49 years were excluded from the study. Questionnaire, containing closed and open ended questions, was structured and pretested before administration. Information obtained on the questionnaire included sociodemographic characteristics of the respondents, current usage and knowledge of both modern and traditional contraceptives, and certain quantitative measures of the characteristics of the respondents on the role and use of TCMs.
Data were entered in to a personal computer and analyzed using Statistical Package for Social Sciences (SPSS) Electronic Software (IBM SPSS Statistics 19, Inc, Chicago, IL, USA). Chi-squared test was used for categorical data. Where the criteria for applying Chi-squared test were not met, Fishers' exact test was used, and the P < 0.05 was considered to be statistically significant. In this study, TCMs refer to family planning methods that pre date the emergence of modern contraceptive methods such as abstinence, withdrawal methods, cervical mucus, and use of herbal medicine.
Sample size estimation
The sample size was determined using the formula (n = z2 pq/d2).
where, n = minimum sample size,
z = normal standard deviate set at 95% confidence limit = 1.96,
q = 1–p (complementary probability),
d = margin of error = 5% =0.05,
p = the least prevalence 0.5 (50%).
P = 0.5
q = 1–0.5
n = (1.96)2 × 0.5 × 0.5
n = 3.8416 × 0.5 × 0.5
n = 0.9604
n = 384.16
To account for incomplete response, the minimum sample size was approximated to 400.
| Results|| |
During the study period (from March 1 to July 31, 2017), 400 consenting participants (women of reproductive age group) were selected for the study. The mean age ± standard deviation (SD) was 29.1 ± 6.22 years. The median age was 28 years.
A large proportion (133, 33.3%) of the respondents were within the age group of 25–29 years while the least number of the respondents 4 (1.0%) were of the age group of 45–49 years [Table 1].
Majority of the respondents (381, 95.3%) were married. The divorced constituted 13 (3.3%).
Hausa (n = 350, 87.5%) was the largest ethnic group among the respondents. Other tribes, 32 (8.1%) were Bula, Kanuri, Fulani, Idoma, Birom, Igala, Babur, and Ibira.
Most of the respondents (196, 49.1%) attained secondary school level as their highest level of education; tertiary and primary level of education constituted 69 (17.2%) and 92 (23.1%), respectively.
A large proportion of the respondents were home managers (150, 37.5%); students constituted 8 (2.1%) [Table 1]. A large number of the respondents' husbands (258, 64.5%) were self-employed; the unemployed constituted 20 (5.0%).
The mean age (at marriage) ±SD was 17.7 ± 3.00 years. The mean number of children (±SD) was 3.9 ± 2.27. The mean age (±SD) at first child was 18.9 ± 3.90 years.
More than a half of the respondents (214, 53.5%) knew about modern contraceptive methods, but only 83 (20.7%) ever used them [Table 2].
An alarming figure of 280 (70.0%) had heard about TCMs, but only 147 (36.8%) used them. Out of these 147, 47 (32.0%) used withdrawal method, 24 (16.3%) used abstinence, and 67 (45.6%) used herbal medicines [Figure 1].
[Table 3] depicted the types of TCMs used by the respondents, the frequency of which these methods were used was also shown. Other forms of traditional contraceptives used by the respondents were charms, beads, religious prayers, and other household products such as salt and potash.
The mean number of children (±SD) of the respondents who used the TCMs was 4.0 ± 2.03. The mean number of children (±SD) of the respondents who never used the traditional methods of contraceptives was 3.9 ± 2.41. There was no statistically significant difference between the two means (t = 0.382, df = 398, P = 0.703, 95% confidence interval [CI]: −0.374–0.555).
Up to 121 (82.3%) thought the traditional method of contraceptives was effective for them while 134 (91.2%) believed there were advantages with the use of TCMs [Table 3].
[Table 4] depicted association between the use of TCMs and some sociodemographic characteristics. There was no statistically significant association between the respondents' age group ([χ2 = 2.221, P = 0.528], ethnicity (χ2 = 0.014, P = 0.906), and religion (P [Fischers'] =0.766) and the use of traditional contraceptives. However, educational status was statistically associated with the use of traditional contraceptives (χ2 = 8.327, P = 0.005).
|Table 4: Cross tabulation between variables and use of traditional contraceptives|
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| Discussion|| |
Findings from this study showed that the mean age at marriage ± SD was 17.7 ± 3.00 years. Results from the Nigerian Health and Demographic Survey (2013) also showed half of the women age 25–49 were married by 18 years, and their median age at first marriage was 18.1 years. The mean number of children (±SD) was 3.9 ± 2.27. This is lower than the average national figure of 5.5 children per woman. The mean age (±SD) at first child, which is regarded as a useful indicator for gauging the success of family planning programs aiming to reduce maternal mortality, increase contraceptive use, delay age at first marriage, and improve the health of newborns was 18.9 ± 3.90 years. This is slightly lower than the 20.90 years national estimate. This suggests that there was low success or nonusage of both modern and TCMs within the 1st year of marriage among the respondents. This is not surprising since every couple is expected to have their first child within the 1st year of marriage at least to confirm their fertility. It has been discovered that in developing nations like Nigeria, children are valued as they not only demonstrate the masculinity of the men but equally provide the extra useful hands in communities where agriculture is the major source of income. In addition, the earlier the first child is conceived and delivered after marriage, the more the happiness and anticipation that an heir to the family who will shoulder their responsibility in the near feature has arrived.
Knowledge of modern contraceptive methods was above average (53.5%) in this study, but the utilization was low (20.7%). This was lower than the 99.7% knowledge of modern contraceptive methods among married women in Zaria, Northwestern Nigeria, reported by Aliyu et al. The utilization was also lower than the 51.9% reported by Envuladu et al. in Jos, Plateau State, Nigeria. This poor utilization may not be unconnected to the fear of side effects such as spotting, dizziness, mood changes, headache, and weight gain which are associated with hormonal contraceptives.
While 280 (70.0%) of the respondents demonstrated knowledge of TCMs, utilization was also low 147 (36.8%), though the figure was still better than that of modern contraceptives. This might suggest that the respondents preferred the TCMs perhaps because they believed traditional contraceptives are safer, easy to use, with no known side effects. Ram et al. reported that the side effects of modern contraceptives such as health concerns, opposition from self, husband, and others were the main reasons why women preferred TCMs in India.
The main disadvantages of traditional contraceptives are the lack of scientific proof and evidence of their efficacy. Trussell and Kost reported that traditional medicine lacked precise dosage; its unhygienic method of preparation predisposed to spread of infections. Therefore, health awareness about the benefits of modern contraceptive methods, recommendation of specific types of method over others, and awareness of health risks and uncertainty of the efficacy of TCMs should be uncovered to facilitate the acceptance of modern contraceptive methods.
The mean number of children (±SD) for the respondents who used the TCMs (4.0 ± 2.03) was similar to the mean number of children (±SD) for those who never used the traditional methods of contraceptives (3.9 ± 2.41).(t = 0.382, df = 398, P = 0.703, 95% CI: −0.374–0.555), and they were both lower than the current total fertility rate in the country (5.46). From the results of this study, it would appear therefore that the use of TCMs has no significant effect on family size compared to its none use in family planning.
A few number of the respondent 46 (31.3%) thought there were disadvantages associated with the use of TCM, and few respondents 29 (19.7%) considered discontinuation of the method. As such, there is a need to do more research on the harmful effect of some of the traditional methods of contraceptives, their contraceptive effect and recommended dosages. To our surprise, 118 (80.3%) acknowledged the side effects of traditional contraceptives; however, they failed to consider discontinuation of the methods. Whether lack of availability of the modern contraceptives, improper counseling about the choices of modern contraceptive methods, pressure from spouse, in-laws or parent are the compelling reasons for the usage are what were not explored in this survey. A study conducted by Apanga and Adam in the Talensi District of Ghana on the factors influencing the uptake of family planning services; showed that misconceptions about family planning methods and husbands' refusal to allow their wives to access family planning services were the major reasons against usage of family planning services.
| Conclusion|| |
There was knowledge of TCMs. Herbal medicine was the most commonly used method. There was also no clear role for traditional contraceptive usage in determining family size.
The study also revealed the poor utilization of the modern contraceptive methods and a fair level of utilization of the TCMs.
It is recommended that;
- The TCMs should be studied more to know its benefits and health implications
- Awareness should be raised about modern methods of family planning
- More counseling on the use of contraceptives should be done in clinics as it contributes in allaying fear and anxiety toward the side effects.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Okonofua F, Lambo E, Okeibunor J, Agholor K. Advocacy for free maternal and child health care in Nigeria – Results and outcomes. Health Policy 2011;99:131-8.
Delano G. Guide to Family Planning. New Edition. Ibadan: Spectrum Books, Ltd.; 1990.
Alkema L, Kantorova V, Menozzi C, Biddlecom A. National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: A systematic and comprehensive analysis. Lancet 2013;381:1642-52.
Mairiga AG, Garba A, Kullima A, Bako B. The practice of traditional family planning among rural Kanuri communities of Northeastern Nigeria. Int J Biol Med Res 2012;3:1277-80.
Mairiga AG, Kullima AA, Bako B, Kolo MA. Sociocultural factors influencing decision-making related to fertility among the Kanuri tribe of North-Eastern Nigeria. Afr J Prim Health Care Fam Med 2010;2:94. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4565922/
. [Last accessed on 2018 Jan 07].
Aninyei LR, Onyesom I, Ukuhor HO, Uzuegbu UE, Ofili MI, Anyanwu EB, et al.
Knowledge attitude to modern family planning methods in Abraka communities, Delta state, Nigeria. East Afr J Public Health 2008;5:10-2.
Malarcher S, Spieler J, Fabic MS, Jordan S, Starbird EH, Kenon C, et al.
Fertility awareness methods: Distinctive modern contraceptives. Glob Health Sci Pract 2016;4:13-5.
Vogelsong KM. Training Courses. Geneva Foundation for Medical Education and Research 11th
Postgraduate Course for Training in Reproductive Medicine and Reproductive Biology. Natural Contraceptive Methods. Research Area for Male Fertility Regulation/Male Reproductive Health UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, (HRP) Department of Reproductive Health and Research. Geneva, Switzerland: World Health Organization CH-1211. Available from: http://www.gfmer.ch/Endo/Lectures_11/Naturalc.htm
. [Last accessed on 2017 Sep 08].
Keller S. Traditional beliefs part of people's lives. Netw Res Triangle Park N C 1996;17:10-1.
United Nations. Department of Economic and Social Affairs, Population Division. World Contraceptive Use 2010 (POP/DB/CP/Rev2010). United Nations; 2011.
Wolf M, Abubakar A, Tsui S, Williamson NE. Child spacing attitudes in Northern Nigeria. Vol. 6. Arlington: FHI; 2008.
Shehu CE, Ibrahim MT, Oche MO, Nwobodo EI. Determinants of place of delivery: A comparison between an urban and a rural community in Nigeria. J Public Health Epidemiol 2016;8:91-101.
National Population Commission [Nigeria] and ICF International. Nigeria Demographic and Health Survey 2013. Rockville, Maryland, USA: National Population Commission and ICF International; 2014. Available from: https://www.dhsprogram.com/pubs/pdf/SR213/SR213.pdf
. [Last accessed on 2017 Sep 12].
Myrskyla M, Margolis R. Happiness before and after the kids. Max Planck Institute for Demographic Research. Konrad-Zuse-Strasse 1 D-18057 Rostock. Germany: MPIDR Working Paper WP; 2012-13. p. 1-43. Available from: https://www.demogr.mpg.de/papers/working/wp-2012-013.pdf
. [Last accessed on 2018 Feb 18].
Aliyu AA, Dahiru T, Oyefabi AM, Ladan AM. Knowledge, determinants and use of modern contraceptives among married women in Sabon Gari Zaria-Northern Nigeria. J Biomed Sci 2015;14:13-21.
Envuladu EA, Agbo HA, Mohammed A, Chia L, Kigbu JH, Zoakah AI. Utilization of modern contraceptives among female traders in Jos South LGA of Plateau state, Nigeria. Int J Med Biomed Res 2012;1:224-31.
Lidegaard Ø, Løkkegaard E, Svendsen AL, Agger C. Hormonal contraception and risk of venous thromboembolism: National follow-up study. BMJ 2009;339:b2890.
Ram F, Shekhar C, Chowdhury B. Use of traditional contraceptive methods in India and its socio-demographic determinants. Indian J Med Res 2014;140 Suppl 1:S17-28.
Trussell J, Kost K. Contraceptive failure in the United States: A critical review of the literature. Stud Fam Plann 1987;18:237-83.
Apanga PA, Adam MA. Factors influencing the uptake of family planning services in the Talensi district, Ghana. Pan Afr Med J 2015;20:10.
[Table 1], [Table 2], [Table 3], [Table 4]