ABSTRACT

This study investigated the factors contributing to the use of modern contraceptives among women of childbearing age in Sandpit Community, Buea, Cameroon. A cross-sectional descriptive design was employed, with data collected from 200 women aged 15–49 years using a structured questionnaire.

The study assessed knowledge, attitudes, and barriers associated with contraceptive use. Findings revealed high awareness (97%) of modern contraceptives, but deeper understanding was limited, with misconceptions such as associating contraceptives with wealth or complete birth cessation.

Injectable methods were the most recognized (35%), while comprehensive knowledge of multiple methods remained low (10%). Attitudes were mixed: 50% agreed contraceptives effectively prevent pregnancy, but 52% expressed uncertainty about their safety, and 60% believed contraceptives promote promiscuity. Key barriers included partner disapproval (37%), fear of side effects (35%), and cost (28%).

The study highlights the need for targeted education to dispel myths, improve contraceptive literacy, and address cultural and partner-related barriers. Recommendations include strengthening healthcare counseling, involving men in family planning discussions, and subsidizing contraceptives to enhance accessibility. Addressing these challenges can improve contraceptive uptake and reduce maternal health risks in the community.

Keywords: Modern contraceptives, family planning, maternal health, knowledge, attitudes, barriers

CHAPTER ONE

INTRODCTION

1.1 BACKGROUND

Family planning allows individuals and couples to anticipate and attain their desired number of children while helping them to space and limit births. It is achieved through the use of contraceptive methods ( Vlassoff M., et al 2014).

A woman’s ability to space her pregnancies has a direct impact on her health and wellbeing as well as on the outcome of pregnancy. The use of modern contraceptive methods is one of the cornerstones in the fight against maternal, infant and neonatal morbi-mortality. It reduces the need for abortion, especially unsafe abortion ( International Federation of gynaecology and obstetrics 2014).

Though Africa hosts only 12% of the world’s population, 99% of maternal deaths in the World are registered in Africa ( Vooking MZ., et al 2014). In the 21st century, family planning is considered an essential intervention for significant improvement of maternal and child health. As a result, ensuring universal coverage and utilization of modern contraceptives can help meet the Sustainable Development Goal (SDG) target of reducing maternal and neonatal morbidity and mortality.Furthermore, unwanted pregnancy, unsafe abortion-related social, mental and obstetric complications and maternal mortality can be averted through effective utilization of modern contraceptives.

Also, modern contraceptives have individual benefits such as preventing unwanted pregnancy and its related emotional, financial and social problems such as discrimination by friends, family and the community.They also empower women by allowing continued education and the opportunity to work, positively contributing to societal and national development through increased women’s participation in the labour market and optimization of limited resources due to reduced population growth.9,10

Globally, of the 1.1 billion women who needed family planning in 2019, 842 million used contraceptive methods, while the remaining 270 million had unmet needs. Worldwide, 75% of women are satisfied with their family planning needs, however, coverage is <50% in Central and West Africa.

Although Cameroon has ratified the Family Planning 2020 (FP2020) initiative and committed to meeting the SDG target to reduce maternal and neonatal mortality through improved utilization of modern contraceptives, national family planning coverage remains extremely low.For example, according to the 2018 Cameroon Demographic and Health Survey (CDHS), the use of modern contraceptive methods among married women was <15%, although it was higher among sexually active non-married women, at 43%.11 In Cameroon, an increase in the utilization of modern contraceptive methods has not been satisfactory, from 4% to 15% from 1991 to 2018.Recently a community-based study in the northwest region estimated a modern contraceptive utilization rate of 13%.

Several scholars in African countries have shown that modern contraceptive use is linked to socio-economic conditions, women’s empowerment, partner support and geographic-related factors. The fact that few studies are available in Cameroon on modern contraceptive methods and continued poor uptake, motivated us to investigate wide-ranging predictors for modern contraceptive use in the country, using nationally representative data and a robust methodological approach.

In Cameroon, the rate of maternal mortality is very high, with a good proportion attributed to unsafe abortion (Mosoko A., et al 2004,  Ekana Geh., et al 2014, Tabeu PM., et al 2007, Schuster S 2005). A majority of abortions in Cameroon are induced; most resulting from unplanned pregnancies ( IFGO 2014). In 2013, an estimated 40% of pregnancies in Cameroon were unintended ( IFGO 2014). Cameroon therefore is called to step-up the use of modern contraception in order to take control of this rising family health threat.

The results of recent demographic and health surveys show that the rate of use of modern contraception among women in a union has gradually risen in Cameroon from 1991 to 2011 (National institute of statistics 2012). Despite this increase, the rate has slightly dropped in Yaoundé and Douala between 2004 and 2011 ( National institute of statistics 2012)The consequence of not using contraception is very heavy on Cameroon. In fact, it was documented in 2013 that Cameroon can save about 2.7 billion XAF every year by providing half of the contraception needs in the country meanwhile about 6000 women die every year in Cameroon due to pregnancy and child bearing because of a lack of access to modern services of family planning (Vlassoff M., et al 2014)

It is now clear that increasing contraceptive use in Cameroon requires an insight of the determinants of use and non-use of contraception. This can permit the redesigning of existing interventions and designing of new ones to better tackle this component of family planning before it slips up. The use of modern contraceptive methods can be influenced by many factors which can be grouped into factors related to the health system and factors related to the woman and her environments (Delac K., et al 2011,  Fusi-Ngwa CK., et al 2013,  Nkwabong E., et al 2014,  Elie N., et al 2014,  Mah mungyeh E., et al 2014,  Egede JO., et al 2015). This paper attempts to identify barriers to the modern contraceptive use in the Biyem-Assi Health district in Cameroon by looking critically at factors related to the woman and her environments.

1.2 PROBLEM STATEMENT

Family planning is the ability of individuals and couples to anticipate and attained their desired number of children with the spacing and timing of their births which is achieved through use of contraceptive methods (WHO, 2015).

It is important because it helps couples to avoid unintended pregnancies, reduce the spread of sexually transmitted diseases, increase standard of living, reducing rate of infertility and equally preventing maternal and infant morbidity and mortality. In Africa the research carried out in 2000 showed that 36% of women were using a modern contraceptive and those were predominantly urban women using pills and injectable while those in the rural are (Montez et al., 2011) which led to a high rate of infant and maternal mortality and morbidity because of child bearing age endure frequent pregnancy throughout their reproductive lifespan.

In Cameroon, the prevalence of unintended pregnancies is 27.8% (Ameyaw et al., 2019) and the rate of maternal mortality, with a good proportion attributed to unsafe abortion (Ekena et al., 2013) is high approximately hundreds of thousands of women who want no more children do not currently practice family planning because of it contrary side effects like weight gain, irregular bleeding, breast tenderness and decrease sexual desire (Gaveme et al., 2014).

The prevalence of unmet needs ranges from 15-58% (Wullfan et al., 2016). The consequences of inadequate family planning services will lead to voluntary induced abortions, unintended pregnancy, high infant and maternal mortality and morbidity rate, increased rate of poverty, low standard of living among families, malnourished children, and low birth rate.

As a midwifery student living in sandpit community, it was noticed that a lot of couples transfer aggressions on their spouse and children using phrases such as “if not of you I would have gone far in life”. During my stay in sandpit community, it was observed that most couples refused to take Contraceptives when being mentioned and their refusal was due to inadequate knowledge on on this as some of them said ” My friend told me that family planning leads to excessive bleeding”, ” I heard that family planning leads to excessive weight gain” while others complained ” some women died because of family planning”.

1.3 RATIONAL

As a Midwifery student living in sandpit community, I noticed that a lot of people transfer aggressions on their spouse and children using phrases like ” if not of you I would have gone far in life ” , some women go as far as taking family planning on their own without consulting their spouses and when noticed it led to constant violence by the spouse which in some case led to divorce.

More over, Sandpit community which is one of the oldest quarters in Buea has various factors influencing their beliefs such as religious beliefs (Catholics), cultural beliefs, fear of side effects are potentials which have greater impact on the acceptance and use of Contraceptives by individual and couples there by the need to investigate factors contributing to the use of Contraceptives as it will go a long way to improve on their knowledge, reduce unintended pregnancies, maternal and infant mortality and morbidity in this community.

1.4 RESEARCH QUESTIONS

1. Knowledge of women of child bearing age on modern contraceptives in Sandpit community?
2. What attitude do women of child bearing age possess towards modern Contraceptives in sandpit community?
3. Factors associated with the use of modern Contraceptives among women of child bearing age in the Sandpit community

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