Factors influencing Family Planning Uptake among Women aged 18-49 years in the Moyo District, Uganda

TABLE CONTENTS

DEDICATION

ACKNOWLEDGEMENT

LIST OF TABLES

LIST OF FIGURES

ABREVATION AND ACRONYMS

OPERATIONAL TERMS

ABSTRACT

CHAPTER ONE: INTRODUCTION
1.1 Background
1.2 Statement of the problem
1.3 Study objectives
1.3.1 Main objective
1.3.2 Specific objectives
1.4 Research questions
1.5 Scope of the study
1.5.1 Geographical scope
1.5.2 Content scope
1.5.3 Time scope
1.6 Justification
1.7 Significance of the study
1.7.1 Policy
1.7.2 Practices
1.7.3 Research
1.8 Conceptual Framework on factors for uptake of family planning services
1.8.1 Narrative

CHAPTER 2: LITERATURE REVIEW
2.0 Introduction
2.1 Uptake of family planning.
2.2 Factors influencing family planning uptake among women aged 18-49 years
2.2.1 Demographic Factors
2.2.1.1 Age
2.2.1.2 Marital status
2.2.1.3 Parity
2.2.1.4 Education of women
2.2.2 Socio-cultural Factors
2.2.2.1 Partner’s consent in making a final decision
2.2.2.2 Peer influence
2.2.2.3 Religion
2.2.3 Socio-economic Factors
2.2.3.1 Income
2.2.3.2 Residence
2.2.4 Facility based factors
2.2.4.1 Trained workers
2.2.4.2 Quality of services
2.3 Gaps in literature
2.4 Conclusion

CHAPTER THREE: METHODOLOGY
3.1 Study design
3.2 Study site & setting
3.3 Study population
3.4 Study procedure
3.5 Sample size determination
3.6 Sampling techniques
3.7 Eligibility criteria (inclusion & exclusion)
3.7.1 Inclusion criteria:
3.7.2 Exclusion criteria:
3.8 Data management
3.8.1 Data collection method and instrument
3.8.2 Data entry & cleaning
3.8.3 Data analysis
3.8.4 Measurement of variables
3.9 Quality control (validity & reliability)
3.10 Ethical considerations
3.10.1 Approval
3.10.2 Consent
3.10.3 Privacy protection
3.10.4 Confidentiality
3.10.5 Safety
3.11 Study limitations

CHAPTER 4: RESULTS
4.0 RESULTS
4.1 Family Planning uptake
4.2 Family planning methods used
4.3 Demographic characteristics
4.4 Socioeconomic and Cultural factors
4.5 Facility based factors
4.6 Association between health-related factors and Family Planning uptake

CHAPTER 5: DISCUSSION
5.0 Introduction
5.1 Prevalence of Family planning uptake
5.2 Demographic Factors associated with FP uptake
5.3 Socio-economic and Socio-cultural factors associated with FP uptake
5.4 Facility related factors associated with FP Uptake

CHAPTER SIX: CONCLUSION AND RECOMMENDATION
6.1 Introduction
6.2 Conclusion
6.2.1 Prevalence of home deliveries in Moyo Subcounty.
6.2.2 Demographic Factors associated with FP uptake
6.2.3 Socio-economic and Socio-cultural factors associated with FP uptake
6.2.4 Facility related factors associated with FP Uptake
6.3 Recommendations
6.4 Implications for further research

REFERENCES

APPENDIX
Appendix I: Questionnaire
Appendix II: Key Informant Guide
Appendix III: informed consent
Appendix IV: Budgets of the study
Appendix V: Work Plan

DEDICATION

This report is dedicated to my loving parents and siblings for financial support and encouragement. Thank you for giving me a chance to prove and improve myself through all my walks of life.

I love you all.

ACKNOWLEDGEMENT

All thanks go to the Almighty God for His gift of nature, the abundance of good health and the means through which I have been successful.

Nobody has been more important to me in the pursuit of this research than the members of my family. I would like to thank them for all the finances, love and guidance to me in whatever I pursue.

I am grateful to all of those with whom I have had the pleasure to work during this and other related activities especially Byawele Jairus Wangusa and Kadito Easter.

I extend my appreciation to my supervisor-Mr. Omute Tom who has provided me extensive personal and professional guidance and taught me a great deal about scientific research.

I am also indebted to all the staff of Lira University, Department of Public Health for providing a knowledge and skills of report writing.

May God bless you all.

LIST OF TABLES

Table 1: Family Planning uptake

Table 2: Demographic characteristics of the respondents and family planning uptake

Table 3: Social characteristics of the respondents and Family Planning uptake

Table 4: Socio-economic characteristics of the study population

Table 5: Socio- cultural characteristics of the study population

Table 6: socioeconomic and sociocultural factors associated with family planning uptake

Table 7: Health related characteristics of the respondents

Table 8: Association between health-related factors and family planning uptake in Moyo Sub County

Table 9: Reasons associated with non FP uptake

Table 10: Multivariate annalysis of predictors of FP Uptake

Table 10: The proposed budget.

Table 11: showing work plan.

LIST OF FIGURES

Figure 1 Conceptual Framework

Figure 3: Distribution of Family Planning methods used in Moyo Subcounty

ABREVATION AND ACRONYMS

AIDS Acquired Immune Deficiency Syndrome

CPR Contraceptive Prevalence Rate

FP Family planning

HIV Human Immunodeficiency Virus

MoH Ministry of Health

SDG Sustainable Development Goal

STI Sexually Transmitted Infections

SPSS Statistical Package for Social Science

TFR Total Fertility Rate

UBOS Uganda Bureau Of Statistics

UDHS Uganda Demographic Health Survey

UNFPA United Nation Population Fund

UNICEF United Nation Children Fund

WHO World Health Organization

OPERATIONAL TERMS

Abortion This is an induced termination of pregnancy.

Contraceptives These are drugs or method used to prevent pregnancy.

Family planning uptake: This referred to use of any form of either modern or traditional family planning (FP) method

Modern FP methods: FP methods such as pills, injectables (Depo-Provera), condoms, implants, Intra uterine contraceptive devices, vasectomy, bilateral tubal legation

Traditional FP methods: Other FP methods such as Lactational Amenorrhea, Fertility Awareness Based methods and herbs:

Maternal mortality: This is death that occurred to a woman who is pregnant or within 42 days after termination of pregnancies that is aggravated by the existence of the pregnancy but not accidental or incidental

ABSTRACT

Background: Sub-Saharan Africa continue to have the highest fertility rate due to low contraceptive uptake compared to other regions. Uganda continues to present undesirable fertility rate of 4.96 births per woman and maternal mortality ratios of 336 maternal deaths per 100,000 live births that are associated with contraceptive nonuse. The high fertility rates have contributed to a population growth rate of 3.02%. Moyo has an estimated contraceptive prevalence rate of 22%, uptake rate of 16% and an unmet need for family planning at 21.9%.

Objectives: The major purpose of the study was to determine prevalence and factors influencing family planning uptake in Moyo Sub-county, Moyo District.

Materials and Methods: A cross sectional study was carried out among women aged 18-49 years. The study employed structured questionnaire and KII to collect the data. Data was be analyzed using SPSS version 23 and thematic content analysis for quantitative and qualitative data respectively.

Results: Results from this study show low prevalence in the uptake of family planning with only 102 (35.2%) using at least one family planning methods. The low prevalence of family planning use could also have been due to the fact that the study was done in a community setting where health education isn’t given so often. As indicated in table 2, majority of the respondents were aged ˃30 year (43.6%). Most participants 157 (547.1%) were Christians. The married were the most dominant 196 (67.5%) participants as far as Marital Status was concerned. Majority had attained A’Level and higher 110 (37.9%), most of the respondents 76 (26.2%) were involved in business as their occupation while 66.2% of the study participants were from non-polygamous families.

Recommendations: Based on the findings from the study some recommendations are, education should be given at the point of service to enable choice of method depending on the type of need for contraception (limiting and spacing), Economically empower women to make them self-sustaining. The results show that contraceptive use rate is low among respondents without adequate income. Social self-help support groups can be empowered through the process of starting businesses, which would put more income in women’s hands.

CHAPTER ONE: INTRODUCTION

1.1 Background

Population growth has been a public health concern over the recent years. The highest impacts of population growth lies among low- and middle-income countries(Steinbach & Rudi, 2019). Although there has been a declining trend due to a number of factors including availability of modern contraceptive methods, adequate support for family planning programs(Alex C, 2009), population growth rates are still high and by the end of 2015, the Sustained Developmental Goal (SDG) 1-3 (IIASA, 2016).

Globally, population growth rate stands at 1.05% with an estimated 81m people per year and an estimated 10b people by 2057(Worldometer, 2021). Among 1.9 billion women of reproductive age group (15-49 years) worldwide in 2019, it is estimated that 1.1 billion still have a need for family planning, of these, only 842 million are using contraceptives and 270 million have an unmet need for contraceptives(UNICEF, 2018). The proportion of the need for family planning satisfied by modern methods sustainable development goals (SDG) indicator 3.71, was 75.7%(WHO, 2019) .

Sub-Saharan Africa has the highest average fertility rate in the world of 4.6 births per woman more than twice any other region in the world(Bongaarts, 2020) and a population growth rate of 2.6% (Worldbank, 2019). Contraceptive use among women of reproductive age in the SSA is only 28% accounting for nearly 14million unplanned pregnancies annually and majority of maternal deaths (66%)(Otim, 2020). The low contraceptive uptake has been attributed to factors like poor knowledge of contraceptive methods and their side effects has been associated with poor uptake(Wafula, 2014), myths and misconceptions that many women hold about potential side effects and negative outcomes(Ochako et al., 2015).

Another key barrier is lack of physical and financial access to family planning commodities. Studies have shown that health facilities offering family planning are not equitably distributed throughout the country(RR Ettarh & C Kyobutungi, 2009). Women complain of frequent stock-outs and the associated costs of lost wages, transport and other financial challenges. Studies have shown that, among youth, lower socioeconomic status has been associated with less condom use(Caroline W, 2009).

Uganda continues to present undesirable fertility rate of 4.96 births per woman and maternal mortality ratios of 336 maternal deaths per 100,000 live births that are associated with contraceptive nonuse(Otim, 2020). The high fertility rates have contributed to a population growth rate of 3.02%(Worldbank, 2019).

In Uganda, almost everybody (close to 99%) has knowledge on contraceptive use though the knowledge is not equitable to current contraceptive use as only 39%women of reproductive age use contraceptives, attributed to indistinct factors across particular regions of the country. Studies on contraceptive nonuse in Uganda report socio-economic and demographic predictors such as; educational level, age, wealth status, fear of side effects, residence, low quality of contraceptive services, alcohol intake, income, sex, and age at first sex. Conspicuously, wide variations in contraceptive nonuse, and consequent fertility, and maternal mortality exist within regions in Uganda despite continued good strategies and rigorous efforts to lower contraceptive nonuse in the country.(Otim, 2020).

In 2008, an estimated 1.2 million unintended pregnancies occurred in Uganda, representing more than half of the country’s 2.2 million pregnancies(DHS, 2013). Such unintended pregnancies result in unplanned births and unsafe abortion, maternal death and injury. The current maternal mortality ratio in Uganda is which is very high compared to that of other developed countries. (UDHS & ICF, 2016).

More than four in 10 births (43%) are unplanned(UDHS, 2011). The proportion of births that are unplanned is higher among rural, poor and less educated women than among their urban, wealthier and better educated counterparts (Rubina H, 2013).

Uganda government has made impressive strides in increasing access to sexual and reproductive health services for youths over the past 20 years, One key intervention was the formulation of health policy that involved removal of user fees for all services in 2001 (Benova et al., 2018).

Uganda has been committed to scale up the use of modern family planning methods to ensure that every Ugandan woman can choose when and how many children to have. In 2017 it revised its original commitment of 2012 to reduce the unmet need among adolescents from 30.4% in 2016 to 25% in 2021(Family Planning, 2020).

Uganda intends to achieve this by improving the number of health structures in hard-to-reach places, expanding reach and provision of services and method mix, including long acting, reversible, and permanent methods. These commitments are to contribute to the nation’s ambitious goal to reduce unmet need for family planning from 40% to 10% and increase the modern contraceptive prevalence rate to 50% by 2020(Family Planning, 2020).

This will enable it achieve its SDG of increasing modern contraceptive uptake to 67% and reduce fertility to 2.2% by 2040(UNFPA, 2017).

Despite the commitments and interventions by the government, Uganda’s total fertility, maternal mortality, and teenage pregnancy rates remain among the highest globally(Namasivayam A, 2019).

This has prompted many researches to be conducted in various regions of the country so as to ascertain the undesirable low uptake of family planning in the country despite the interventions of the government.

However, no study has been conducted in Moyo district among this particular age group to assess the factors influencing the uptake of family planning, and it is not clear if the factors reported by these studies elsewhere apply to Moyo district yet the uptake of family planning in west Nile region remains the lowest in the country at 19%(UDHS & ICF, 2016).

Therefore, it is only through a study that these factors can be ascertained hence the aim of the current study. Findings from the study will help to contribute significantly towards Uganda’s achievements and set innervations to increase family planning Uptake.

1.2 Statement of the problem

There are high rates of population growths and teenage pregnancies in Moyo Sub-county owing to a low uptake of family planning services among women of reproductive age (18-45 years). This has subsequently led to high fertility rates and increased population growth in the face of economic instability facing Uganda and if not addressed, teenage pregnancies and STIs coupled with population growth are like to undermine the country’s efforts of socio-economic development and attainment of vision 2040.

The total fertility rate in Moyo is estimated at 6.2 leading to 7,297 pregnancies and 7,727 expected births per year(Moyo District Local Government, 2018). Moyo has an estimated contraceptive prevalence rate of 22%, uptake rate of 16% and an unmet need for family planning at 21.9%(UDHS & ICF, 2016).

Despite various efforts by Ministry of Health and other implementing partners in the bid to ensure that contraceptives are available to women in Moyo like provision of better health facilities, empowerment of VHTs, effective communication through the TVs and radio stations, counseling services and free family planning service provision, most women still don’t make use of the contraceptives. Many studies in and outside Uganda have attributed the low uptake of family planning to lack of awareness, religious inclination, poor services, spouse disapproval, fear of side effects, fertility desires, long distances among others but it is not clear whether these factors also explain the low uptake of family planning in Moyo Sub County, Moyo district since it has different characteristics.

Furthermore, there is limited published information about factors influencing uptake of family planning in the sub-county and district as well. It is therefore against this background that this study aims to assess the factors influencing uptake of family planning in Moyo sub-county which will help to provide evidence for establishing practical interventions.

1.3 Study objectives.

1.3.1 Main objective

To determine the prevalence and factors that influence the uptake of family planning among women aged (18-49years) in Moyo sub-county, Moyo district.

1.3.2 Specific objectives

I. To determine prevalence of family planning uptake among women aged (18-49years) in Moyo sub-county, Moyo district.
II. To assess the factors influencing family planning uptake among women aged (18-49years) in Moyo sub-county, Moyo district.

1.4 Research questions

This research was guided by the following questions;

I. What is the prevalence of family planning uptake among women aged (18-49years) in Moyo sub-county, Moyo district?
II. What are the factors influencing family planning uptake among women aged (18-49 years) in Moyo sub-county, Moyo district?

1.5 Scope of the study

1.5.1 Geographical scope.

This study was carried out in Moyo Sub-county, Moyo district. Moyo sub-county is one of the 9 sub-counties of Moyo district which is located in the West Nile region of Uganda. The district covers an area of 2,059 Km[2].

1.5.2 Content scope.

The research focused on use of data primarily collected from the respondents in assessing the factors influencing family planning uptake among women aged (18-49years) in Moyo sub-county, Moyo district. The dependent variable was level of family planning uptake and the independent variables included facility-based factors, demographic factors and socio-economic (cultural) characteristics of women.

1.5.3 Time scope.

The data collection took place within 2 weeks from 12th April to 26th April 2022.

1.6 Justification

Uganda’s SDG as envisioned in 2040 is to lower the fertility rate from 5.4% in 2017 to 2.2% and to increase the mCPR to 67%(UNFPA, 2017). But however low uptake of family planning is still acute in the rural areas of Uganda where the actual fertility rate is 1.3 children higher than the wanted fertility rate, and 1 in 4 females become pregnant between the ages (15-19years)(Kalyesubula et al., 2021).

Therefore Uganda’s total fertility, maternal mortality, and teenage pregnancy rates remain among the highest globally(Namasivayam A, 2019).

But however, the negative impact of adolescent and unwanted pregnancy should not be underestimated. As they are the leading cause of unplanned births, unsafe abortions and maternal and child mortality rates as well as social, economic and psychological consequences(Bahk et al., 2015).

This research will therefore provide information that is necessary for interventions so as to increase the uptake of family planning to slow the rate of population growth as well as improve maternal and child health.

1.7 Significance of the study

1.7.1 Policy

The study can aid the Ministry of Health as a policy making body and its partners in identification of real factors influencing family planning uptake and direct program designs and implementation.

The district managers can find the findings of the study an important tool containing sufficient concepts regarding the local understanding and perspective of women contraceptive use Moyo district.

1.7.2 Practices

The findings of this research can be used by the management of Moyo Sub-county to come up with evidence-based interventions to increase contraceptive uptake and subsequently improve health outcomes of women and their expected babies.

1.7.3 Research

The report of this study may be useful for further studies undertaken on family planning and a reliable source of literature for reference by the academia in public health or any other interested groups especially of Lira University.

1.8 Conceptual Framework on factors for uptake of family planning services

A conceptual framework showing indications for uptake of family planning services

1.8.1 Narrative

In this study, the adapted conceptual framework captures factors that influence uptake of family planning.

The first variable is conceptualized as the demographic factors such as age, marital status, and woman’s education level which have both a direct and indirect influence on the uptake of family planning. It influences FP uptake indirectly through affecting facility-based factors. Demographic factors like education tailor the way individuals perceive their own health for example un controlled childbirths may be considered or seen as a normal occurrence which does not require family planning by illiterates since it is not a disease leading to reduced family planning uptake.

The second variable is conceptualized using socioeconomic factors like wealth status and residence that have direct influence on FP uptake. For example, many rural women experience precarious obstacles and a large proportion of them are not able to access FP services because they lack enough resources, including for transport.

The third variable is defined by facility-based factors like Accessibility of FP services, Availability of FP methods, Quality of care, Training skills, Integration of services have a direct effect on the uptake of family planning. For example, the positive impact of quality could be attributed to the fact that in the process of making a decision on using family planning services, perceived quality of the service is given a high consideration as supported by theory whereby taste and preference is an important factor in making demand decision.

The fourth variable is defined by social cultural factors like Religious beliefs, Cultural norms, Peer influence, Partner support and parity which have a direct effect on family planning uptake.

CHAPTER 2: LITERATURE REVIEW

2.0 Introduction

This chapter deals with the literature reviewed on the uptake of family planning and identified gaps in various studies.

2.1 Uptake of family planning.

Uptake of family planning is low especially in developing countries where the burden of unplanned and ill-spaced pregnancies together with morbidity and mortality that result from sexually transmitted infections, the HIV/AIDS scourge included, is unacceptably high (Igbodekwe et al., 2014).

In 2015, findings of a study that was conducted in 2008 assessing contraceptive use among adolescents (15 – 19 years) in Ghana was published in the BMC women’s health journal. It was found out that the overall contraceptive utilization in the sample of 1037 women was 18.3 % comprising 14.6 % of modern methods and 3.7 % of traditional methods (Nyarko, 2015). Recent studies have indicated an upward trend in utilization of family planning among Ugandan women, more so among the married ones (Nyarko, 2015). According to (UBOS, 2014), contraceptive utilization among married women increased from 18% in 2000 to 26% in 2011 but among sexually active unmarried women, it remained at 44% in the same time period.

A recent published study in Uganda on trends of family planning showed that there was an upward trend in modern contraceptive use - from 11.6% in 1995 to 32.1% in 2011, (Andi et al., 2014) this level is still very low.

2.2 Factors influencing family planning uptake among women aged 18-49 years

2.2.1 Demographic Factors

2.2.1.1 Age

The age plays an important role in the process of deciding when women will start and finish the process of giving birth and how long to wait after the birth of the next child. As well as the use of family planning. In a recent study by Sserwanja in 2021, the use of family planning was found to be highest among women aged between 20 – 39 years compared to those below 20 years and above 39 years(Sserwanja, 2021). Rice and Leyland in their study in 1996 reputed that 49% of the women that were using contraceptives were aged 20- 29 years, 41% were aged between 30 - 39 years, while no woman aged 50 years and above was found to be using any form of family planning services.(Rice & Leyland, 1996). Many other studies also show that younger age especially age group (20-29) years was more likely to be associated with use of modern contraceptive (Utomo et al., 1983).

2.2.1.2 Marital status

Marital status refers to whether one is married or single (de Vargas Nunes Coll et al., 2019). Oyedokun A.O et al. in his study revealed that family planning varies across marital status with married women using the services most compared to single women due to high incidences of sexual activities compared to single women. Thus contraceptives was aimed at helping to space children and prevent unwanted pregnancy among the married women.(Oyedokun A.O. ,et al., 2007).

The positive influence of marital status on the likelihood of using family planning services could be attributed to the fact that couples might decide to postpone raising children by resorting to use of family planning services. A study by Otim in 2020 reputed that the value of the marginal effect simply means that a married woman is 2 percent more likely to use family planning services than a single woman(Otim, 2020). Another study in rural Lagos, Southwest of Nigeria by Afo;ani et al. showed that there was a discrepancy in contraceptive use among married and single women in May of 2015 as the overall utilization of contraceptive use was 51.9% with nonuse of contraceptives among married women being 43% and 67% among singles(Afolabi et al., 2015)

2.2.1.3 Parity

A study by Oyedokun A.O. et al. in 2007 reputed that sex combinations of surviving children and women’s education were the most important significant determinants of family planning use and method choice (Oyedokun A.O. ,et al., 2007). Mahidu et al. in 1998 stated that the positive influence of the number of living children on the likelihood of using family planning services could be attributed to the woman’s desire for children having been satisfied (Mahidu et al., 1998).

Feldman et al. in his 2009 study found that out of the women that were using family planning services, 36 percent had 4 – 6 children, followed by those with between 1-3 living children at 30 percent. On the other hand, 17 percent of those respondents using family planning services had between 7 – 9 living 15 children, while 15 percent had no living child. Women in Zimbabwe who had several children wanted to avoid further pregnancies (Feldman et al., 2009). This reveals that the higher the number of living children, the more the desire to use family planning services.

2.2.1.4 Education of women

Education is a strong determinant of modern contraceptive utilization and exposes women to reproductive health information and empowers them to make appropriate decisions. A study in Uganda by Assiimwe et al. in 2004 showed that increase in education levels were significantly associated with high contraceptive use. Results also show that women who had attained post-secondary level of education had very high odds (OR = 11.82; p = 0.005) of using contraceptives compared to those who had not gone to school(Asiimwe et al., 2014).

Contraceptive nonuse among less schooling women can be associated to lack of knowledge, fatalism, and lack of contraceptive access. However no study in Uganda can justify the differences in effect of women’s educational level on contraceptive nonuse across all regions(Otim, 2020). In another study by Sultan Ayaz and Sengul Yaman in 2009, It was found that women who had a primary school graduate or higher education, had 1–3 pregnancies and did not want more children in the future got higher scores on the family planning attitude scale(Sultan Ayaz and Şengül Yaman Efe, 2009). As the level of education increases, the number of children required decreases. The reason for this can be explained by the opportunity to learn about family planning and to raise awareness about the issue.

2.2.2 Socio-cultural Factors

2.2.2.1 Partner’s consent in making a final decision

The most important determinant of the likelihood of the respondents in slums using family planning services was partners’ approval, 56 percent of the women sought approval before using contraceptives, while 23 percent did not bother (Raiford et al., 2008). The remaining 21 percent of the respondents were however uncertain an indication that they were either not having a regular sexual partner whom they could seek approval from, or that they were not sexually active. The high percentage of those who sought approval from a partner clearly indicates the importance of a partner’s consent in making a final decision on use of family planning services. Another study by Wolff et al. in 2000 reputed that the wife and husband’s approval of FP use positively influenced the adoption of all methods. Partner opposition was found to cause a statistically significant increase in unmet need accounting for as much as 20 percent of unmet need reported by women (Wolff et al., 2000).

2.2.2.2 Peer influence

There are individual factors that determine a person's use of services such as FP are mediated by the characteristics of the community in which the individual lives. It is important to look beyond individual factors when examining FP use or non-use(Stephenson & Tsui, 2003). Disapproval by friends, neighbors and relatives, stories from social networks proved to be more salient than medical opinions in shaping safety and perceptions. Women with strong social networks such as friends are likely to use short term methods.

2.2.2.3 Religion

Srikanthan & Reid, 2008 reputed that religiosity affiliations have been found to have no significant role to contraceptive use and choice, education among the youth had an association consistently (Srikanthan & Reid, 2008). In his study, basing on religious background of the woman, out of the 51 percent that were using contraceptives, 52 percent were Protestants, 35 percent Muslims while only 13 percent were Catholics. This is an indication that use of contraceptives vary across religion with Catholics using the least. The probability of a woman using family planning services if she was a Catholic was 28 percent lower compared to others with different religious background such as Protestant and Muslims. This is because catholic faith discourages its faithful from using contraceptives as birth control measures. This finding clearly indicates a significance difference in the use of family planning services between Catholics and other religions. Neeti .R. et al, 2010 explored the perceptions and attitudes of Muslim women towards FP and currently available contraceptives and facilitating factors and barriers that determine adoption of contraception especially terminal methods.

2.2.3 Socio-economic Factors

2.2.3.1 Income

A study in Kenya by Sharma et al. in 2012 showed that out of the total number of women using contraceptives, 31 percent had an average monthly income of Ksh 20,000 and above while 28 percent had an average monthly income of between Ksh.15,000 to 20,000. On the other hand, 7 percent of users had an average monthly income of less than 5,000. Those with no income were, however, the least users of family planning services. The results thus reveal that in the absence of an income source, usage of family planning would decline. The lower the economic status of the households, the higher the non-users (Sharma et al., 2012).

2.2.3.2 Residence

Many studies support that social factor such as place of residence, affect the contraceptive utilization patterns. A study by Otim in 2020 showed that urban women were found more likely to use contraceptives compared to rural women. these differences were attributed to better availability of social services such as education, access to health services, information and family planning services, majority of the respondents (82.3%) resided in rural areas while only 17.7% resided in urban areas. A statistically significant relationship was found between place of residence and FP uptake. FP uptake was higher among respondents in urban areas (78.6%) relative to those in rural areas (54.7%)(Otim, 2020).

2.2.4 Facility based factors

2.2.4.1 Trained workers

In one study by Ketende et al., results showed that increased availability and uptake of FP methods, was positively associated with the presence of a number trained FP service providers (Ketende et al., 2003). Discussion of FP between clients and service providers during ANC of the first child was key to subsequent use of family planning methods and reduction of unmet need for family planning. Use of pills, condoms, traditional methods, injectables and IUCDs was higher in women who had home visitations by welfare assistants. Studies further indicate that FP counseling and regular follow-up was accompanied by a high rate of contraceptive use and a low pregnancy incidence after delivery (Brou et al., 2009).

2.2.4.2 Quality of services

With regard to quality of family planning services, the probability of a woman using family planning services was 17percent higher for respondents who perceived the services to be of high quality than for those who perceived otherwise(Otim, 2020). The positive impact of quality could be attributed to the fact that in the process of making a decision on using family planning services, perceived quality of the service is given a high consideration as supported by theory whereby taste and preference is an important factor in making demand decision.

2.3 Gaps in literature.

The previous research focused mostly on married women, this research will have a focus on all women of reproductive age because of the changing trends in marriage concepts by the current generations and their eligibility. The study will go deeper to ascertain the type of marriage relationship to contraceptives use, which has been a missing factor on the relationships. Muslims and Savedees had been in-depthly studied unlike the other denominations, this study will look at all religious groups.

2.4 Conclusion

The researcher reviewed literature on the factors that influence family planning among women of reproductive age. This study will deal with demographics, socio-economic, socio-cultural and facility-based factors that are thought to have a great influence on the same. Other factors are knowledge, attitudes and practice which will lead to uptake of services by the FP clients. In terms of preference, literatures shows that younger women will prefer short acting methods compared to older women who will prefer traditional and permanent methods. Literature is very limited on the service care providers.

CHAPTER THREE: METHODOLOGY

3.1 Study design

This was a cross-sectional study employing both quantitative and qualitative methods. The design was chosen because all the required data from the study respondents can be obtained once with no need for follow up, making it to be the most suitable research design.

3.2 Study site & setting

This study was conducted in Moyo sub-county, Moyo district. Moyo District is located in the West Nile region of Uganda. The district is bordered by South Sudan to the north and east, Adjumani to the south, across the waters of the Nile and Yumbe district to the west. The area is about 1,800.8km[2] with a population of 412,500 people. Moyo sub-county is one of the 9 sub-counties of Moyo district with 3parishes and 35 villages.

According to the 2002 Population and Housing Census Report about 80% of the households in Moyo District depend mainly on subsistence agriculture as their main economic activity.

Only 9.7% of the population was dependent on earned incomes and 0.4% on property income The major crops grown include sweet potatoes, sorghum, cassava, simsim, groundnut, finger millet, maize, cowpeas and beans.

The s/c has 1 general hospital, 1 HC/IV, HC/III, HC/II and is characterized by high rates of poverty, poor roads and infrastructures.

3.3 Study population

This study targeted women aged 18 to 49years in Moyo sub-county, Moyo district who were be obtained from the community.

3.4 Study procedure

The proposal written by the researcher was reviewed by the university supervisor and approved by lira university REC.

The REC issued a letter that was submitted to the stipulated study area requesting for their participation in the research. The authorities of the stipulated area of study issued a letter of permission to participate in the study from which data was collected.

The questionnaire was designed and pretested before it was used in actual data collection. Sampling was done using a simple random method to obtain participants from the purposively chosen sub county. Data collection was done by conducting researcher-administered interviews using structured questionnaires after getting consent from the participants. A report was written after the results had been produced from analysis in order to summarize the findings which was later disseminated for utilization.

3.5 Sample size determination

The sample size was obtained using the Kish Leslie’s formula (1965) as shown below.

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The minimum sample size was 264 respondents. The sample was further increased by 10% to account for contingencies such as non-response or recording error resulting to a total sample of 290 participants.

The study involved a total of 290 participants.

For qualitative data, 10 participants were recruited purposively based on the researcher’s criteria.

3.6 Sampling techniques

Simple random sampling was done using lottery random method to obtain 6 villages out of the 35 villages from the purposively chosen sub-county.

Simple random sampling using a table of random numbers was conducted to choose the participants that were recruited in the study to obtain quantitative data.

For qualitative data, participants were recruited purposively based on the researcher’s criteria. This enabled the researcher to squeeze a lot of detailed information which allowed for the description of major influences of family planning uptake.

3.7 Eligibility criteria (inclusion & exclusion)

3.7.1 Inclusion criteria:

All women aged 18-49 years in Moyo sub-county were eligible and were included in the study.

3.7.2 Exclusion criteria:

All women aged 18-49 years in Moyo sub-county who could not consent or have speech and psychological problems were excluded.

3.8 Data management

3.8.1 Data collection method and instrument

Researcher administered interviews using questionnaires were employed to obtain quantitative data.

KIIs using KI interview guide were conducted to obtain qualitative data from respondents.

3.8.2 Data entry & cleaning

The responses on the questionnaires will be manually entered into the computer Microsoft excel spread sheet and removal or correction of errors and inconsistencies in a data set or database due to the inaccurate entry of the data will be done. Incomplete, inaccurate or irrelevant data will be identified and then either replaced, modified or deleted.

3.8.3 Data analysis

Thematic content analysis was conducted for qualitative data first by familiarization, coding, theme generation, review of themes, defining themes and finally writing up.

Quantitative data was coded and fed into Statistical Package for Social Statistics (SPSS) version 25 for analysis.

Simple frequencies and proportions were used to describe the socio-economic and socio-cultural, demographic and facility related characteristics of the respondents in univariate analysis.

Chi-square test were used to assess the relationship between family planning uptake and the explanatory variables in bivariate analysis to determine the relationship between the outcome variable and the independent variables.

For this study, p-value ≤0.05 will be considered as statistically significant.

Qualitative and quantitative data were then be integrated and became interdependent in addressing the common research questions.

3.8.4 Measurement of variables

The dependent variable was the Uptake of family planning which was measured in terms of number of women who acknowledged the use of family planning.

The independent variables explanatory variables like socioeconomic, sociodemographic, social cultural and facility-based factors were also studied.

3.9 Quality control (validity & reliability)

Random sampling was used to avoid biases

A pilot study was done to enable the researcher to re-design the research instruments to improve the reliability and the validity of data.

Questionnaire pretesting was done to ensure accuracy

3.10 Ethical considerations

3.10.1 Approval

This study was first approved by the administration of Lira University, which issued an introductory letter to the LC III-Moyo sub-county, who granted permission for the study to be conducted.

3.10.2 Consent

The research participants (women aged 18 to 49years) were given detailed information about the research process, procedures, methodologies, benefits and risks when obtaining consent for participation.

3.10.3 Privacy protection

The researcher reached each research participant at their place of convenience and the research was individual based and rather than gatherings for discussion.

3.10.4 Confidentiality

Storing information about clients in lockable cabinets, using codes to record data and eliminating participant identifiers.

3.10.5 Safety

Being a COVID-19 pandemic, respondents were strictly required to have masks, practice hand washing, sanitize and maintain social distancing to avoid COVID-19 transmission.

3.11 Study limitations

Language barrier which was solved through use of an interpreter to ease the process of communication

Some study participants refused to participate in the study and thus were accorded due respect. The sample size was further increased by 10% to cater for such contingencies.

CHAPTER 4: RESULTS

4.0 RESULTS

Information was obtained from interviews of 290 mothers from six villages of Moyo Sub-county; and there was a 100% response rate. Qualitative data was obtained from 12 individuals (4 health workers, 4 men and 4 women).

4.1 Family Planning uptake

Table 1: Family Planning uptake

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Source: Primary Data

About a third, 35.2% (102) of the respondents were using at least some form of family planning method. Majority (64.8%, n=188) of those who were not on FP method expressed desire to use FP given favorable conditions.

4.2 Family planning methods used

Figure 2: Distribution of Family Planning methods used in Moyo Subcounty

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Source: Primary data

The study found out that the most used family planning method was injectables (37%), followed by Condoms (24%), Pills (19%), LAM (16%), IUD (10%) and lastly Female sterilization which accounted for 1%.

4.3 Demographic characteristics

Table 2: Demographic characteristics of the respondents and family planning uptake

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Source: Primary Data

As indicated in table 2 above, majority of the respondents were aged ˃30 year (n=126, 43.6%). Most participants 157 (547.1%) were Christians. The married were the most dominant 196 (67.5%) participants as far as Marital Status was concerned. In terms of level of education, majority had attained A’Level and higher 110 (37.9%), only very few had not attained any formal education (n=33, 11.4%). Most of the respondents 76 (26.2%) were involved in business as their occupation. A greater percentage 66.2% of the study participants were from non-polygamous families and majority 166 (57.4%) reported having their last born between ages of 6-12 months.

Bivariate analysis

Table 3: Social characteristics of the respondents and Family Planning uptake

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Source: Primary data

The findings from Table 3 revealed that about 32% of the mothers who reached secondary education used FP methods compared to 22% of those who had only primary education, however, the difference was not statistically significant (P=0.16). Salaried respondents were more likely to use FP methods (40%) compared to those in business (28.6%), housewives (25%) and peasant farmers (25%), but these differences in uptake of FP methods were not statistically different (P= 0.55). However, age of the last-born baby in months was statistically significant (P=0.010).

4.4 Socioeconomic and Cultural factors

Table 4: Socio-economic characteristics of the study population

Abbildung in dieser Leseprobe nicht enthalten

Source: Primary Data

Most respondents were employed in private/public sector (n=120, 41.4%). Many revealed not to have enough income (n=244, 84.2%) compared to those who had enough income (n=46, 15.8%). Highest percentage of respondents get family planning information from media 69.4%).

Table 5: Socio- cultural characteristics of the study population

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Source: Primary Data

Many respondents prefer to wait for more than two years from then had a representation of 47.1%, those who had no desire completely had a representation of 36.1%. While those who desired to have a child soon were of 12.9% and 3.8% of respondents were undecided.

Those who ever discussed family planning with their partners were 66.3% while 33.7% reported never discussed. The husbands/partners who approve the use of family planning were 38.8% while 61.2% did not approve. Most respondents revealed that religion has an influence on FP (73.9%).

Bivariate analysis of Socioeconomic and Socio-cultural factors associated with Family Planning.

In this study, failure to discuss family planning issues with the spouse (husband) hindered the chances of FP uptake of a mother, OR = 0.41 (p value=0.000). However, the desirable another child did not affect the likelihood of FP uptake. Likewise, religious influence did not affect the chances of current FP uptake (p value=0.402).

Table 6: socioeconomic and sociocultural factors associated with family planning uptake

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Source: primary data

During the interviews with men, it was found out that men are knowledgeable of the various FP methods and the benefits in using FP. The men also agreed with the fact that even men should take up FP services although they tended to prefer the supportive role to their wives.

“… if I am the head of the household responsible for all family financial burdens, how can I refuse to support my wife to use FP services! The challenge is when a man has more than one wife; the women then start competing in having more children”, KI man.

4.5 Facility based factors

Table 7: Health related characteristics of the respondents

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Source: Primary Data

Findings revealed that most mothers’ privacy during examination and family planning sessions by the health workers is taken into account and that they credit the health center for that (33.8%). Regarding the availability of health workers, most of the participants (68.9%) revealed that the health workers were always available on the clinic days to attend to them and that they were enough. The general sanitation of the health centre was fair as reported by most of the respondents (37.9%).

4.6 Association between health-related factors and Family Planning uptake

Following the univariate analysis, a bi-variate analysis was done to assess the association between family planning uptake and health related factors are summarized in table 7 below.

Table 8: Association between health-related factors and family planning uptake in Moyo Sub County

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Source: primary Data

Only availability of health workers (P=0.021) was found to be associated with family planning uptake. It was revealed in this study that general cleanliness of the place and mother’s privacy had no significant influence in determining uptake of FP (p > 0.05).

During the discussion with some health workers and community members, it was found out that some of the challenges at health facility which would hinder effective FP service provision included: Lack of competences and skills of the health workers in FP service provision, Poor attitudes towards FP service provision, and understaffing coupled with excessive work load resulted in lack of integration of FP. The following quotes depict some of the health service-related barriers to FP provision;

“... Some health workers do not have competencies; they need to build skills; others have poor attitudes towards FP. Then lack of equipment especially for long term methods, for example if you want to insert an IUD. This can result even in de-motivation of providers” KI health worker.

“... Even at the facility there may be only one midwife who will hence prioritize clinical services. The understaffing results in allocation of days for particular services. A mother comes after walking over 5 km and you tell her to come back tomorrow for family, I cannot definitely come back” KI Mother

Table 9 : Reasons associated with non FP uptake

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Source: Primary data

The reasons that were identified as significant by the study and had an influence on the non-uptake of FP were workers’ attitude (p=0.008) and fear of side effects (p=0.001).

Table 10: Multivariate annalysis of predictors of FP Uptake

Abbildung in dieser Leseprobe nicht enthalten

Source: Primary data

As indicated in table 9, multiple logistic regression model revealed that age of the baby in months, level of education and health worker availability were significant predictors of FP uptake among the study participants (p<0.05). Those with children ˂6 months were less likely to take up FP as compared to those with 6-12 months children. The non-educated, primary and secondary level respondents were less likely to take up FP services than those who had attained A’level education. Chances of taking up FP services increased with the availability of service providers at the facility.

CHAPTER 5: DISCUSSION

5.0 Introduction

This study assessed the factors that influence Family Planning Uptake Among Women Aged (18-49years) in Moyo Sub- County, Moyo District. This chapter presents discussions in accordance to the specific objectives of the study and related literature.

5.1 Prevalence of Family planning uptake

Results from this study show low prevalence in the uptake of family planning with only 102 (35.2%) using at least one family planning methods. These findings are in agreement with findings of a separate study conducted in Nairobi’s Harambee and Jericho Estates where family planning prevalence rate was at 37.7% and 30.8% respectively (APHR, 2011). The low prevalence of family planning use could also have been due to the fact that the study was done in a community setting where health education isn’t given so often.

The prevalence of FP uptake in Moyo subcounty is higher than that stipulated by UDHS-2016 which highlighted FP uptake level being 16% in Moyo district (UDHS & ICF, 2016). The prevalence, however, is relatively lower than that reported in the neighboring district of Adjumani (45%) and Yumbe District (46.4%) (World bank, 2018).

Family planning uptake was higher among young girls aged below 20 years (14.8%) than those above 30 years (3.4%). In the same way, FP uptake was higher among currently married women (31.0%), Those in monogamous families (22.8%), those with babies aged below 6months (19.0%), and Christians (20.0%) than Muslims (15.2). The proportion of FP uptake was higher among women who didn’t discuss with their spouses about FP (24.8%), women who rated general cleanliness as fair (11.7%), and women who said health workers were always available (24.8%).

On contrary, a study by Gueye (2015) revealed that the prevalence of modern methods of contraception among married young adults and Christians is low in most countries. Low contraceptive use among young women is often considered to reflect a desire to become pregnant, particularly in settings where there is socio-cultural pressure to prove fertility (Gueye, A., 2015)

Majority of respondent prefer using injectables (37%) followed by condoms (24%), pills (19%), LAM (16%), IUD (10%) and lastly female sterilization (1%) as a long-term method. Most respondents from Moyo prefer using the short-term methods. The natural method used mostly is LAM. Condom was the preferred possibly due to cost; however, injectables were most preferred than pills possibly due to their side effects.

These results are similar to what other studies have found that the injectables were the most popular among youths and adolescents (Kalyesubula et al., 2021). There has been a concern that this trend may be influenced by health workers who find it easier to administer the method compared to the other methods (Naanyu et al., 2013). It is known that the longer acting methods are more cost-effective and are less likely to be discontinued (Benson et al., 2017; Keesara et al., 2018; Ochako et al., 2015).

5.2 Demographic Factors associated with FP uptake

As indicated in table 2, majority of the respondents were aged ˃30 year (43.6%). Most participants 157 (547.1%) were Christians. The married were the most dominant 196 (67.5%) participants as far as Marital Status was concerned. Majority had attained A’Level and higher 110 (37.9%), most of the respondents 76 (26.2%) were involved in business as their occupation while 66.2% of the study participants were from non-polygamous families.

At multivariate, logistic regression model revealed that age of the baby in months and level of education were the only significant predictors of home delivery among the study participants (p<0.05). Those with children ˂6 months were less likely to take up FP as compared to those with 6-12 months children. The non-educated, primary and secondary level respondents were less likely to take up FP services than those who had attained A’level education.

These results were contrary to a study done on utilization of family planning and associated factors among reproductive age women with disability in Arba Minch Town in Southern Ethiopia which revealed that level of education and the age of the child are not predictors of family planning uptake. The same study also asserts that Age, marital status and religion are significant predictors of Family planning uptake (Mesfin et al., 2019).

The results were consistent with a study done in Ethiopia on sexuality and reproductive health of disabled young people where it was reported that majority of the respondents were aged 20 years (Kassa et al., 2016).

These findings are also similar to the findings of Rahman and Kabir (2005) which indicated that the level of education of respondents has a significant role in the usage and choice of contraceptives (Kabir, 2007). Again, the research finding of , Šagri, Višnji, Tasi, and Markovi (2006) further indicates that the relevance of the educational background of respondents plays a very important role in the usage and choice of contraceptives. In another Nigerian-based study, the findings stress that women with a higher educational level, are more likely to make self-choices on contraceptives than women with secondary or lower education (Asekun-Olarinmoye et al., 2013).

It is worthy of note that, the findings this study again establish age of the baby in months is directly related with the usage and choice of contraceptives among women accessing family planning units. The outcomes of this study indicate that women having a child between 6-12 months have the higher possibility of contraceptive usage than those who have children of less than 6 months probably due to dependance on LAM and ignorance on possibility of pregnancy before 6 months postpartum. This is in juxtaposition with a Tanzanian study confirms that the age of a last child plays a major role in choice and usage of contraceptives (Miller & Babiarz, 2016).

5.3 Socio-economic and Socio-cultural factors associated with FP uptake

Most respondents were employed in private/public sector (n=120, 41.4%). Many revealed not to have enough income (n=244, 84.2%) compared to those who had enough income (n=46, 15.8%). Highest percentage of respondents get family planning information from media 69.4%). Those who ever discussed family planning with their partners were 66.3% while 33.7% reported never discussed. The husbands/partners who approve the use of family planning were 38.8% while 61.2% did not approve. Most respondents revealed that religion has an influence on FP (73.9%).

At multivariate analysis, none of the variables was found to predict FP uptake though only discussion with the spouse (P=0.000) had some level of association at bivariate analysis (table 6).

On contrary, a study on factors influencing the choice of contraceptives among women at a specialist hospital in Sokoto-Nigeria, showed that economic factor is one among the key determinants that influence the utilization and choice of contraceptives. Finding of this current study, has however revealed that, economic factors have no influence on usage and choice of contraceptives on participants accessing service probably due free FP services provided by the government of Uganda and other faith-based institutions in Moyo S/C. These findings have a similitude to the study of Orach, (2015) which revealed that economic status is not linked with family planning uptake (Orach et al., 2015).

This study finding revealed that partners’ approval has some significance in the uptake and choice of contraceptives among the women. This finding is similar to the finding in southern Ghana which revealed that spousal approval is very important in the use and choice of contraceptives (Adongo et al., 2013).

In a study by Okech et al., (2011), the findings emphasized spousal approval in the usage and choice of contraceptives. A similar study which was also conducted in Kenya revealed the importance of spousal approval in the uptake and choice of contraceptives to both couples in that most men opposed contraceptive use depicting a low uptake for those that discussed (Okech et al., 2011).

5.4 Facility related factors associated with FP Uptake

Findings revealed that most mothers’ privacy during examination and family planning sessions by the health workers is taken into account and that they credit the health center for that (33.8%). Regarding the availability of health workers, most of the participants (68.9%) revealed that the health workers were always available on the clinic days to attend to them and that they were enough. The general sanitation of the health centre was fair as reported by most of the respondents (37.9%).

As indicated in table 9, logistic regression model revealed that only health worker availability was significant predictors of FP uptake among the study participants (p<0.05) in that the chances of taking up FP services increased with the availability of service providers at the facility. The finding shows a significant association of worker availability with FP uptake probably due to clients receiving education on contraceptives from the health workers. This finding is similar to that of Okech et al. (2011) which stress that the association of service providers presence at the facility has a positive impact on the usage and choice of contraceptives and this again confirms the study of Abdulai (2015) in Tamale Metropolis.

Again, women who were discouraged by the service provider’s attitude (p=0.008) and fear of side effects (p=0.001) were less likely to use contraceptives.

Women who highlighted to the following statements of using contraceptives: ‘ even if my husband does not approve it’, ‘the service provider educates me on contraceptives usage and its available choices, ‘ but side effects of my family planning method do discourage me from using contraceptive ’. The involvement of health workers in providing information on FP is critical in the provision of informed choice for a modern method.

CHAPTER SIX: CONCLUSION AND RECOMMENDATION

6.1 Introduction

This chapter gives a summary of the major findings as discussed in chapter 5. It also includes the researcher’s recommendations based on the study findings

6.2 Conclusion

This research study sought to determine factors influencing family planning uptake among women aged (18-49years) in Moyo sub- County, Moyo district.

In this study, the number of questionnaires administered amounted to 290 out of which all of them were successfully completed and returned making the response rate of 100%. The target population for undertaking this study was community based.

6.2.1 Prevalence of home deliveries in Moyo Subcounty.

Results from this study show low prevalence in the uptake of family planning with only 102 (35.2%) using at least one family planning methods. The low prevalence of family planning use could also have been due to the fact that the study was done in a community setting where health education isn’t given so often.

6.2.2 Demographic Factors associated with FP uptake

As indicated in table 2, majority of the respondents were aged ˃30 year (43.6%). Most participants 157 (547.1%) were Christians. The married were the most dominant 196 (67.5%) participants as far as Marital Status was concerned. Majority had attained A’Level and higher 110 (37.9%), most of the respondents 76 (26.2%) were involved in business as their occupation while 66.2% of the study participants were from non-polygamous families.

At multivariate, logistic regression model revealed that age of the baby in months and level of education were the only significant predictors of home delivery among the study participants (p<0.05). Those with children ˂6 months were less likely to take up FP as compared to those with 6-12 months children. The non-educated, primary and secondary level respondents were less likely to take up FP services than those who had attained A’level education.

These results were contrary to a study done on utilization of family planning and associated factors among reproductive age women with disability in Arba Minch Town in Southern Ethiopia which revealed that level of education and the age of the child are not predictors of family planning uptake. The same study also asserts that Age, marital status and religion are significant predictors of Family planning uptake (Mesfin et al., 2019).

6.2.3 Socio-economic and Socio-cultural factors associated with FP uptake

Most respondents were employed in private/public sector (n=120, 41.4%). Many revealed not to have enough income (n=244, 84.2%) compared to those who had enough income (n=46, 15.8%). Highest percentage of respondents get family planning information from media 69.4%). Those who ever discussed family planning with their partners were 66.3% while 33.7% reported never discussed. The husbands/partners who approve the use of family planning were 38.8% while 61.2% did not approve. Most respondents revealed that religion has an influence on FP (73.9%).

At multivariate analysis, none of the variables was found to predict FP uptake though only discussion with the spouse (P=0.000) had some level of association at bivariate analysis (table 6).

This study finding revealed that partners’ approval has some significance in the uptake and choice of contraceptives among the women.

6.2.4 Facility related factors associated with FP Uptake

Findings revealed that most mothers’ privacy during examination and family planning sessions by the health workers is taken into account and that they credit the health center for that (33.8%). Regarding the availability of health workers, most of the participants (68.9%) revealed that the health workers were always available on the clinic days to attend to them and that they were enough. The general sanitation of the health centre was fair as reported by most of the respondents (37.9%). Women who were discouraged by the service provider’s attitude (p=0.008) and fear of side effects (p=0.001) were less likely to use contraceptives.

6.3 Recommendations

Based on the findings from the study some recommendations are

1. Education should be given at the point of service to enable choice of method depending on the type of need for contraception (limiting and spacing)
2. There is need to economically empower women to make them self-sustaining. The results show that contraceptive use rate is low among respondents without adequate income. Social self-help support groups can be empowered through the process of starting businesses, which would put more income in women’s hands.
3. It is important to stress men's shared responsibility and promote their active participation in responsible parenthood and sexual and reproductive behavior, including family planning and other reproductive rights. Men should be continuously involved in family planning education.
4. Integration of FP services in sexual and reproductive health, most especially in child health clinics and immediately after delivery before mothers are discharged is critical in order to improve FP uptake. The MOH should provide a policy framework on provision of postpartum FP services to guide health workers in quality service provision
5. To ensure increased FP uptake strategies should be put in place that promote improved awareness about the available FP services, their possible side effects and benefits among the general population, but especially for women in the reproductive age group.
6. Re-orientation of health providers in FP services is paramount to improve their knowledge and skills as well as motivation for quality and effective service provision, especially given the fact that health facilities and private clinics serve most of the clients’ FP needs/methods.

6.4 Implications for further research

Research should be replicated in a rural set up. Further research also be needed to find out the status of reproductive health of adolescents, premarital sex and knowledge of the risk of early pregnancy relative to unmet need for Family planning.

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APPENDIX

Appendix I: Questionnaire

Questionnaire number

Family planning method currently used

1. What family planning method are you currently using?
a) Natural method
b) Withdrawal method
c) Intra uterine device (IUD)
d) Implant Abbildung in dieser Leseprobe nicht enthalten
e) Injectable Abbildung in dieser Leseprobe nicht enthalten
f) Condom Abbildung in dieser Leseprobe nicht enthalten
g) Tubal ligation Abbildung in dieser Leseprobe nicht enthalten
h) Oral pills Abbildung in dieser Leseprobe nicht enthalten
i) Other (Specify)…

2. What don’t like about them
a) Side effects Abbildung in dieser Leseprobe nicht enthalten
b) workers’ atttitude Abbildung in dieser Leseprobe nicht enthalten
c) Non user friendly Abbildung in dieser Leseprobe nicht enthalten

A. DEMOGRAPHIC CHARACTERISTICS

3. What is your age?.

4. What is your age group?
a) 18-24 years Abbildung in dieser Leseprobe nicht enthalten
b) 25-30 years Abbildung in dieser Leseprobe nicht enthalten
c) 30 above Abbildung in dieser Leseprobe nicht enthalten

5. What level of education have you attained?
a) Completed primary school Abbildung in dieser Leseprobe nicht enthalten
b) Completed secondary school Abbildung in dieser Leseprobe nicht enthalten
c) Completed college/university Abbildung in dieser Leseprobe nicht enthalten

6. What is your marital status?
a) Married Abbildung in dieser Leseprobe nicht enthalten
b) Not married Abbildung in dieser Leseprobe nicht enthalten
c) Separated/divorced Abbildung in dieser Leseprobe nicht enthalten
d) Widowed Abbildung in dieser Leseprobe nicht enthalten

7. How long have you been in your marriage/relationship?

8. How many living children do you have?
a) 1 Abbildung in dieser Leseprobe nicht enthalten
b) 2 Abbildung in dieser Leseprobe nicht enthalten
c) 3 Abbildung in dieser Leseprobe nicht enthalten
d) 4+ Abbildung in dieser Leseprobe nicht enthalten

9. Do you want to have another child?
a) Do not want Abbildung in dieser Leseprobe nicht enthalten
b) Want soon Abbildung in dieser Leseprobe nicht enthalten
c) Want, but wait for more than 2 years from now Abbildung in dieser Leseprobe nicht enthalten

B. SOCIOECONOMIC CHARACTERISTICS

10. What is your employment status?
a) Unemployed Abbildung in dieser Leseprobe nicht enthalten
b) Self employed Abbildung in dieser Leseprobe nicht enthalten
c) Employed in private/public sector Abbildung in dieser Leseprobe nicht enthalten

11. Is your income adequate to meet your basic needs?
a) Enough Abbildung in dieser Leseprobe nicht enthalten
b) Not enough Abbildung in dieser Leseprobe nicht enthalten

12. Do you get family planning on media?
a) Yes Abbildung in dieser Leseprobe nicht enthalten
b) No Abbildung in dieser Leseprobe nicht enthalten

13. How long do you take to get an emergency treatment?
a) < 30 minutes Abbildung in dieser Leseprobe nicht enthalten
b) 30-60 minutes Abbildung in dieser Leseprobe nicht enthalten
c) 60 minutes or more Abbildung in dieser Leseprobe nicht enthalten

C. SOCIAL CULTURAL FACTORS

14. Do you discuss with your husband/partner on number of children to have?
a) Never discussed Abbildung in dieser Leseprobe nicht enthalten
b) Ever discussed Abbildung in dieser Leseprobe nicht enthalten

15. As a woman can you recommend use of family planning?
a) Approve Abbildung in dieser Leseprobe nicht enthalten
b) Disapprove Abbildung in dieser Leseprobe nicht enthalten

16. Does your husband/partner approve family planning use?
a) Yes Abbildung in dieser Leseprobe nicht enthalten
b) No Abbildung in dieser Leseprobe nicht enthalten

17. What is your religious affiliation?
a) Catholic Abbildung in dieser Leseprobe nicht enthalten
b) Protestant Abbildung in dieser Leseprobe nicht enthalten
c) Muslim Abbildung in dieser Leseprobe nicht enthalten
d) Hindu Abbildung in dieser Leseprobe nicht enthalten
e) Others (Specify)

18. Does your religion influence your use/non use of contraceptives?
a) Yes Abbildung in dieser Leseprobe nicht enthalten
b) No Abbildung in dieser Leseprobe nicht enthalten

Abbildung in dieser Leseprobe nicht enthalten

Is there any information that you feel we need to know?

Thank you very much for your participation may God bless you

Appendix II: Key Informant Guide

I am, a student of Lira University pursuing Bachelor of Science in Public health. I am carrying out a study on factors influencing family planning uptake among women aged 18 to 49 in Moyo Sub County. What you will tell me will help in improving on uptake of family planning services. Whatever you will share with me will be handled with confidentiality.

1. What is your opinion about family planning services?
2. What do you think are the reasons for women failing to adopt family planning services?
3. Do u think there are ways women can have better access to FP services? If yes how?
4. Why have you decided to use FP?

Thank you very much for your time, it has been extremely valuable.

Appendix III: informed consent

Factors influencing family planning uptake among women aged 18-49 in Moyo Sub-county, Moyo District.

Introduction

A student from Lira University is carrying out a study on above topic in Moyo sub-county, eastern Uganda

You have been identified to take part in this study.

Purpose of the study: The study aims to assess Factors influencing uptake of family planning services among women aged 18-49 in Moyo Sub- County. I kindly ask for your participation in providing information regarding this subject matter.

Study procedure: If you decide to participate, I will ask you questions regarding your experiences in home deliveries. The interview will last approximately 22 minutes

Voluntary participation/ withdrawal from the study: Your participation in this study is entirely voluntary, and you are free to discontinue the interview at any time. Refusing to participate will not affect your ability to continue receiving the necessary care and treatment for you and the child from this facility.

Potential risks: There is no potentially risky procedure associated with this study. Questions included in this interview do not present any foreseeable risk. Nevertheless, you may choose not to answer any question that makes you uncomfortable

Benefits: The results of this study will be used to make informed decisions and allow for the design and implementations of interventions to improve family planning uptake.

Confidentiality: The information you provide is anonymous and strictly confidential. Your identity and that of the child will not be revealed in any presentation or publications of this study and will not be discussed in any fora. Names shall not be used in this study; I shall assign a registration number to your questionnaire and confidential information will only be used for research purposes.

Compensation: There will be no compensation for participating in the study. All efforts have been made to ensure that the conduct of the study minimizes risks of injury and discomfort to the participants.

Statement of consent

... has described to me what is going to be done, the risks, the benefits involved and my rights as a participant in this study. I understand that my decision to participate in this study will not affect me in any way. In the use of this information, my identity will be concealed. I am aware that I may withdraw at any time. I understand that by signing this form, I do not waive any of my legal rights but merely indicate that I have been informed about the research study in which I am voluntarily agreeing to participate. A copy of this form will be provided to me.

Participant Name…

Signature of participant…Date ...

Interviewer Name….

Signature of interviewerDate….

Appendix IV: Budgets of the study

Table 11: The proposed budget.

Abbildung in dieser Leseprobe nicht enthalten

Appendix V: Work Plan

Abbildung in dieser Leseprobe nicht enthalten

Table 12 : showing work plan.

Frequently Asked Questions About the Family Planning Language Preview

What is the purpose of this document?

This document provides a comprehensive language preview of a study on family planning. It includes the table of contents, objectives, key themes, chapter summaries, and keywords. It is intended for academic use, specifically for analyzing themes in a structured and professional manner.

What are the main chapters covered in the study?

The study is divided into six chapters:

• Chapter One: Introduction
• Chapter Two: Literature Review
• Chapter Three: Methodology
• Chapter Four: Results
• Chapter Five: Discussion
• Chapter Six: Conclusion and Recommendation

What is the main objective of the study?

The main objective is to determine the prevalence and factors that influence the uptake of family planning among women aged 18-49 years in Moyo sub-county, Moyo district.

What specific factors are being investigated in the study?

The study examines various factors including:

• Demographic factors (age, marital status, education, parity)
• Socio-cultural factors (partner’s consent, peer influence, religion)
• Socio-economic factors (income, residence)
• Facility-based factors (trained workers, quality of services)

What is the study's geographical scope?

The study was conducted in Moyo Sub-county, Moyo district, located in the West Nile region of Uganda.

What methodology was used in the study?

The study employed a cross-sectional design using both quantitative and qualitative methods. Data was collected using structured questionnaires and key informant interviews.

What are some of the operational terms defined in the document?

The document defines key terms such as:

• Abortion
• Contraceptives
• Family planning uptake
• Modern FP methods
• Traditional FP methods
• Maternal mortality

What are the main findings of the study related to family planning uptake?

The study revealed a low prevalence of family planning uptake, with only 35.2% of respondents using at least one method. Injectables were the most commonly used method.

What demographic characteristics were associated with family planning uptake in the study?

Multivariate analysis revealed that the age of the baby in months and level of education were significant predictors of family planning uptake.

What socio-economic and socio-cultural factors were found to be associated with family planning uptake?

At the bivariate level, only discussing family planning issues with a spouse was significantly associated with family planning uptake. At multivariate analysis, this was not significant.

What facility-related factors were associated with family planning uptake?

The availability of health workers was found to be significantly associated with family planning uptake. Workers' attitudes and fear of side effects influenced the non-uptake of FP.

What recommendations were made based on the study's findings?

The study recommended:

• Providing education at the point of service.
• Economically empowering women.
• Involving men in family planning education.
• Integrating FP services into other health services.
• Improving awareness of available FP services.
• Re-orienting health providers in FP services.

What are the limitations of the study?

Language barriers and participant refusal to participate were mentioned as study limitations.

What appendices are included in the document?

The appendices include:

• Questionnaire
• Key Informant Guide
• Informed Consent form
• Budgets of the study
• Work Plan