Factors Affecting Uses of Different Family Planning Methods among Women from Different Social Levels at Minia University

Introduction

Family planning (FP) plays a pivotal role in population control, poverty reduction, and human development. FP services have a range of benefits, including maternal and infant survival, better nutrition and prevention of sexually transmittable diseases (STDs), and environmental conservation (1). Good reproductive health implies that people are able to have a satisfying and safe to have the capability to reproduce and the freedom to decide, when, and how often to do so. Men and women should be informed about and have access to safe, effective, affordable, and acceptable methods of family planning of their choice, and the right to appropriate health-care services that enable women to safely go through pregnancy and childbirth (2).

 In Egypt, the latest demographic and health survey (EDHS) in 2008 acknowledged that many Egyptian women are having more births than they consider ideal. Overall, 14 percent of births in five years prior to the survey were reported not wanted among these,5% of births were identified as "mistimed", meaning wanted later; while 9%were unwanted entirely (3).

 There are many factors, which affect women utilization of family planning services. Factors related to contraceptive methods as (safety of the method, effectiveness, availability and the cost of all contraceptive methods); Factors related to the couples using contraceptives includes (demographic and biological factors as age of women, maternal education and husband education, parity, Sociocultural factors, occupational and economic factors, religious factors, legal factors and psychological factors) (4).

 The acceptance of family planning influenced by many socio-cultural and demographic factors at levels of individual, family and society. Among these different factors, education is considered to exert the most profound effect on family planning acceptance and fertility. In other words, education is the most dynamic and influential tool for inducing positive attitude among couples towards the method and measures of family Planning (5) .

The aim of this study was:

Assess factors affecting acceptance and uses of different family planning methods among women from different social levels.

Research Question :

What are the factors affecting acceptance and uses of family planning methods among women from different social levels?

Significance of the study

The low uptake of family planning is largely blamed on many factors. It has been observed that the awareness of the availability of family planning services has a great influence on the uptake of family planning services. (6)

In last decades Egypt had suffered major socioeconomic consequences of overpopulation problem. This resulted from high level of birth rate (7). Every 10 seconds the world population increases by 30 individuals and is likely doubled over the next 40 years. Over population and unplanned population growth impede the socioeconomic development, hinder prosperity, and threatens the health status of community members (8) So this study will be conducted to assess the factors affecting acceptance and uses of family planning methods because take theses factor in consideration and develop family planning program .    

Subjects and Methods

Research Design:

 Descriptive explanatory study was adopted to meet the aim of the study.

Study area and sittings:

The study was carried out at Minia University, Minia governorate, Egypt (28.10 N° and 30.75 E° and the distance from Cairo was 241 km). Sample collected from eight University Faculties and Minia University Hospitals all of this faculties and two university hospitals located in-side Minia University build only Minia university hospital it's in the  south of Minia town.

Sample:

Sample was staff members, employees and workers from eight Minia University Faculties (Nursing - Science - Agriculture - Pharmacy - Arts - Education - Physical education and Dar-ELuloom) and Minia University Hospitals (Renal and Urinary Hospital - Obstetric Gynecological and Child Hospital and Minia University Hospital).

Sample size and sampling procedure:

Sample size calculation was done using (Epi-info status, CDC, 2000) program take on consideration prevalence of family planning use of purposive sample technique of 488 women in reproductive age are included in this study 20% of the total number in every setting participated in this study. Inclusion Criteria: All married women in reproductive age range (15-49 years) in chosen organizations. Exclusion Criteria: not married women; newly married women; unwilling to participate in the study; women who were sterile or had sterile husbands; and too sick to be given consent or to be interviewed.

Tool and technique of data collection:

Tools developed by researcher after extensive review of literature and it was structured from in-depth interviewing questionnaire which was developed & translated into

Arabic language and was consisted of the following parts:-

• Part I: Personal, socio-demographic data, obstetrical and medical history: such as (age, sex, address, social level, occupation etc.);
• Part II: Includes assessment acceptance level about family planning services such as (From where you get your method? Does the provider in the family planning  clinic treated professionally with you?, What is your acceptance level about services? There are medical centers or health unit offering family planning services in the vicinity of where you live? etc..) 
• Part III: it includes knowledge about used family planning method: such as (type of method e, how to choose the method, where get the method, etc.)
• Part IV: It includes knowledge about other different family planning methods: such as (do you hear about emergency contraceptive before? do you know about the effect of some method on the vascular system? etc.).

Validity and reliability:

Validity is the accuracy and meaningfulness of inferences, which are based on the research results. Tool tested for content validity by a Jury of three experts in the field of the study who reviewed the instruments for clarity, relevance, comprehensiveness understanding, applicability and easiness for administrative minor modifications and necessary modifications were done.

 Also, tool was tested for internal reliability (reliability referred to the consistency of measurement and was frequently assessed using the test-retest reliability method). To achieve reliability of the questionnaire, the instrument was designed with great care matching questions with objectives for the study it was found (87.3) respectively. 

Ethical Considerations:

• Approval was sought from the Provincial and District ethical committee before undertaking the research.
• The purpose of the study was explained to all participants.
• The participant had ethical rights to agree or refuse to participate in the study.
• Written consent was obtained from every participant.
• Every participant was informed that the information and data obtained was confidential and used only for the purpose of the study.  

Study procedure:

An official letter of the study approval was obtained from the Dean of the Faculty of Nursing at Minia University to Head Manager of Minia University, then to the chairmen of the previously mentioned setting. This letter included a brief explanation of the aim of the study and permission was requested from each chairman to carry out the study. Written consent was obtained from the participants before being involved in the study after explanation of the nature of the study, its benefits and there are no risks or cost in participation, and there are voluntary participation and confidentiality of each subject who agree to participate to fill the questionnaire. Data was collected two days per week, at official work time. Data were collected within 5 months from May   to October 2016, two days/week at official work time from 8 Am: 12 pm. The researcher met the participants and they were interviewed in their work place at times that were convenient for them. The time spent to fill the questionnaire ranged between 20 to 30 minutes according to the needed explanation. Measures were taken to protect ethical rights of participants

Statistical Design:

Data entry was done using the compatible personal computer by the researcher. The statistical analysis was done using Spss17 statistical software package and excel, 2007 for figures. The content of each tool was analyzed, categorized by the researcher. Data were presented using descriptive statistics in the form of frequencies and percentages for qualitative variables and was presented in the form of mean ± SD for quantitative data. Quantitative continuous data were compared using student T-test in case of comparisons between two groups. For multiple groups, F-test or (ANOVA) was used. Pearson correlation analysis was used for assessment of the inter-relationships among quantitative variables. Multiple regression analysis was used to determining the significance of factors affecting using FP methods. Statistical significance was considered at p. value < 0.05. Pvalue was considered to be significant if less than 0.05, high significance if less than 0.01, or insignificant if more than 0.05.

Results

  .Table  (1): socio-demographic data of all participants

Socio-demographic characteristics are shown in the table (1). The age of the participants ranged from 21 – 48 years with a mean of 33.2 years, (30.3%)  participants of them were staff members, (58.2%) were employees and (11.5%)   of them were workers. 

Table (2): Assessment of acceptance level about family Planning services.

 Table (2) presents the results of the assessment of acceptance level about family planning services. study participants, 90.4% used family planning methods and the rest of them (9.6%) did not use family planning methods (59.0%) of them      got family planning methods from governmental organizations and (31.4%) deliver it from private clinics. (60.8%) of cases had medical centers or health unit offering family planning services in the vicinity of where they live. (49.0%) said that the provider in the place treated well with them, but (58.7%) were not satisfied that there was an appropriate place for waiting in the place

. 

Table (3): Data about the knowledge of other family planning methods.

Also, high percent   of them (88.3%) did not know the effect of contraceptive methods on your eyes or blood vessels and clots, however, (91.6%) of them did not know what is tubal ligation and did not know the Islamic view in this process. 

Table (4):  Factors affecting acceptance and uses of family planning methods

*Significant (p<0.05).          **Significant (p<0.01). NS Not significant

Results of the table (4) showed that relation between participants who used FP methods and who did not use in demographic data. Participants who did use FP methods had significantly lower age than those who do not use family planning methods and significantly higher educational level among participant and significant difference between participants who have high educational level and who have lower educational level Table (4) revealed that there were no significant differences between participants who used FP methods and who did not use in obstetric history.