CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

According to WHO, family planning is defined as the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. (NCBI, 2019). Contraceptive effect can be obtained temporarily through man made means such as pills, IUDs, condoms and diaphragms and obtain permanently through sterilization (vasectomy and tubal occlusion).

Family planning is now a necessity in every society and Cameroon is not an exception. Relation to an increase in worlds total population having an adverse effect on the world economy; family planning serves as a means of birth control. Family planning allows individuals and couples to anticipate and attain their desired number of children while helping them to space and limits births. It is achieved using contraceptive methods (Njotang et al., 2017).

Globally, the number of women of reproductive age (aged 15-49 years) rose from 1.3 billion in 1990 to 1.9 billion in 2021, an increase of 46 per cent (United Nations, 2022). There was an even larger increase in the number of women of reproductive age who have a need for family planning that is, they are married or in a union, or are unmarried and sexually active, they are fecund and they intend to delay or avoid childbearing.

Specifically, the number of women with a need for family planning rose from 0.7 billion in 1990 to 1.1 billion in 2021, an increase of 62 per cent. This need is increasingly satisfied by the use of modern contraceptive methods. At the same time, total fertility declined globally from 3.3 births per woman in 1990 to 2.3 births per woman in 2021 (United Nations, 2022). On average, women today live longer periods of their reproductive lives wanting to delay or avoid childbearing.

A recent report on the topic of family planning analyzed trends in contraceptive use and their relationship to fertility trends (United Nations, 2020). The report showed that there is generally an inverse relationship between fertility and contraceptive use within countries, but that the relationship between the two can vary depending on the mix of contraceptive methods women use, the incidence of abortion, patterns of marriage and sexual activity, as well as various economic and social influences.

Another recent report reviewed the progress towards the achievement of target 3.7. with special attention to the increase in the numbers of women of reproductive age in low and lower-middle-income countries that will require expansion of sexual and reproductive health services, including family planning (United Nations, 2020).

In Africa, thirteen countries, mostly in Sub Saharan Africa, reports fairly low rates of birth control use among married women ages 15˗49. There was a low prevalence (22.2%) of use of modern contraceptives across 37 countries used in Sub˗Saharan Africa. This showed a considerable variation from as low as 3.5% in the Central Africa Republic to 49.7% in Namibia.

The most common type use of contraceptives were injections (39.4%), condoms (17.5%) and implants (26.5%). Muslim majority countries in Sub Saharan Africa have lower rates of birth control and higher fertility rates and reports fairly low rates of birth control use amongst married women It is clear that efforts are needed to improve access to and uptake of modern contraceptives in SSA.

However, little research has investigated personal and socio demographic factors associated with contraceptive use. (Ferdousi, 2020) identified fear of side effects as a major reason for not using contraceptives followed by religious reasons and husbands and family disapproval. This is because Islam is conventionally deemed as a religion with doctrines that encourage relatively large family, thus permitting plurality spouses and considering some forms of contraception as forbidden (Ilyas, 2019).

In Cameroon, the rate of voluntary induced abortions remains very high and varies from urban to rural zones. In a cross sectional survey in Cameroon (2011), the rate of voluntary induced abortions in Yaoundé (Urban) was 25.6% against 27.1% in rural setting (Wum District Hospital). Increasing the use of modern contraception in Cameroon will go a long way to reduce the already high rates of voluntary induced abortions and their complications.

Contraceptive methods readily available in Cameroon and more precisely in the North West Region include: implants, intra-uterine device (IUD), combined oral contraceptives (COC), hormonal injectable methods, and condoms. In 2011, the rate of use of these methods among women of child-bearing age in rural Cameroon was as follows: Condoms (3.6%); injectables (2.5%); oral pills (1.3%), implants (0.5%) and IUD (0.2%).

IUDs, implants, oral pills and injectables are most often obtained from both private and public health facilities while condoms are easily gotten from shops and road side hawkers. Family Planning services are offered by trained nurses integrated into the prenatal and postnatal packages in some facilities while in some cases, hospitals create special family planning units for the delivery of these services.

Findings from the 2011 national Demographic and Health Survey (DHS) in Cameroon state that only 16% of women of childbearing age were using a modern contraceptive method. There was a significant difference between the urban and rural zones (6% rural against 21% urban) and 17% had an unmet need for family planning (22% urban against 24% rural). The rate of modern contraceptive use was 20.9% in the Northwest Region of Cameroon with a 17.7% prevalence of unmet need for family planning.

The potential demand for contraception (the proportion of women who had characteristics indicating that they were potentially in need of contraception) in the Northwest Region was at 55.8% with only 68.3% of this demand met as of 2011 (the percentage of women with a potential demand of contraception who were actually using contraception). There was a significant difference between the potential demand for family planning services in urban and rural Cameroon (56.1% urban against 38.7% rural). (Esambe .E. Emmanuel et al., 2018).

1.2. Problem Statement

Family planning service is one of the most common challenges face by postpartum women in Cameroon which is posting a global problem to the public health sector. Every year about 65% of Cameroonian postpartum women suffer from unwanted pregnancy, unsafe abortion, poor maternal and infant health, due to poor knowledge on the use of contraceptive and family planning service.

Absent of early sensitization on the use of contraceptive to postpartum women and family planning service uptake cause the effects to become chronic. Some women turn to give birth more especially at a very young age with very short birth intervals. Despite the increasing trends in contraceptive utilization, the prevalence of short birth intervals has remained unchanged within some Muslims and Catholic Christians. Age, religion, education, wealth status, the sex of the indexed child and the ideal number of children were found to be significantly associated with short birth intervals. (Ghosh S and Chattopadhyay 2017).

From a personal point of view, according to some cultures and religions, the use of contraception is considered a taboo or forbidden. From a personal point of view, most who found family planning as a taboo to their faith reported that their responsibility is to give birth to as many children as God would give them.

Some Muslim and Christians think that it is forbidden not to give birth to as many children as possible because God made and sent them into the world to multiple and not limit.  become a channel for women’s sexual promiscuity and it might initiate sexual relationships if they receive knowledge about family planning or use them because it’ll lead as a sexual motivation hence destroy sexual modesty as the inclusion of ethical and religious modalities of sexual behaviors. (Azam Rahmani et al., 2017).

The high rate of unplanned pregnancies caused multiple challenges for women and their families. The lack of knowledge can limit efforts to obtain contraception and continue using it, thereby increasing the risk of unintended pregnancies and abortions. Unintended pregnancies, maternal and child mortality, induced abortions as well as sexually transmitted diseases like, HIV, and Syphilis are all reduced when people practice family planning.

Despite several modern contraceptives being available, the problem of unwanted births persists, which may be attributed to a lack of information and misunderstanding of contraception. (Bongaarts and Sinding 2009).

1.3 Research Objectives

1.3.1. Main Objective

Assessing the knowledge and Practices of postpartum women towards family planning methods at the Buea regional hospital.

1.3.2. Specific Objectives 

1. To assess the knowledge of postpartum women on family planning in the Buea regional hospital.
2. To evaluate contraceptive practice carried out by postpartum women on family planning in the Buea regional hospital.
3. To identify the challenges faced by postpartum women on the practices of family planning in the Buea regional hospital.

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