Abstract

Family planning remains a cornerstone of reproductive health, yet significant challenges persist in its utilization, particularly in low-resource settings like Cameroon. Despite global efforts, unmet need for family planning services continues to contribute to unintended pregnancies, unsafe abortions, and maternal mortality, with 57.9% of women of reproductive age worldwide facing barriers to access.

In Cameroon, contraceptive prevalence remains low (19% among married women), exacerbated by cultural resistance, misinformation, and limited male involvement. This study aimed to investigate the challenges faced by men and women (15–49 years) in utilizing family planning services at Cite Verte District Hospital, Yaoundé. Using a hospital-based descriptive cross-sectional design, data were collected from 230 participants via semi-structured questionnaires, employing simple random sampling to ensure representativeness.

The Statistical Package for Social Sciences (SPSS) version 23.0 was used for data analysis, with results presented in frequencies and percentages. Key findings revealed that 53.5% of women lacked adequate family planning knowledge, 44.1% cited cultural/religious barriers, and 48.0% feared side effects, while men’s involvement was hindered by low awareness (73.2%) and societal norms (55.1%). Proposed solutions included education campaigns (80.3%), male-inclusive counseling (78.7%), and affordable services (82.7%).

The study concludes that misinformation, gender dynamics, and systemic gaps limit family planning utilization, recommending targeted sensitization programs, male-friendly services, and policy-level interventions to improve access and equity in reproductive healthcare. These measures could significantly reduce maternal risks and empower individuals to make informed family planning choices.

CHAPTER ONE

INTRODUCTION

• Background of Study

Access to and utilization of family planning services are fundamental to achieving positive reproductive health outcomes for women, their families and communities. The ability of women to make informed choices about their fertility and family size is a crucial aspect of their human rights and empowerment.

Despite global progress in expanding access to contraception and family planning information, significant challenges remain, particularly in underserved communities. The World Health Organization (WHO) defines family planning as “the ability of individuals and couples to anticipate and attain their desired number of children and to space and time their births.”

Effective family planning allows women to delay, space or limit pregnancies contributing to an improved maternal and child health outcome, thereby reducing maternal mortality and decreased rates of unsafe abortions (WHO, 2023). Thomas Obinchemti et al., (2016) identified males also encounter some certain barriers when it comes to FP such as financial constraints, inadequate information on FP methods and the desire for a large family size.

Among 1.9 billion women of reproductive age (15- 49years), an estimated 874 million women use a modern contraceptive method and 92 million, a traditional contraceptive method. Yet, there are still 164 million women who want to delay or avoid pregnancy and are not using any contraceptive method (UN DESA, 2022). While WHO ( 2020) reports that approximately 214 million women of reproductive age in developing countries have unmet needs for modern contraceptive methods which are attributed to socio-economic factors.

Around 69.2% of European women of child bearing age (15-49years) who are married or living with a partner use some form of contraception. Pragyan P et al., (2022) reported in their study carried out in India that there was a good involvement of males in family planning of about (10.9%).

However, this rate is lower in North America and the Latin America region (UNDESA, 2020) According to the Centers for Disease Control and Prevalence (CDC, 2022- 2023), 35.7% of women aged 15-49 in the United States of America received a family planning service in the past 12months. In the United States, women face various challenges in accessing family planning services. In 2021, 18.6% of women reported experienced three to more barriers compared to 16.1% in 2017 (Guttmacher institute, 2022). Specifically, 23.5% received a birth control method. (Guttmacher Institute, 2022)

In Africa, the use of contraceptives remains very low; it went from 23% in 2008 to 24% in 2012 (Kassa k. et al., 2014). Sub-Saharan Africa faces significant challenges in family planning utilization, illustrated by varying contraceptive prevalence rates (CPR) and high unmet needs. Tosin Oni et al., (2024) showed that 54% of the studies measured male involvement through approval for FP, while 46.7% measured it through the attitude of males to FP.

About 31% measured male involvement through input in deciding FP method, while others measured it through inputs in the choice of FP service center (13.6%), attendance at FP clinic/service center (17.8%), and monetary provision for FP services/materials (12.4%). WHO stresses family planning’s role in maternal health, yet Sub-Saharan Africa faces disparities, with Nigeria’s 17% CPR (WHO, 2022) contrasting South Africa’s 65% (DHS).  Niger has one of the lowest CPRs globally, around 13% (UNFPA, 2023), reflecting strong cultural resistance and limited access, while countries like Rwanda have made strides, with CPRs reaching approximately 58% due to focused government initiatives and improved access. Nigeria, with its vast population, presents a complex picture. Its CPR hovers around 17% (WHO, 2022), indicating significant gaps in service delivery and socio-cultural barriers, especially in northern regions. The Democratic Republic of Congo, characterized by conflict and weak infrastructure, shows a CPR of roughly 28% as reported by the UNFPA, 2022 highlighting the impact of instability on reproductive health services.

In Cameroon in particular, the rate of FP intake increased from 16.1% in 1991 to 23.4% in 2011. This low uptake has been due to negative perceptions regarding FP among men and women and also the fact that men believe FP to be the woman responsibility (Adelekan A et al., 2014).

According to the 2018 Demographic and Health Survey (DHS), family planning prevalence in Cameroon shows that approximately 19% of married women aged 15-49 utilize any form of family planning, with roughly 15% employing modern methods and 4% traditional method. Among sexually, unmarried women in the same age group, 43% use a modern method.  In other regions like the north west and south west have a contraceptive use of 19% and 22% respectively (DHS, 2018). CDHS, 2018 shows 18% of married women age 15-49years in yaounde use a modern method of family planning. This rate in urban areas like biyam-assi with a modern contraceptive prevalance of 63.1% as compared to the national coverage (DHS, 2015).

• Problem Statement

Among the 1.9 billion women of reproductive age (15-49years) worldwide in 2021, 1.1 billion which is equivalent to 57.9% of these women have an unmet need for family planning (WHO, 2023) leading to the increasing rates of unsafe abortions and high maternal death rate. In the United States 35% of women aged 15-49years were not using any form of family planning (CDC, 2020). While in Africa, 61.4% of women who wanted to avoid pregnancy were not using any method of contraception (UN, 2020). Thus, ending up with complications such as infertility, infections and even death due to the different traditional herbs they consume without consulting a herbalist.

Recognizing the urgency of this alarming figures, various interventions have been implemented by governments, non-governmental organizations (NGOs), and international agencies. UNFPA (2012) focuses on bringing the family planning information and services closer to the community by distributing condoms, contraceptive pills and training community health workers in counseling (Tessema et al., 2024). Pragyan P et al., (2022) reported in India that there was a good involvement of males in family planning of about 10.9%. Ashford et al., (2008) explored the impact of specific strategies, such as conditional cash transfers to incentivize FP adoption and interventions aimed at increasing male involvement in FP decision-making (Pulerwitz et al., 2000). These initiatives have demonstrated varying degrees of success in specific contexts, often leading to increased awareness and short-term uptake of certain FP methods.

Unfortunately, these initiatives have not been sufficient enough to halt the rising presence of unintended pregnancies and low utilization of modern contraceptive methods. We still experience an increase in maternal death due to unsafe abortions and infections such as STIs. Thomas Obinchemti et al., (2016) identified males also encounter some certain barriers when it comes to FP such as financial constraints, inadequate information on FP methods and the desire for a large family size.

So, this study will investigate the reasons why men and women of reproductive age 15-49years tend to avoid the use of proper family planning services if their reasons maybe related to religion, the fear of the negative effects of these contraceptives like increasing the infertility rate, accessibility, lack of knowledge or if truly there are other reasons which hinder these young females from utilizing family planning services.

• Research Question
  • Main research question

What are the challenges faced by men and women of reproductive age (15-49years) in utilizing family planning services in the Cite Verte District Hospital Yaoundé?

• Specific research question

1. What are the challenges influencing the utilization of family planning services among women of reproductive age in the Cite Verte District Hospital?
2. What barriers hinder men’s involvement in family planning decisions?
3. What are some proposed solutions to improve the utilization of family planning services in the Cite Verte District Hospital?

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