family planning thesis statement

• Open access
• Published: 04 April 2022

Factors affecting family planning literacy among women of childbearing age in the rural Lake zone, Tanzania

• Mohamed Kassim 1 &
• Faraja Ndumbaro  

BMC Public Health volume  22 , Article number:  646 ( 2022 ) Cite this article

27k Accesses

5 Citations

1 Altmetric

Metrics details

A Correction to this article was published on 02 May 2022

This article has been updated

Low uptake of various recommended modern family planning methods is associated with inadequate family planning literacy among potential beneficiaries of the methods. As such, understanding factors affecting family planning literacy is key to addressing this problem. This study, therefore, explored factors affecting family planning literacy among women of childbearing age in the rural Lake Zone of Tanzania.

The study utilized an exploratory descriptive qualitative research approach using focus group discussions to collect data. A total of eight focus group discussion sessions were held to solicit information from childbearing age women involved in the study. Thematic analysis was used to analyze the data collected from the study participants.

Several factors were found to negatively affect the family planning literacy of women of childbearing age in the communities under review. These factors were low levels of education, religious affiliation, and low family income. Other factors that were also found to negatively affect women’s family planning literacy include fertility preference, negative perceptions of family planning, preference of unproven family planning methods, limited access to reliable sources of family planning information, household responsibilities, and poor male partner support on family planning matters.

This study has identified a multitude of factors affecting the family planning literacy of women of childbearing age. These factors can limit the women’s capacity to make informed decisions on the utilization of modern family planning methods. Thus, addressing these factors is pivotal in increasing the women’s overall uptake of various recommended family planning methods and enhancing their reproductive health outcomes.

Peer Review reports

Family planning is essential in helping women and their male partners to decide freely on whether to have children, how many to have, and when to do so [ 1 , 2 ]. It improves both maternal and child health, reduces the prevalence of unwanted pregnancies and unsafe abortions, prevents sexually transmitted infections, and enhances economic well-being of families [ 3 , 4 , 5 ]. In fact, family planning also promotes women’s sense of autonomy and their ability to make health decisions [ 6 ]. As a result, the United Nations (UN) has prioritized it to increase and sustain the utilization of family planning because of its importance in the attainment of sustainable development goals. In particular, emphasis has been put on universal access to a full range of safe and reliable family planning methods to help couples realize their rights to freely and responsibly decide the number and spacing of their children [ 2 , 7 ].

According to the World Health Organization (WHO), almost 60% of women of childbearing age use using family planning globally [ 8 ]. Even though evidence shows a global increase in the use of family planning, especially in Asia (62%) and Latin America (67%), sub-Saharan Africa, Tanzania inclusive, paints a different picture as there is average of less than 20% month use of family planning [ 9 ]. Furthermore, less than 30% of women of childbearing age in sub-Saharan Africa are use family planning [ 8 ] with more than 200 million women wishing to prevent unwanted pregnancies yet not using these services [ 10 ].

Tanzania has witnessed a notable increase in the utilization of modern family planning methods among women from 7% in 1991 to more than 30% in 2015 [ 11 , 12 , 13 ]. Despite such growth, more than 20% of various forms of family planning needs among women of childbearing age are unmet in the country [ 14 ]. There is also a high rate of contraceptive discontinuation among women [ 15 ]. Furthermore, there is a large geographical variation in access to and use of family planning methods in the country with some regions having considerably lower usage than the national average [ 16 ].

Persistently low uptake of family planning has been evident more in the Lake zone of Tanzania (15%) than in any other part of the country [ 11 , 12 , 17 ]. This zone also has a high (33%) of unmet need for family planning compared to the rest of the country as many women in need of such services fail to access them [ 11 , 17 ]. Such women remain susceptible to various reproductive health and socioeconomic problems. Evidence shows that the low uptake of family planning has contributed to high fertility rates [ 18 ], which is as one of the risk factors for maternal morbidity and mortality [ 19 ]. Women and their families are likely to face financial burdens resulting from costs of health services, as a result [ 4 , 18 ].

Low uptake of family planning services in most sub-Saharan countries, Tanzania included, is associated with inadequacy health literacy among women of childbearing age [ 6 , 20 , 21 , 22 ]. Health literacy refers to the degree to which people have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions [ 23 , 24 ]. This concept is one of the most significant social determinants of health [ 25 , 26 , 27 ] and is, thus, essential in changing people’s attitudes towards accepting and taking various recommended family planning methods.

Evidence in literature shows that people with inadequate health literacy tend to be less knowledgeable of their health conditions, less likely to use preventive health care services, and more likely to be hospitalized [ 28 ]. Such individuals can also be easily misguided by incorrect sources of health information [ 29 ]. In the context of family planning, inadequate family planning literacy is reported to contribute to poor acceptance, wrong use, and low uptake of various recommended family planning methods [ 20 , 21 , 22 , 30 ].

Inadequate health literacy, as reported in previous studies [ 31 , 32 , 33 ], is more prevalent among people in rural areas than those in urban ones. This appears to explain the reported low uptake of recommended family planning methods by most people in rural areas [ 15 , 18 , 22 , 34 , 35 ]. Research shows that, unlike their urban counterparts, women residing in rural areas are likely to be affected by all types of unmet needs for family planning services [ 22 , 35 ]. Women in these areas are likely to identify inadequate health literacy as the main barrier to their uptake of recommended family planning methods [ 22 ].

Exploring factors affecting the family planning literacy of women residing in rural areas is crucial in addressing the problem of low uptake of various family planning methods among women of childbearing age in these areas. This study, therefore, explored the perspectives of women of childbearing age residing in rural Lake Zone, in Tanzania, on factors affecting their family planning literacy.

This study employed an exploratory descriptive qualitative research approach to explore factors affecting the family planning literacy of women of childbearing age in rural Lake Zone of Tanzania. This zone comprises six regions namely Mwanza, Geita, Shinyanga, Mara, Simiyu, and Kagera. The zone has a comparatively lower (15%) uptake of family planning than the rest of the country [ 11 , 12 , 17 ]. From the six regions of the zone, four (Shinyanga, Simiyu, Mara, and Kagera) were purposively selected for the study. Many women living in the rural areas of these regions face problems associated with access to healthcare [ 13 ], hence their selection. From each of these regions, one district (Shinyanga Rural in Shinyanga, Bariadi in Simiyu, Musoma rural in Mara, and Bukoba rural in Kagera) was purposively selected for the study. These districts are mainly rural, a characteristic of interest in this study. Subsequently, one ward (Iselamagazi in Shinyanga rural, Dutwa in Bariadi, Kemondo in Bukoba rural, and Mugango in Musoma rural) was selected from each of the four study districts. These wards serve as administrative headquarters of the districts under review and, thus, contain a heterogeneous population in terms of education levels, occupation, and religious affiliation.

The study targeted women of childbearing age residing in the selected wards. Purposive sampling was used to select respondents for inclusion in the study. Woman aged between 15 to 49 years, living in rural areas, and capable of expressing themselves concerning the topic in question were included in the study. Local community health workers (CHWs) from the respective villages helped to identify potential households from which individuals meeting the set inclusion criteria were picked. The CHWs also helped to identify potential study participants in the selected households and establish trust between the researchers and study participants.

Data from the study participants were mainly collected using focus group discussions (FGDs) based on a guide initially developed in English and translated into Kiswahili for easy comprehension among the participants. The guide consisted of open-ended questions on participants’ perspectives concerning factors affecting their family planning literacy. In all, 8 FGDs sessions involving a total of 72 participants were held in the selected wards of the four study districts. The number of participants in each group ranged from 8 to 10. In each ward, a stratified sampling technique was used to group studied women in three strata based on levels of education, differences in age, and distance to health facilities. These are essential variables in assessment of health information literacy. The strata were used at the sampling stage to ensure that each group accommodate heterogeneous nature of the sub population. Meaning saturation [ 36 , 37 ] was a criterion for reaching the study’s sample size as more FGDs were needed to understand factors affecting women’s family planning literacy. Prior to the commencement of the FGDs sessions, researchers presented to the participants the motive of the study and core objectives of the sessions. Also, researchers together with participants set ground rules for discussions including effective participation, speak one at a time, and respect for other people’s opinions. All 8 FGD sessions were conducted by the researchers. Each session lasted between 60 and 90 min. To ease participants’ attendance, the discussions were held at places of their convenience.

Measures such as identification and formulation of the research problem, selection of study participants, and accuracy in data collection, analysis, and interpretation helped to ensure trustworthiness of the study findings. Audio recordings and field notes captured all the discussions during data collections. These recordings then underwent verbatim transcription in Kiswahili, the language of researchers with participants, before being translated into English and reviewed by the researchers. After the review, the transcripts were imported, coded, and analyzed thematically using NVivo software (QSR version 12). Themes generated from the narratives of the FGDs were then organized to group similar ones from the transcriptions into a cluster. The themes are socio-demographic factors, fertility preferences, negative perceptions, and misinformation on family planning, use of unproven methods of family planning, limited access to reliable sources of family planning information, household responsibilities, and men’s involvement in family planning.

Ethical considerations

Ethical clearance certificate with reference number NIMR.HQ/R.8a/Vol. IX/3185 was obtained from the National Health Research Ethics Review Committee (NHRERC) of the Tanzania National Institute for Medical Research (NIMR). Permission to conduct the study was also sought from the local authorities in the four selected regions. Written informed consent was obtained from the participants who were able to read while verbal informed consent wa obtained from the participants who could not write. Informed consent for minors (those aged below 18 years), was obtained from their parents/guardians. In addition to this, the minors were fully informed about the study and made aware that they were free to decide to participate on not. The consent process was approved by the ethics review committee (NHRERC). All the study participants were assured that their participation would be kept anonymous throughout the study.

A total 72 women of childbearing age from rural areas of the four selected regions participated in the FGDs. The ensuing discussions revealed several factors that affected family planning literacy of the study participants. These factors have been grouped into seven themes as described in sections that follow:

Socio-demographic factors

Three socio-demographic factors namely education, household economic status, and religious beliefs were found to affect the family planning literacy of women of childbearing age in this study.

There were mixed feelings from study participants about how education affects their family planning literacy. On the one hand, many women that took part in the FGDs attributed their inadequate family planning literacy to low levels of education among them and their male partners. The women argued that their low levels of education made it is difficult for them to comprehend family planning information from diverse sources. As a result, many of them failed to utilize available family planning services. Some women mentioned facing difficulties following the calendar method to prevent unintended pregnancies:

… sometimes we are told to use a calendar as one of the family planning methods. However, this method might be good for those with adequate levels of literacy as it might be easier for them to follow their calendars. The problem is that it is difficult, especially for us who have not gone to school, to apply such a method as most of us do not know how to follow such a calendar (FGD 2, Musoma).

On the other hand, other women, particularly literate ones, who had at least primary education, argued that education enabled them to know various family planning methods. The women reported that reading enabled them to follow family planning messages from different sources including those in print format. As a result, these women were interested in finding more information on various family planning methods before deciding on whether to use any one of them or not:

Many educated and more informed people are using family planning to control the number of children they want to have. Thus, you may find them interested in finding information on different forms of family planning (FGD 2 – Shinyanga rural).

Household economic status

The family’s economic status emerged as one of the determinants of women’s family planning literacy. Firstly, discussion participants reported that economic hardships a family with many children faces made it difficult for them to take care of all the children. Such hardships compelled women to consider using family planning to reduce the number of unintended pregnancies and have manageable family sizes. Thus, gathering information on family planning from different sources becomes crucial:

Our incomes very small, but we have numerous children to take care of. So, we thought that now is the right time to start family planning. That is why we have started gathering information on it (FGD 1 – Bukoba).

Study participants also linked household economic status to their families’ ability to own radio and television for getting family planning-related information. These women reported that their poor economic status made many of them unable to afford a radio or television set. As a result, they failed to follow family planning information disseminated via these sources:

We know that we can also get such information from the radio or television. However, we do not have any of them. We cannot just go to other people’s homes to listen to their radio or watch television just for family planning information . It is a disgrace (FGD 2 – Bariadi).

Religious beliefs

Religious beliefs were also found to affect women’s family planning literacy. In this regard, study participants reported that some religions discouraged them to use family planning because doing so prevented eggs fertilization by the sperm thus preventing pregnancy. This, according to them, is against God’s will for people to fill the earth. Family planning thus constitutes interfering with God’s plan:

Our religion does not allow us to use any form of family planning. Using it is like killing your eggs and your unborn child. That is why you will never hear any Imam or Sheikh in the mosque preaching to his followers about using family planning. That is why many people are not even interested in finding information on it (FGD 1 – Bukoba).

Our religious leaders discourage us from using family planning. They tell us that our religion [Roman Catholicism] prohibits the usage of such services [contraceptive]. They want us to continue giving birth because that is what we have been created for…giving birth (FGD 2 – Musoma).

This situation, as recounted by the women, discourages them and their male partners from seeking any family planning-related information and, as a result, their family planning literacy remains low. In consequence, some women and their partners do not use any kind of recommended modern family planning methods.

Fertility preference

There were also contrasting views among study participants on the role of fertility preference in their family planning literacy. Some of the study participants indicated that there is a relationship between desire to have large a family and inadequate family planning literacy. Such desire is linked to preference of some family members, particularly male partners, and the community to have many children. FGD participants reported that such a factor influenced women and their male partners to ignoring various family planning messages they receive from different channels:

It is not that we don’t want to use family planning. The problem is that our spouses want to have many children. They say that their families had only a few children and most of them were females. So, they bear the responsibilities of developing their clans. Therefore, they don’t want to hear anything about family planning (FGD 2 – Shinyanga rural).

In contrast, other women in the FGDs insisted that many couples now prefer having fewer children as compared to the past. The women attributed these changes to low-income levels, which made using family planning an attractive proposition. They generally believed that having many children could impair their economies and make them fail to take care of their families:

To be honest, life is very difficult. How are you going to raise all your children during these difficult times? How are you going to provide for them? It’s time now we stop that kind of thinking. Having many children in the family is a burden. We have started thinking about using family planning. We just want to have a small manageable family (FGD 1 – Bukoba).

Negative perceptions of and misinformation on family planning

Findings from this study also reveal that there were still many negative perceptions of and misinformation on family planning among many women in rural areas. As a result, women’s efforts to seek accurate family planning information remained severely limited which affected their family planning literacy. A widely held perception among most of the study participants was that many modern family planning methods have negative side-effects harmful to the body:

We think there is confusion when it comes to using of family planning. It might be true that we have never used any family planning methods before, but what we hear from other people, especially those who have tried to use them, is that these methods have many side-effects on those using them (FGD 1– Shinyanga rural).

The family planning side-effects they mentioned include continuous bleeding, irregular menses, cancer, loss of sexual desire, swollen stomachs, weight gain or loss, conceiving a disabled child, and becoming infertile. In fact, there was a consensus among study participants that, to a large extent, these perceptions affected their understanding of modern family planning methods hence contributing to their family planning low usage:

Another side-effect that most people talk about is the danger of women developing cervical cancer. They say that once you start using the pills, your belly will start swelling…that is when you know that you have problems. As a result, many people discourage their use (FGD 2 – Musoma).

At our school, we have a special program for disabled children. Now if you try to trace the source of many children’s disabilities, you will find that they are a result of their mothers’ use of syringes [contraceptives] when they were pregnant. So, the syringes affected the fetus in the womb and that is why the children were born disabled (FGD 2 – Bariadi).

These misconceptions instill so much fear in women such that their utilization of the various family planning methods remains low. Comparatively, many of these misconceptions were more apparent in Musoma district than in the other three districts under review.

Use of unproven family planning methods

Consistent use of unproven methods of family planning, especially local concoctions and magic (that have not been scientifically proven) was also reported to affect the family planning literacy of some women of childbearing age in some of the communities. This problem was reported more in Musoma district than in three other districts. Some women in this district reported preferring using concoctions from traditional healers than the recommended modern family planning methods. Such concoctions served as an alternative free of side-effects believed to be common among many modern family planning methods:

Someone may tell you that she took a pill and then her belly started to swell…others may say they have bled the whole month after using some modern family planning methods, or they were very thin but after using the pills they suddenly started gaining weight. So, these things are real. You may ask why you should expose yourself to all these problems when there are other safer options from traditional healers (FGD 1 – Musoma).

We normally go to traditional healers for their concoctions…we would rather use the concoctions than those medicines from a health center. At least the concoctions won’t make us infertile like the medicines from the health center (FGD 2 – Musoma).

Why should I kill myself with the pills from the hospital? We already know that they are unsafe. If you are using herbals your belly will not swell, you will not gain weight, and there will be no over bleeding. Your body will just be the same (FGD 1– Bariadi).

From the discussions of study participants, it emerged that some women also believed in magic as a way of controlling unwanted pregnancies. In this regard, the women reported that if they wanted to prevent pregnancies, they went to traditional healers (normally older women) who then drew a tattoo-like mark on their back and inserted a small stick believed to have power to prevent conceiving. The difference between this method and the modern implant is that the one who inserted the traditional remedy had the power to remove it from the woman before she can get pregnant again. Such a woman would only get pregnant when such a traditional healer removes the stick and not otherwise:

Unlike modern family planning methods, this method has no side effects. The only problem with it is that when you want to remove the stick, it must be removed by the one who inserted it; not anyone else (FGD 2 – Musoma).

Although most of study participants admitted to having inadequate family planning literacy, they questioned the use of such methods to prevent unwanted pregnancies. The women argued that it was risky to trust a traditional healer on matters related to family planning. The women also revealed that, sometimes a woman might have such a stick installed but still get pregnant. So, in cases like that, doing so is as good as not using any form of family planning.

Overall, findings from FGDs indicate that the belief in and use of concoctions and other unproven family planning methods have made some women less interested in seeking information on modern family planning methods while resorting to such traditional methods. Nonetheless, as noted earlier, the women’s use of these unproven family planning methods is attributable to negative perceptions and fear of potential side-effects of various modern family planning methods.

Limited access to reliable sources of family planning information

Inability to access family planning-related information from reliable sources was also mentioned by respondents as one of the factors that affected their family planning literacy. This problem was attributed to the shortage of health facilities and limited number of professional health service providers in some remote rural areas. This is especially true for all women staying far from village centers where health care facilities are available. These women use informal sources of information to meet their various health information needs, including family planning ones, as a result. Some study participants said that they usually consulted their immediate relatives or drug sellers in drugstores for such information:

Sometimes it is difficult to get information on family planning, especially for us who stay far from the health center. So, if we have not gone to the health center but still need to know something about our health or any family planning issue, we will ask our mothers about it. If they are not around, we will just go to the drugstores and ask the sellers about it. (FGD1 – Bariadi).

Generally, findings from all FGDs indicate that the absence of health facilities in some of the remote rural areas led many women in these areas to turn to drugstore attendants for health information. However, the problem with these sources, as narrated by some of the participants, is that they do not always provide relevant family planning information.

Household responsibilities

Study participants also mentioned household responsibilities as one of the factors that affected their family planning literacy. Generally, during the discussions it emerged that their engagement in various household activities robbed them of enough time to engage effectively in seeking information on family planning. Although the women admitted that sometimes such information was disseminated through various mass media sources such as radio and television, they said that their tight schedules made it difficult for them to get information from these sources:

Living in rural areas presents challenges. As women, we engage in every activity in our households…from taking care of children in the house to working in our family farms. You hardly get time to listen to the radio, let alone go to the clinic for family planning services (FGD 1– Musoma).

When asked about accessing family planning information through mobile phones (which could help them access such information at their convenience), the women reported being unaware of such services despite having access to such devices. Furthermore, those that said they were aware of such services mentioned that they had either not subscribed to such services or subscribed but ignored the family planning messages sent to their mobile phones. Again, the women cited household chores as an obstacle to accessing such information:

We have subscribed to that service. But as you know, sometimes we might be too busy to check messages when we hear notifications on our mobile phones, we just ignore them…the day may end without reading the messages (FGD 2 – Bariadi).

Men’s involvement in family planning matters

Almost all the study participants acknowledged the importance of their partners’ involvement in family planning particularly in enhancing their family planning literacy. The women recounted that their partners’ involvement in family planning helped them as couples to make decisions together on using the recommended family planning methods. The women also mentioned their male partners likelihood to adhere to various family planning instructions and information given by health service providers if they are involved in family planning matters from the very beginning:

If your partner is also involved in family planning matters, let’s say, you are both provided with family planning information, it will be easier for him to adhere to the requirements because he is also informed. In fact, you are rest assured that once you forget anything, he will be the one to remind you about it (FGD 1– Shinyanga rural).

Yes, they may allow us to go to the clinic for family planning services, but the problem here is that we might not tell them exactly what we have been taught at the clinic. If we go together, they will also have the same opportunity as ours, to listen to health service providers about family planning. This helps us as couples to make decisions together regarding whether to use a certain family planning method or not. Otherwise, if they refuse to attend, they are also discouraging us from attending (FGD 2 – Musoma).

These narrations imply that women whose male partners are supportive of reproductive health solutions were more likely to have adequate family planning literacy than those with unsupportive partners. Yet, only a few study participants reported receiving such support from their male partners. As it would be expected, these women admitted that they were able to discuss various family planning matters with their male partners:

They are very supportive. We usually talk about it… they even accompanying us to the clinic. (FGD 1 – Shinyanga rural).

In contrast, many women involved in the study mentioned poor involvement of their male partners in family planning matters as one of the major factors limiting their family planning literacy. These women revealed that their male partners were not supportive of family planning:

He kept on yelling at me… “ So, you want me to carry your handbag and go with you to the clinic? Am I the one who want to use family planning? Didn’t you hear that such things have many side effects? Do you want also to get such problems? ” That is what he was telling me... At such a point, I didn’t have anything to say. I just sat down and cried. I was so disappointed (FGD 2 – Bukoba).

The women associated their male partners’ poor support for family planning-related matters with their fear of potential side effects of modern family planning methods, preference to have many children, and low levels of education. Consequently, the males discouraged their partners from using family planning methods. Eventually, the women failed to seek family planning-related information such that when the information is sought, it is done without the knowledge of their male partners.

In this study, a qualitative approach has been used to explore the perspectives of women of childbearing age on factors affecting their family planning literacy. Evidence from numerous studies [ 30 , 38 , 39 ] shows that adequate family planning literacy is one of the most important determinants of family planning uptake among women of childbearing age. This study identified a multitude of factors that affect the family planning literacy of women of childbearing age in the studied communities. The findings reveal a significant effect of socioeconomic inequalities on the study participants’ family planning literacy. This is clear when it comes to the extent of unmet family planning information needs among women with no education and those with poor economic status compared to those with at least a primary level of education and above, and those with a better economic status. In fact, the study shows that though most of women who had no education were unable to follow and comprehend various family planning information, those with poor economic status failed to access information disseminated through the mass media sources such as radio and television. In this study, possession of these media sources has been found to be directly linked to one’s economic status. Evidence from previous studies [ 6 , 40 ] shows that education and wealth have an association with levels of family planning literacy of women in rural areas. However, this study’s revelation that poor household economic status has influenced some women in the communities under review starting to seek family planning information is an encouraging development. This clearly boosts family planning literacy which is likely to translate into uptake of various recommended family planning methods. Nevertheless, findings from other contexts such as coastal regions of Tanzania show that regardless of economic status or level of education, having many children in a family is considered as a prestige [ 34 ]. This, therefore, suggests that context might also be one of the factors that affect the family planning literacy of women of childbearing age.

Consistent with findings from other studies [ 18 , 41 ], this research has also found that religious beliefs negatively affected the family planning literacy of women of childbearing age. Some women that participated in this study treated the usage of family planning as going against God’s will for people to give birth and replenish the world. The women cited their religious leaders’ discouragement of using of family planning as an obstacle to their family planning information seeking. This, however, might be due to varying interpretations of religious texts concerning family planning by some religious leaders as noted in a prior study [ 41 ]. According to the study, while some religious leaders encourage the use of family planning, others do not [ 41 ]. This situation limits the family planning literacy of women and puts them in a dilemma as to whether they should use family planning or not. This finding illustrates the influence that religious leaders have on their followers when it comes to matters related to family planning.

Unexpectedly, although the women in this study admitted to being restricted by their religious leaders to use family planning, the study’s findings show that some of them still use unproven methods of family planning such as concoctions and magic. The women attributed their preference for unproven family planning methods to fear of potential side effects of modern methods. As a result, these women fail to initiate any efforts aimed to seek information on modern family planning methods. This, however, is not only against their religious beliefs, but also the consistent use of unproven methods put them at more risk than using the modern ones. This finding is similar to those of a study in Nigeria which also reported women’s use of unproven family planning methods [ 42 ]. Nevertheless, in the present study most of study participants disapproved the usage of these methods, citing risks the methods might present to their reproductive health. However, although only a minority of study participants confirmed the use of unproven family planning methods, this finding cannot be ignored since these women live in the same communities with the majority that do not use the method. As such, their beliefs are likely to defuse to other women and negatively influence the communities’ family planning literacy.

Despite various efforts aimed to provide communities and women with family planning-related information [ 43 ], this study has found that there are still unmet needs for this important information in most of the communities under review. The findings demonstrate that there are still many misconceptions on family planning that affect women’s understanding of various modern family planning methods. In fact, many women and their partners still associate modern family planning methods with potential side-effects such as cancer, over-bleeding, infertility, irregular menses, having disabled children, and swollen stomachs. Such misconceptions discourage women from using different forms of modern family planning. These findings, however, are not peculiar to this study considering that numerous previous studies have also reported the same [ 3 , 18 , 30 , 44 ].

The shortage of primary health care facilities and limited skilled personnel in some remote rural areas was also reported to affect the family planning literacy of women of childbearing age in this study. Because of such shortage, women in these areas reported relying on their immediate family members and drugstore attendants available in their villages as their sources of family planning information. These sources, however, might not have any formal training on health matters for them to provide relevant health information to the women as reported in various past studies [ 45 , 46 , 47 ]. Reliance on these sources, therefore, puts women at risk of receiving irrelevant family planning information which may contribute to their low uptake of various family planning methods. Unlike the findings in the present study, studies done elsewhere have reported women’s reliance on health workers, television, and radio for family planning information [ 6 , 20 ].

As noted in this study, there was a common consensus among the women that their engagement in various household activities also limits their family planning literacy. Such engagements denied them sufficient time to engage effectively in seeking family planning information. Although the women admitted that they could also get such information from the mass media sources such as radio and television, they argued that being engaged in various household activities deters their access to these sources of information. It appears that some women in this study had limited exposure to mass media sources. This, as a result, limits their exposure to various family planning messages disseminated through these media.

It is also important to note that, although there is increasing evidence that mobile phones have the potential of improving family planning literacy through family planning text messages [ 48 , 49 ], a greater proportion of this study’s participants reported not being aware of such an opportunity. The findings demonstrate further that those who were aware of the opportunity and had subscribed to family planning text message services tended to ignore the messages sent to them through their mobile phones. This course of action amounts to a missed opportunity by the women since this service could help them receive family planning information at their convenience and, as such, allow them to improve their family planning literacy. Therefore, there is a need to strengthen campaigns geared towards sensitizing women in rural areas to use their mobile phones to access various health information, including that of family planning.

While male’s involvement in family planning is essential in increasing the support their female partners need in the overall uptake of various recommended family planning methods [ 50 ], this study’s findings illustrate poor male involvement in family planning matters generally. Specifically, study participants cited poor involvement of their male partners in family planning as one of the major stumbling blocks to their family planning literacy and overall utilization of various recommended modern family planning methods. Various other studies [ 38 , 50 , 51 ] have also reported similar findings. Like in the aforementioned studies, this study’s participants attributed this problem to their partners’ limited awareness of matters related to family planning, fear of side effects of modern family planning methods, and preference for having many children. As a result, many men are reported to prevent their female partners from engaging in family planning matters.

Furthermore, the study findings show that male partners’ preference of many children in their families made their female partners ignore family planning messages that are disseminated through different channels altogether. Consequently, women’s family planning literacy remains low. The study findings echo those from previous studies [ 1 , 34 , 41 ] that have documented the role of men as the sole decision-makers in matters related to family planning. These findings also signal the influence men have on their female partners’ overall acceptance of various modern family planning methods. This problem, however, can be explained by the fact that for quite a long time, many family planning programs had been focusing on women, thus, excluding men [ 52 , 53 ].

Adequate family planning literacy among women of childbearing age is essential in their general uptake of various modern family planning methods. The findings of this study demonstrate a multitude of factors that affect women’s family planning literacy. These factors limit the women’s overall utilization of modern family planning methods. As such, addressing them is imperative in enhancing the effective utilization of modern family planning methods by women. Raising the general literacy level of women in rural areas by reinforcing campaigns geared towards increase their education level is pivotal for them to comprehend various family planning messages from different sources. Efforts to integrate family planning education and information with religious teachings should also be strengthened to eliminate social dilemmas preventing women and their male partners from adopting family planning. Furthermore, improving women’s and their partners’ access to family planning information and encouraging continuous and constant exposure can reduce misconceptions couples have on family planning, thus significantly changing their attitudes and increasing acceptance of various recommended family planning methods. This study supports several initiatives aimed to provide men with family planning education and information. Future research can explore the perspectives of men on their overall uptake of various family planning methods.

Availability of data and materials

The authors wished to include the guide as suggested, however, the guide contains some more questions which are yet to be used for different manuscripts. As those manuscripts are underwriting, we deem it inappropriate to upload the guide. However, the datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Change history

02 may 2022.

A Correction to this paper has been published: https://doi.org/10.1186/s12889-022-13258-x

Anasel MG, Mlinga UJ. Determinants of contraceptive use among married women in Tanzania : policy implication. Afr Popul Stud. 2014;28(2):978–88.

Google Scholar  

Starbird E, Norton M, Marcus R. Investing in family Planning : key to achieving the sustainable development goals. Glob Heal Sci Pract. 2016;4(2):191–210.

Article   Google Scholar  

Mustafa G, Azmat SK, Hameed W, Ali S, Ishaque M, Hussain W, et al. Family planning knowledge, attitudes, and practices among married men and women in rural areas of Pakistan: findings from a qualitative need assessment study. Int J Reprod Med. 2015;2015(1):1–8.

Nansseu JRN, Nchinda EC, Katte J, Nchagnouot FM, Nguetsa GD. Assessing the knowledge, attitude and practice of family planning among women living in the Mbouda health district, Cameroon. Reprod Health. 2015;12(92):1–7. https://doi.org/10.1186/s12978-015-0085-9 .

Solanke BL. Drivers of unmet need for family planning among women of advanced reproductive age in urban Western Africa. In: Family Planning. London: IntechOpen; 2018.

Mahadeen AI, Khalil AO, Sato T, Imoto A. Knowledge, attitudes and practices towards family planning among women in the rural southern region of Jordan. East Mediterr Health J. 2012;18(6):567–72.

Article   CAS   PubMed   Google Scholar  

United Nations. World fertility and family Planning 2020: highlights [internet]. New York: United Nations; 2020. Available from: https://www.un.org/en/development/desa/population/publications/pdf/family/World_Fertility_and_Family_Planning_2020_Highlights.pdf

World Health Organization. Family planning / Contraception [Internet]. 2020 [cited 2020 May 13]. p. 1–9. Available from: https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception

Tolefac PN, Nana TN, Yeika EV, Awungafac NS, Ntsama Y, Njotang PN. Trends and patterns of family planning methods used among women attending family planning clinic in a rural setting in sub - Sahara Africa : the case of Mbalmayo District Hospital , Cameroon. BMC Res Notes. 2018;11(541):10–4. https://doi.org/10.1186/s13104-018-3658-1 .

Sedgh G, Ashford LS, Hussain R. Unmet need for contraception in developing countries: examining women ’ s reasons for not using a method. New York: Guttmacher Institute; 2016. Available from: http://www.guttmacher.org/report/unmet-need-for-contraception-in-developingcountries .

Afnan-holmes H, Magoma M, John T, Levira F, Msemo G, Armstrong CE, et al. Tanzania’ s countdown to 2015: an analysis of two decades of progress and gaps for reproductive, maternal, newborn, and child health, to inform priorities for post-2015. Lancet Glob Health. 2015;3:396–409.

Ministry of Health Community Development Gender Elderly and Children. Tanzania national family planning costed implementation plan 2019-2023. Dar es Salaam; United Republic of Tanzania; 2019. Available from https://fp2030.org/sites/default/files/Tanzania_CIP_2019-2023.pdf .

MoHCDGEC, MoH, NBS, OCGS, ICF. Tanzania Demographic and Health Survey and Malaria Indicator Survey (THDS-MIS) 2015-16. Dar es Salaam; United Republic of Tanzaniap; 2016. Available from https://www.dhsprogram.com/pubs/pdf/FR321/FR321.pdf .

UNFPA Tanzania. Fact Sheet: Family planning. Dar es Salaam: United Nations Population Fund; 2018. Available from: https://tanzania.unfpa.org/sites/default/files/pub-pdf/familyplanning_A5_13nov_highres.pdf .

Safari W, Urassa M, Mtenga B, Changalucha J, Beard J, Church K, et al. Contraceptive use and discontinuation among women in rural north-West Tanzania. Contracept Reprod Med. 2019;4(18):1–10.

Family Planning 2020. Investing in Family Planning for Tanzania’s Health and Development. Dar es Salaam: United Republic of Tanzania, 2016. Available from: https://www.familyplanning2020.org/resources/investing-family-planning-tanzanias-health-and-development .

Shariff H. Family planning in Tanzania: An investment in our women and our future. Washington, DC: Devex; 2020. Available from: https://www.devex.com/news/family-planning-intanzania-an-investment-in-our-women-and-our-future-84386 .

Chebet JJ, Mcmahon SA, Greenspan JA, Mosha IH, Callaghan-koru JA, Killewo J, et al. “ Every method seems to have its problems ” - Perspectives on side effects of hormonal contraceptives in Morogoro Region, Tanzania. BMC Womens Health. 2015;15(97):1–12. https://doi.org/10.1186/s12905-015-0255-5 .

Article   CAS   Google Scholar  

Zureick-Brown S, Newby H, Chou D, Mizoguchi N, Say L, Suzuki E, et al. Understanding global trends in maternal mortality. Int Perspect Sex Reprod Health. 2013;39(1):32–41.

Article   PubMed   Google Scholar  

Adekannbi JO, Olumide MA. Information literacy of women on family planning in rural communities of Oyo state Nigeria. Inf Dev. 2017;33(4):351–60.

Kassim M. Maternal health information needs and seeking behaviour of women in rural Tanzania: a case of Mpwapwa District, Dodoma Region: University of Dar es Salaam; 2018.

Kilfoyle KA, Conor RO, Bailey SC, Vitko M. Health literacy and women ’ s reproductive health: a systematic review. J Women's Health. 2016;25(12):1237–55. https://doi.org/10.1089/jwh.2016.5810 .

Eriksson-Backa K, Ek S, Niemela R, Huotari M-L. Health information literacy in everyday life: A study of Finns aged 65 – 79 years. Health Inform J. 2012;18(2):83–94.

Kohan S, Ghasemi S, Dodangeh M. Associations between maternal health literacy and prenatal care and pregnancy outcome. Iran J Nurs Midwifery Res Autumn. 2007;12(4):146–52.

Ghanbari S, Ramezankhani A, Montazeri A, Mehrabi Y. Health literacy measure for adolescents (HELMA): development and psychometric properties. PLoS One. 2016;11(2zxzr4):1–13.

Nutbeam DON. Health literacy as a public health goal : a challenge for contemporary health education and communication strategies into the 21st century. Health Policy Plan. 2000;15(3):259–68.

Vozikis A, Drivas K, Milioris K. Health literacy among university students in Greece: determinants and association with self-perceived health, health behaviours and health risks. Arch Public Heal. 2014;72(1):1–6.

Shipman J, Kurtz-Rossi S, Funk C. The health information literacy research project. J Med Libr Assoc. 2009;97(4):293–301.

Article   PubMed   PubMed Central   Google Scholar  

Tang C, Wu X, Chen X, Pan B, Yang X. Examining income-related inequality in health literacy and health-information seeking among urban population in China. BMC Public Health. 2019;19(221):1–9.

Mprah WK, Anafi P, Yeaboah PYA. Exploring misinformation of family planning practices and methods among deaf people in Ghana. An Int J Sex Reprod Heal Rights. 2017;25(50):20–30.

Freer R. Health literacy and how rural communities understand hypertension information in Kabale, Uganda. In: Adult Eduation research conference. Kansas: New Prairie Press; 2015.

Marimwe C, Dowse R. Health literacy test for limited literacy populations (HELT-LL): validation in South Africa. Cogent med. 2019;6(01). https://doi.org/10.1080/2331205X.2019.1650417 .

Schrauben SJ, Wiebe DJ. Health literacy assessment in developing countries: a case study in Zambia. Health Promot Int. 2017;32:475–81.

PubMed   Google Scholar  

Cyril A, Siaity E, Brownie S, Holroyd E. My husband will love me more if I give birth to more children: rural women’ s perceptions and beliefs on family planning services utilization in a low resource setting. Int J Africa Nurs Sci. 2019;10:152–8. https://doi.org/10.1016/j.ijans.2019.04.005 .

Hailemariam A, Haddis F. Factors affecting unmet need for family planning in southern nations, nationalities and peoples region, Ethiopia. Ethiop J Health Sci. 2011;21(2):77–89.

Hennink MM, Kaiser BN, Weber MB. What influences saturation? Estimating sample sizes in focus group research. Qual Health Res. 2019;29(10):1483–96.

Hennink MM, Kaiser BN, Marconi VC. Code saturation versus meaning saturation: how many interviews are enough? Qual Health Res. 2017;27(4):591–608.

Ahmed WAM, Shokai BS, Abduelkhair IH, Boshra A. Factors affecting utilization of family planning services in a post-conflict setting, South Sudan: a qualitative study. AIMS Public Heal. 2015;2(4):655–66.

Lam Y, Broaddus ET, Surkan PJ. Literacy and healthcare-seeking among women with low educational attainment: analysis of cross-sectional data from the 2011 Nepal demographic and health survey. Int J Equity Health. 2013;12(95):1–12.

Kim TY, Haider M, Hancock GR, Boudreaux MH. The role of health literacy in family planning use among Senegalese women. J Health Commun. 2019;24(3):244–61.

Sundararajan R, Yoder LM, Kihunrwa A, Aristide C, Kalluvya SE, Downs DJ, et al. How gender and religion impact uptake of family planning: results from a qualitative study in northwestern Tanzania. BMC Womens Health. 2019;19(99):1–10.

Ajayi AI, Adeniyi OV, Akpan W. Use of traditional and modern contraceptives among childbearing women: findings from a mixed methods study in two southwestern Nigerian states. BMC Public Health. 2018;18(604):1–9.

Kakoko DC, Ketting E, Kamazima SR, Ruben R. Provision of family planning services in Tanzania: a comparative analysis of public and private facilities. Afr J Reprod Health. 2012;16(4):140–8.

Kriel Y, Milford C, Cordero J, Suleman F, Beksinska M, Steyn P, et al. Male partner influence on family planning and contraceptive use: perspectives from community members and healthcare providers in KwaZulu-Natal, South Africa. Reprod Health. 2019;16(89):1–15.

Kassim M. A qualitative study of the maternal health information-seeking behavior of women of reproductive age in Mpwapwa district, Tanzania. Health Inf Libr J. 2020;38(3):182–93.

Mayora C, Kitutu FE, Kandala N, Ekirapa-kiracho E, Peterson SS, Wamani H. Private retail drug shops: what they are, how they operate, and implications for health care delivery in rural Uganda. BMC Health Serv Res. 2018;18(532):1–12.

Aziz MM, Jiang M, Masood I, Chang J, Zhu S, Raza MA, et al. Patients’ anticipation for the pharmacies of rural communities: a qualitative study from Pakistan. Int J Environ Res Public Health. 2019;16(143):1–14.

Lee S, Begley CE, Morgan R, Chan W, Kim S. Addition of mHealth (mobile health) for family planning support in Kenya: disparities in access to mobile phones and associations with contraceptive knowledge and use. Int Health. 2019;11:463–71.

Mangone ER, Agarwal S, Engle KL, Lasway C, Zan T, van Beijma H, et al. Sustainable cost models for mHealth at scale: Modeling program data from m4RH Tanzania. PLoS One. 2016;11(1):1–12. https://doi.org/10.1371/journal.pone.0148011 .

Msovela J, Kessy AT, Mubyazi GM. Access to family planning information and contraception methods use among Tanzanian men: a cross-sectional study in Kibaha District. J Epidemiol Prev Med. 2016;2(2):1–6.

Mselle LT, Kohi TW. Healthcare access and quality of birth care: narratives of women living with obstetric fistula in rural Tanzania. Reprod Health. 2016;13(87):1–9. https://doi.org/10.1186/s12978-016-0189-x .

Msovela J, Tengia-Kessy A, Rumisha SF, Simba DO, Urassa DP, Msamanga G. Male partner approval on the use of modern contraceptive methods: factors determining usage among couples in Kibaha district, Tanzania. Contracept Reprod Med. 2020;5(3):1–7.

Sensoy N, Korkut Y, Akturan S, Yilmaz M, Tuz C, Tuncel B. Factors affecting the attitudes of women toward family planning. In: Family planning. Ankara: IntechOpen; 2018.

Download references

Acknowledgements

This research was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Carnegie Corporation of New York (Grant No—G-19-57145), Sida (Grant No:54100113), Uppsala Monitoring Centre and the DELTAS Africa Initiative (Grant No: 107768/Z/15/Z). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (UK) and the UK government. The statements made and views expressed are solely the responsibility of the Fellow.

This research was funded by the Consortium for Advanced Research Training in Africa (CARTA).

Author information

Authors and affiliations.

Information Studies Programme, University of Dar es Salaam, P. O. Box 35092, Dar es Salaam, Tanzania

Mohamed Kassim

You can also search for this author in PubMed   Google Scholar

Contributions

Both MK and FN have equally contributed to designing the study, developing tools, data analysis, and manuscript writing. All authors (MK FN) have approved the manuscript for submission.

Corresponding author

Correspondence to Mohamed Kassim .

Ethics declarations

Ethics approval and consent to participate.

The study received ethical approval with reference number NIMR/HQ/R.8a/Vol. IX/3185 from the National Health Research Ethics Review Committee (NHRERC) of the Tanzania National Institute for Medical Research (NIMR).. Permission to conduct the study was also sought from the local authorities in the four selected regions. Informed consent for study participation was obtained from all study participants. Written informed consent was obtained from the participants who were able to read while verbal informed consent wa obtained from the participants who could not write. Informed consent for minors (below 18 years) was obtained from their parents/guardians who decided on the minors’ participation in the study. In addition to this, the minors were fully informed about the study and made aware that they were free to decide to participate on not. The consent process was approved by the ethics review committee (NHRERC). All the methods used in this study are in accordance with the principles expressed in the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interest.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article has been updated to correct the funding acknowledgment.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Kassim, M., Ndumbaro, F. Factors affecting family planning literacy among women of childbearing age in the rural Lake zone, Tanzania. BMC Public Health 22 , 646 (2022). https://doi.org/10.1186/s12889-022-13103-1

Download citation

Received : 13 November 2020

Accepted : 28 March 2022

Published : 04 April 2022

DOI : https://doi.org/10.1186/s12889-022-13103-1

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Family planning
• Health literacy
• Women of childbearing age

BMC Public Health

ISSN: 1471-2458

• General enquiries: [email protected]

• Research article
• Open access
• Published: 17 January 2019

Family planning among undergraduate university students: a CASE study of a public university in Ghana

• Fred Yao Gbagbo   ORCID: orcid.org/0000-0001-8441-6633 1 &
• Jacqueline Nkrumah 1  

BMC Women's Health volume  19 , Article number:  12 ( 2019 ) Cite this article

35k Accesses

12 Citations

6 Altmetric

Metrics details

Globally, the rate of unplanned pregnancies among students at institutions of higher education, continue to increase annually despite the universal awareness and availability of contraceptives to the general population. This study examined family planning among undergraduate university students focusing on their knowledge, use and attitudes towards contraception in the University of Education Winneba.

The study was a descriptive cross-sectional survey using a structured self-administered questionnaire. One hundred undergraduate students from the University of Education Winneba were selected using a multistage simple random sampling technique. A Likert scale was used to assess the attitude of the respondents towards family planning methods.

Findings show that the respondents had a positive attitude towards family planning with an average mean score of about 4.0 using a contraceptive attitude Likert scale. Knowledge of contraception, awareness and benefits however do not commensurate contraceptive use among undergraduate students since availability, accessibility and preference influence usage. Emergency Contraception (Lydia) was reported as easy to get contraceptive, hence the most frequently used contraceptive (31%) among young female students aged 21-24 years who appeared as the most vulnerable in accessing and using contraceptives due to perceived social stigma.

The observation that levels of Family Planning awareness levels do not commensurate knowledge and usage levels calls for more innovative strategies for contraceptive promotion, and Education on the various university campus. The study recommends that public Universities in Ghana should consider a possible curriculum restructuring to incorporate family planning updates. In this regard, a nationwide mixed method study targeting other tertiary institutions including colleges of education in Ghana is required to explore the topic further to inform policy and programme decisions.

Peer Review reports

The global incidence of unplanned pregnancies amongst students at higher educational institutions every year continues to increase despite the high awareness and knowledge on regular modern contraceptives and emergency contraceptives among students in higher educational institutions [ 1 , 2 ]. Despite the immense contraceptive benefits for students in higher educational institutions [ 3 ], there is no direct positive correlation between the universal awareness, knowledge and use of contraceptives which challenges global health efforts. The poor utilisation of contraceptives in tertiary institutions is associated with many interrelated factors ranging from personal to institutional setbacks [ 4 ]. This eventually contributes to high unplanned pregnancy rates which is estimated to have contributed to about 8 to 30 million annual pregnancies worldwide [ 5 ]. Global estimates have also shown that about 210 million pregnancies occur annually across the world. 75 million (or about 36%) of the 210 are unplanned or unwanted pregnancies [ 6 ]. Students between 18 and 24 years report the highest rates of unplanned pregnancies in the world’s tertiary institutions [ 7 , 8 ]. A situation associated with multiple challenges across the world for countries, academic institutions and the individuals involved [ 9 ].

Studies in Africa, have generally documented low knowledge and awareness levels of effective contraceptive use amongst higher educational students [ 10 ]. Several factors including age, culture, ethnicity, religion, poor access to contraceptive services, peer pressure and lack of partner support were identified as contributing to the non-utilisation of contraceptives in tertiary institutions [ 11 ]. In a study amongst 15 to 24 year old South African women, it was estimated that only 52.2% of sexually experienced women are using contraceptives [ 12 ]. Because 80% of undergraduate students at higher educational institutions are sexually active, it is important that they have access to safe, accessible and adequate contraceptive services [ 13 ].

Although national surveys on family planning [ 14 ] have extensively looked at contraceptive uptake in Ghana, little is known about contraceptive up take among students in Ghanaian Universities. This study therefore examines family planning acceptance among students of the University of Education, Winneba in Ghana to compliment national data on family planning.

A descriptive cross-sectional study design using a quantitative approach of data collection was adopted. This design was chosen because it fits studies in natural setting, explains phenomena from the view point of persons being studied and produces descriptive data from the respondent own written or spoken words [ 15 ].

The study was conducted in the main campus of the University of Education, Winneba. The university was established in 1992 to train middle and top-level manpower for the educational sector of Ghana. It has four main satellite campuses, (Winneba and Ajumako in the Central Region of Ghana, Kumasi, and Mampong campuses in Ashanti Region of Ghana). The Winneba campus has three smaller campuses with five faculties (Faculty of social science education, Faculty of languages, Faculty of science education, Faculty of educational studies and School of creative Arts).

The study population comprised134 ‘non-resident’ undergraduate students of the University of Education Winneba, between ages 17–36 years in 2017 who were registered with an accommodation agent in Winneba that looks for accommodation for students who are unable to obtain university accommodation on campus. This population and age group was selected because anecdotal evidence shows that being a ‘non-resident’ student has the likelihood of making one vulnerable to sexual exploitations whilst seeking accommodation off campus. This age group was considered to be the reproductive age group of the undergraduate students. Because the University only guarantees on campus residential accommodation for only selected first year students, those who do not get the university’s residential accommodation are likely to be victims of sexual exploitations in the Effutu Municipality where the university is situated. This challenge is due to the scarcity of accommodation coupled with the high rent charges for rented accommodation. As per the estimated sample size calculated, a total of one hundred respondents comprising twenty from each of the five faculties were sampled at random to include both male and female students from the various course levels. This was done to ensure a true representation of the student population for the study.

A multistage sampling technique was used to select these respondents for the study. The first stage involved half day orientation of 2 field assistants (male and female) the estimation of the undergraduate students’ population who falls in this category during the period of the study. The second stage involved sample size calculation using an online Raosoft sample size calculator at 95% confidence interval, 5% margin of error and 50% response distribution [ 16 ]. In terms of the figures, the sample size n and margin of error E are given by:

Where N is the population size (134), R is the fraction of responses that the study is interested in, and Z(c/100) is the critical value for the confidence level c. The estimated number of respondents were then randomly sampled and contacted for participating in the in the third stage of the study. The fourth stage of the study involved distributing the developed questionnaires to consented students.

A Structured Questionnaire (See Additional file  1 ), designed by the authors was used to solicit responses from respondents. The questionnaire was exploratory in nature with both opened and closed ended questions to help respondents easily share their views. The questionnaire was pre-tested among 20 potential respondents from a different university. The Contraceptive Attitude Likert scales was used to measure attitudes by asking people to respond to series of statements about the topic, in terms of the extent to which they agree or disagree with them. Thus, tapping into the cognitive and affective components of attitudes [ 17 ]. The Contraceptive Attitude Scale presented positive and negative statements to elicit for responses that portray participants’ attitudes relating to contraception.

One hundred questionnaires were administered, and all the answers to a particular question were arranged, numbered and responses were coded. The responses were again listed and grouped, putting those with the same code together. Data analysis was done after data had been collected and checked for completeness and accuracy. The Statistical Package for Social Sciences (SPSS) software version 23 was used for data analysis. Frequencies, percentages and bar charts were used to describe the data in multivariable tables.

Ethics approval and consent to participate

An approval was obtained from the University prior to data collection. Written consent for participation and publication of findings were also obtained from respondents after the purpose, objectives and potential risk and benefits inherent in the study had been explained to them. Prior to the commencement of the study, the research protocol was presented at the bi-weekly academic research seminars of the Faculty of Science Education, University of Education, Winneba. The seminar brought together lectures of the Faculty (equivalent to an ethical review meeting) who critiqued and reviewed the study protocol for ethical suitability and sound methodology. All participants in the study were given the opportunity to ask questions about the study at any stage, and to withdraw from the study at any time. All data collected were kept confidential and data was analysed anonymously to ensure that results were not traceable to individual respondent.

The overall response rate for the study was 100%. Table 1 presents the background characteristics of respondents. A large number of the respondents were within the age categories of 21 to 24 years and 25 to 28 years. Most of the respondents were single (86.0%) and have no children (86.0%).

Table 2 present results of students’ knowledge, information sources and reasons for accepting or not accepting family planning. Family planning awareness and knowledge among students was a key consideration in the study.

About 94% of respondents answered yes to whether they have ever heard about family planning. Although majority (61%) of the respondents believed FP is helpful, about (67.0%) knew that one could get pregnant by relying on the withdrawal method. It appears most students would be committed to family planning uptake if services are made available. This is evident by 69% of them responding in the affirmative when asked whether they will encourage their family or friends to use family planning services in the University.

Having knowledge of family planning does not necessarily translate into utilization since the respondents had varied reasons for and against using family planning. Respondents who were of the view that FP was not helpful (25.0%) had either not used any family planning method before (28.0%) or had ever suffered unpleasant negative side effects (20.0%) following family planning usage or believed the bible is against family planning (2.0%).

Figure 1 presents respondents’ attitudes towards family planning as estimated using the Contraceptive Attitude Scale. The overall population surveyed had a positive attitude towards family planning (average mean attitude score was about 4.0 out of 5.0).

Attitude towards Family Planning

There were however some divergent responses to the questions relating to contraceptive use. Some of these include:

‘I will not have sexual intercourse if no contraceptive method was available’

‘I will use contraceptives even if my partner does not want me to use it’

‘I will not use contraceptives because they encourage promiscuity’

When the respondents were asked if they have ever used any FP method before, the majority of the respondents (67.0%) mentioned that they had never used any FP method. Regarding availability of family planning service when needed, about 64.0% of the respondents indicated that family planning services are always available in chemical shops and from colleges on campus when needed. About 58% will use FP methods in the future. Regarding information on source of family planning services if required, most of the respondents (85%) knew where to get family planning services in their communities (Table  3 ). Young Female students aged 21-24 years were the most vulnerable in accessing and using contraceptives due to perceived social stigma relating to a female student buying a contraceptive.

Table  4 documents the various family planning choices and reasons for the choices. About 65.0% of respondents reported that they primarily use contraceptives to prevent pregnancy and usually use a contraceptive before sexual intercourse (34.0%). When asked to select the primary methods of contraception frequently used, Emergency Contraception was the most reported frequently used (51%) contraceptive followed by male condoms (34.0%). Various side effects associated with some FP methods were also reported. Some respondents were of the view that there should be education for students on the risk and benefits of FP methods for effective use. Others believed FP should not be tolerated among students because it can be abused leading to major health problems that could affect studies. Knowledge of contraception, awareness and benefits however do not commensurate contraceptive use among undergraduate students since availability, accessibility, preference and cost of contraceptives hinders use.

This study examined family planning among undergraduate university students focusing on their knowledge, use and attitudes towards family planning in the University of Education Winneba. The study was a descriptive cross-sectional survey using a structured self-administered questionnaire for data collection. Various findings obtained from the study had reproductive health programme and policy implications. Informal sources of family planning information such as friends, peers and relatives were common information sources for young people [ 18 ] but yet prone to misconceptions, distortions and half-truths. Other studies ranked the family (parents, brothers and sisters) as the lowest source of information on sexuality [ 19 , 20 , 21 ]. These findings are similar to those reported in the current study that high level of awareness (94.0%) of contraceptives is noted among university students.

An observation that a large number of the respondents were within the age categories of 21 to 24 years and 25 to 28 years of which most (86.0%) were single and have no children (86.0%), is an indication that current university students are relatively young and unmarried. A situation that predisposes them to sexual exploitations and requires knowledge on family planning methods to enable them make informed decision and choices regarding their reproductive intentions. Family planning awareness and knowledge among students was a key consideration in the study. The majority (94%) of respondents indicating that they have ever heard about family planning shows a near universal awareness of family planning methods. This is in line with national reports on family planning awareness in Ghana and a significant departure from many other studies which tended to focus on awareness alone or translate awareness to knowledge [ 22 , 23 ]. Understanding the methods and benefits of contraception are critical to having motivated users. It has also been noted that motivation is one of the important factors in minimizing failure rates in the utilization of contraception [ 24 ]. From previous research findings [ 25 , 26 , 27 ] it was established that the most commonly used Family Planning methods among students were short term methods predominantly, condoms, oral contraceptives and withdrawal methods. This confirms finding of other studies that students had little knowledge about effective contraceptive methods [ 28 ]. In the current study, a remarkable percentage (25%) did not know that pregnancy could occur when one relying solely on withdrawal method. Also about 21.0% of respondents did not know what oral contraceptive pills do, and some 3% also said oral contraceptive pill prevents Sexually Transmitted Infections (STIs). It was surprising to note in this era of increasing STIs that about 2% of respondents’ from a tertiary institution belief a single condom can be reused many times if washed and dried.

At the tertiary level, one would have expected that all respondents would have known the implications of unprotected sexual intercourse. However the study finding that about (61%) of the respondents believed family planning is helpful implies that there are some other students who don’t belief in family planning hence having unprotected sexual intercourse. Although accessibility to family planning methods on campus in this study was very high (66.0%), results from other similar studies were to the contrary [ 29 , 30 ]. This therefore suggests that if students know the benefits and how to use contraceptives, they will not experience unwanted pregnancies and its associated consequences of unsafe abortion complications, disruption in academic work and possible death. Contraceptive education is a component of sex education and is one of the proven approaches to prevent risky sexual behaviour and must be introduced on university campuses to guide students’ family planning choices.

Additionally, findings also shows that there are some students about (67.0%) at the university who knew that one could get pregnant by relying on the withdrawal method yet that is their preferred family planning methods. Various studies [ 31 , 32 ] have explained this observation further by indicating that some adolescents girls feel that a partner’s use of condom suggest that they (the girls) might be classified as unclean, likened to commercial sex workers or seen as engaging in extra-relationship sexual activities if they negotiate for condom use during sexual intercourse. The perception of ‘ I trust my partner so no need for condom use’ further explains the frequency of withdrawal methods being a regular family planning method on campus.

Generally, it appears most students were committed to family planning uptake if services are made available as evident by about 69% of them responding in affirmative when asked whether they will encourage their family or friends to use family planning services in the University. This observation is positive for enhanced family planning service delivery on university campuses to meet the needs of students. Contrary to this observation are those of similar studies which reported that Student frown on invasive family planning methods [ 33 , 34 ]. The distinction between invasive and non-invasive methods bothers on factors such as availability of method, ease of use and adherence to instructions of a health professional to use the method.

Respondents outlined various sources of family planning information of which television adverts constituted the most reported (31%) source of information. This observation is quite worrying since anecdotal evidence from university campuses shows that majority of student rarely have and watch televisions whist on the various campuses. It will therefore be very important and useful to devise innovative ways of educating students on family planning methods whilst on campus.

A finding that having knowledge of family planning does not necessarily translate into usage is very revealing and of public health importance. As it would have been expected, using a method is the surest way of explaining its relevance. However in this study, respondents who were of the view that family planning was not helpful had never used any family planning method before (28.0%). It is there important to use of family planning satisfied client for contraceptive education and promotion on University campuses to ensure the desired positive results. These are students who are likely to positively influence their sexually active peers on contraceptive use since they are likely to say: ‘ I will not have sexual intercourse if no contraceptive method was available’ or ‘I will use contraceptives even if my partner does not want me to use it’ as reported in the study.

Regarding information on source of family planning services if required, most of the respondents (85%) knew where to get family planning services in their communities. For availability of family planning services when needed, about 64.0% of the respondents indicated that family planning services are always available in chemical shops and from colleges on campus when needed. The obvious indicated sources of contraceptives on campus (i.e., chemical shops and peers) do not provide varying choice of services there by limiting students to short term and less effective family planning methods. It is encouraging noting that about 58% of respondents will use FP methods in future. This is an indication of them understanding the importance of family planning to studies as about 65.0% of respondents reported primarily using contraceptives to prevent pregnancy and usually use a method before sexual intercourse (34.0%) despite the various side effects associated with some FP methods reported.

Knowledge of contraception, awareness and benefits however do not commensurate contraceptive use among undergraduate students since availability, accessibility and preference influence usage. Emergency Contraception (Lydia) was reported as easy to get contraceptive, hence the most frequently used contraceptive (31%) among young female students aged 21-24 years who appeared as the most vulnerable in accessing and using contraceptives due to perceived social stigma. This observation shows that Students always have a unique view on issues especially those in youthful ages. It is therefore important to incorporate their views in family planning programming. The observation that some respondents were of the view that there should be education for students on the risk and benefits of family planning methods for effective use is in the right direction and worth exploring. There are also concerns of values clarification as observed by the findings that some respondents believed family planning should not be tolerated among students because it can be abused leading students to becoming promiscuous or suffering major health problems that will affect their studies.

The following recommendations are therefore being suggested to chart a way forward:

Public Universities in Ghana should consider a possible curriculum restructuring to incorporate family planning lessons in the academic programme for students to acquire current knowledge in this area. The reproductive health education programs should include the importance of using dual contraceptive methods as a means to prevent HIV transmission and pregnancy, as well as information on how to make an informed decision relating to contraceptive choices.

The Winneba Municipal Health Directorate should incorporate family planning education on campuses into their public health programs.

The university health service should also create friendly environment for student to access family planning services and also collaborate with the student body to organise programmes to educate the students on family planning methods.

The student representative council (SRC) should also make family planning education a part of their programs and in collaboration with the university health services organise free STI testing and family planning counselling at least once yearly.

A nationwide mixed method study targeting other tertiary institutions particularly colleges of education in Ghana is required to explore the topic further for a national decision on contraceptive security in tertiary institutions in Ghana.

Conclusions

Findings of this study showed that the awareness of family planning among the students was high. However, levels of contraceptive usage were low and restricted to the short term, Emergency Contraceptives and redrawal methods. The perception by a cross-section of respondents (although by a small group) that condoms can be reused more than once confirms the gross ignorance of contraception practices and the potential risk to STIs and Pregnancy. Additionally, Emergency Contraception (Lydia) being reported as easy to get contraceptive, hence the most frequently used contraceptive (31%) among young female students aged 21-24 years, is an indication that this student population appeared as the most vulnerable in accessing and using contraceptives due to perceived social stigma and must therefore be the prime focus of contraception education and services on the University. The University of Education being a tertiary institution mandated to train teachers, is expected to ensure that its students have accurate and current information on family planning methods relevant to educate others. This is an obvious gap that requires policy decisions at all levels and FP education interventions at the tertiary level of education in Ghana.

Abbreviations

• Family planning

Statistical Package for Social Sciences

Sexually Transmitted Infections

University of Education Winneba

World Health Organization (WHO). (2013): Family planning fact sheet. Retrieved from http://www.who.int/mediacentre/factsheets/fs351/en / United Nations. (2011). The millennium development goals report. Retrieved from www.un.org/millenniumgoals/11_MDG%20Report_EN.pdf

Maja TMM, Ehlers VJ. Contraceptive practices in northern Tshwane, Gauteng Province. Health SA Gesondheid. 2004;9(4):42–52 https://doi.org/10.4102/hsag.v9i4.179 .

Article   Google Scholar  

Ersek, J.L., Brunner Huber, L.R., Thompson, M.E. & Warren-Findlow, J., (2011):‘Satisfaction and discontinuation of contraception by contraceptive method among university women’, Matern Child Health J 15, 497–506. PMID: 20428934, https://doi.org/10.1007/s10995-010-0610-y

Hubacher, D., Ifigeneia, M. & McGinn, E., (2008): ‘Unintended pregnancy in sub-Saharan Africa: magnitude of the problem and potential role of contraceptive implants to alleviate it’, Contraception 78, 73–78. PMID: 18555821, https://doi.org/10.1016/j.contraception.2008.03.002

Adhikari, R., (2009): ‘Factors affecting awareness of emergency contraception among college students in Kathmandu, Nepal’, BMC Women’s Health 9, 27. PMID: 19761598, https://doi.org/10.1186/1472-6874-9-27

Singh, S., Sedgh, G., & Hussain, R. (2010) “Unintended pregnancy: worldwide levels, trends, and outcomes”Studies in family planning 41, no. 4:241–250.

Esere MO. Effect of sex education programme on at-risk sexual behaviour of school going adolescents in Ilorin, Nigeria. Africa health science. June. 2008;8(2):120–5.

Google Scholar  

Trieu, S.l., Shenoy, D.P., Bratton, S. & Marshak, H.H., (2011): ‘Provision of emergency contraception at student health centers in California community colleges’, Womens Health Issues 21(6), 431–437. PMID: 21703870, https://doi.org/10.1016/j.whi.2011.04.011

Vermaas, L., (2010). ‘Dealing with unplanned pregnancies and abortions amongst tertiary students’, paper presented at the 6th African Conference on Psychotherapy in Uganda, Kampala, Uganda, 14–16 December, viewed 13 February 2013, from http://www.tut.ac.za/News/Pages/pregnancies.aspx .

Ahmed, F.A., Moussa, K.M., Petterson, K.O. & Asamoah, B.O., (2012), ‘Assessing knowledge, attitude, and practice of emergency contraception: A cross sectional study among Ethiopian undergraduate female students’, BMC Public Health, 12, 110, viewed 06 March 2015, from http://biomedcentral.com/1471 –2458/12/110 Page 7 of Original Research http://www.curationis.org.za doi: https://doi.org/10.4102/curationis.v38i2.1535 .

Golbasi Z, Tugut N, Erenel AS. Knowledge and opinions of Turkish University students about contraceptive methods and emergency contraception. Sex Disabil. 2012;30:77–87 https://doi.org/10.1007/s11195-011-9227-3 .

MacPhail, C., Pettifor, A.E., Pascoe, S. & Rees, H.V., (2007): ‘Contraception use and pregnancy among 15–24 year old south African women: a nationally representative cross-sectional survey’, BMC Med 5, 31. PMID: 17963521, https://doi.org/10.1186/1741-17015/5/31

Bryant, K.D., (2009): ‘Contraceptive use and attitudes among female college students’, Journal of ABNF 20(1), 12–16. PMID: 19278182.

Ghana Statistical Service (2014). Ghana Demographic and Health Survey Report.

Akintade OL, Pengpid S, Peltzer K. Awareness and use of and barriers to family planning services among female university students in Lesotho’, south African journal of Gynaecology 17(3), 72–78.McNab C, (2009): what social media offers to health professionals and citizens. Bull World Health Organ. 2011;87:566.

Raosoft Sample Size Calculator Accessed on 2 nd July, 2012 from http://www.raosoft.com/samplesize.html

Tilahun D, Assefa T, Belachew T. Knowledge, attitude and practice of emergency contraceptives among Adama University female students. Ethiopia Journal of Health Sciences November. 2010;20(3):195–202.

Sigereda G., (2004): Barriers to use contraceptive among adolescents in the city of Addis Ababa. Master’s theses.

Abiodun MO, Olayinka PB. Sexual activity and contraceptive use among female students of tertiary educational institutions in Illorin. Nigeria Contraception. 2009;79(2):146–9.

Mehra, D., Agardh, A., Petterson, K.O. & Ostergren, P.O., (2012): ‘Non-use of contraception: determinants among Ugandan university students’, Glob Health Action 5, 18599. PMID: 23058273, https://doi.org/10.3402/gha.v5i0.18599

Tayo A, Akinola O, Babatunde A, Adewunmi A, (2011): Contraceptive knowledge and usage among female school students in Lagos, south-West Nigeria. Journal of public health and epidemiology January, 3 (1), pg. 34–37.

Bafana T. Factures influencing contraceptive use and unplanned pregnancy in a South African population. MA thesis: Witwatersrand University; 2010.

Egarter C, Grimm C, Ahrendt KNH-J, Bitzer J, Ehlers VJ, Zvavemwe Z. Experiences of a community based contraceptive programme. Int J Nurs Stud. 2009;46(3):302–9.

World Health Organization, WHO. Programming for adolescent health and development: report of a WHO/UNFPA/UNICEF study group on programming for adolescent health. Technical report. Geneva: WHO; 1999. p. 886.

Cadmus E, Owoaje E. Patterns of contraceptive use among female undergraduates in the University of Ibadan, Nigeria. The Internet Journal of Health. 2009;10(2).

John, H. Contraceptive Knowledge, Perceptions and use among adolescents journal of Sociol Res 2012; 3(2):170–180. 25–34.

Appiah-Agyekum, N.N. & Kayi, E.A. (2013). Students’ Perceptions of Contraceptives in University of Ghana, 7(1): 39–44. Beware of AIDS (BAWA), Offinso-Ashanti, Ghana International Conference on AIDS. International Conference of AIDS 12: 1005 (abstract number 60018).

Roberts, C., Moodley, J. & Esterhuizen, T., (2004): Emergency contraception: knowledge and practices of tertiary students in Durban, South Africa’, Journal of Obstetrics and Gynaecology 24(4), 441–445. PMID: 15203588, https://doi.org/10.1080/0144361040001685619

Canadian Statistics, (2010): Trends in the Age Composition of College and University Students and Graduates www. Statcan.gc.ca Accessed 1/4/14.

Dreyer G. Contraception: a south African perspective. Pretoria: Van Schaik Publishers; 2012.

Adegoke AA. Adolescents in Africa: Revealing the problems of teenagers in contemporary African society. Ibadan, Hadassah Publishing; 2003.

Omo-Aghoja LO, Omo-Aghoja VW, Aghoja CO, Okonofua FE, Aghedo O, Umueri C, Otayohwo R, Feyi-Waboso P, Onowhakpor EA, Inikori KA. Factors associated with the knowledge, practice and perceptions of contraception in rural southern Nigeria. Ghana Med J. 2009;43(3):115–21.

CAS   PubMed   PubMed Central   Google Scholar  

McMahon S, Hansen L, Mann J, Sevigny C, Wong T, Roache M. Contraception. BMC Womens Health. 2004;4(Suppl1):S25.

Clements S, Madise N. Who is being served least by family planning providers? A study of modern contraceptives use in Ghana, Tanzania and Zimbabwe. Afr J Reprod Health. 2004;8:124.

Download references

Acknowledgements

The authors are grateful to the University of Education Winneba, Faculty of Science Education for the valuable inputs in shaping the manuscript. Many thanks also to the respondents for their corporation during data collection.

The entire study was jointly funded by the authors.

Availability of data and materials

The raw data and any material related to the study is available upon reasonable request from the corresponding author.

Author information

Authors and affiliations.

Department of Health Administration and Education, University of Education Winneba, Faculty of Science Education, P.O. Box 25, Winneba, Ghana

Fred Yao Gbagbo & Jacqueline Nkrumah

You can also search for this author in PubMed   Google Scholar

Contributions

FYG conceptualized and designed the study. JN supervised the data collection, analysis and drafted the initial report. Both authors discussed the report, edited it together and approved the manuscript for final submission.

Corresponding author

Correspondence to Fred Yao Gbagbo .

Ethics declarations

The research protocol was first presented at the Faculty of Science Education, University of Education, Winneba periodic academic seminars for review and approval for methodology and ethical suitability. This seminar, brings together senior members and research fellows of the University to review research protocols and papers meant for publication and conferences. Approval for data collection and publication were subsequently granted following the full incorporation of comments received from the seminar presentation.

Prior to data collection, verbal and written permissions were sought from the respondents to participate in the study. The permission was granted after the objectives and nature of the study were satisfactorily explained to the respondents.

Consent for publication

The respondents consented for the study to be published but assured of anonymity before administering the questionnaire. The respondents were also given the opportunity to ask questions about the study at any stage, and to withdraw from the study at any time.

Competing interests

The authors declare that they have no competing interests in this study.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Additional file

Additional file 1:.

Appendix I-Questionaire. The appendix I contains the structured question developed by the authors and used for data collection in the study. (DOCX 23 kb)

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Cite this article.

Gbagbo, F.Y., Nkrumah, J. Family planning among undergraduate university students: a CASE study of a public university in Ghana. BMC Women's Health 19 , 12 (2019). https://doi.org/10.1186/s12905-019-0708-3

Download citation

Received : 01 August 2017

Accepted : 02 January 2019

Published : 17 January 2019

DOI : https://doi.org/10.1186/s12905-019-0708-3

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Undergraduate students
• University of Education

BMC Women's Health

ISSN: 1472-6874

• Submission enquiries: [email protected]
• General enquiries: [email protected]

• Open access
• Published: 01 April 2021

Awareness and use of family planning methods among women in Northern Saudi Arabia

• Ghzl Ghazi Alenezi 1 &
• Hassan Kasim Haridi   ORCID: orcid.org/0000-0002-8425-0204 2  

Middle East Fertility Society Journal volume  26 , Article number:  8 ( 2021 ) Cite this article

17k Accesses

5 Citations

1 Altmetric

Metrics details

Evaluation of awareness and use of family planning methods is important to improve services and policies. This study aimed to assess awareness and use of family planning methods among women in an urban community in the north of Saudi Arabia.

A cross-sectional study was carried out in a maternity hospital and 12 primary health care (PHC) centers in Hail City between December 1st, 2019, and May 30, 2020.

Four hundred married sexually active women aged 18–49 years were interviewed using a pretested structured questionnaire. The mean age of the participant was 32.0±7.5 years, 73.5% were university educated, and 58% were housewives. More than two-thirds of them (67.6%) had ≥3 living children. Most women (85%) ever used, and 66.5% were currently using any method of contraception; however, only one in five who get counseling for the contraceptive method used, and 40% of the last births were unplanned for. Almost all women reported unavailable family planning clinics in their primary healthcare centers. Most participants (83.0%) desired to have >3 children, which indicates that the main purpose of family planning was child spacing rather than limitation. Relying on natural methods as being safer (36.3%), desire to have more children (19%), being afraid from side effects (15.3%), and possibility of difficulty getting pregnant or might cause infertility (13.0%) were reasons the participants viewed for unsung modern contraceptives.

This study revealed that most women in urban Hail community, northern Saudi Arabia, were aware about and have a positive attitude towards family planning. The majority of the participants ever used, and two-thirds were currently using any contraceptive method/s, which is higher than the national estimate for Saudi Arabia. However, only one in five counseled by healthcare providers for the type of contraceptive method used. Unavailability of family planning services in primary health care centers impedes getting professional counseling. It is imperious to consider family planning clinics to provide quality family planning services.

A woman’s ability to choose whether and when to become pregnant directly affects her health and well-being. Voluntary family planning saves lives and accelerates sustainable human and economic development [ 1 ]. Family planning implies the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births [ 2 ]. Use of contraception prevents pregnancy-related health risks for women and children. When births are separated by less than 2 years, the infant mortality rate is 45% higher than it is when births are 2–3 years and 60% higher than it is when births are four or more years apart [ 3 ]. Family planning offers a range of potential non-health benefits that encompass expanded educational opportunities and empowerment for women and sustainable population growth and economic development for countries [ 4 ]. Family planning is achieved through contraception, defined as any means capable of preventing pregnancy, and through the treatment of involuntary infertility. The contraceptive effect can be obtained through temporary or permanent means. Temporary methods include periodic abstinence during the fertile period, coitus interrupts (withdrawal), using the naturally occurring periods of infertility (e.g., during breastfeeding and postpartum amenorrhea), through the use of reproductive hormones (e.g., oral pills and long-acting injections and implants), placement of a device in the uterus (e.g. ,copper-bearing and hormone-releasing intrauterine devices), and interposing a barrier that prevents the ascension of the sperm into the upper female genital tract (e.g., condoms, diaphragms, and spermicides). Permanent methods of contraception include male and female sterilization [ 2 , 4 ].

Availability of family planning methods and family planning service quality are important dimensions of the global health policies [ 5 ]. Regarding availability, the principles state that health care facilities, providers, and contraceptive methods need to be available “to ensure that individuals can exercise full choice from a full range of methods” and that furthermore, contraceptive methods are to be accessible without informational or other barriers. Regarding service quality issues, the principles state that “client-provider interactions respect informed choice, privacy and confidentiality, client preferences, and needs” [ 5 ].

Even though women in Saudi Arabia have a high total fertility rate compared to developed countries, a major change has occurred in the last decades. The total fertility rate decreased from 7.17 in 1980 to 4.10 in 2000 and to 2.27 in 2020 [ 6 ], a decrease by 45% in the last two decades and by more than two thirds in the last four decades. This substantial change in fertility profile occurred as a consequence of sociodemographic development in the Saudi community, especially in women’s education and work [ 7 , 8 ] as important factors in changing the beliefs of fertility and behaviors towards birth spacing, and the use of the contraceptives.

Monitoring and evaluation of awareness and utilization of family planning methods in communities are important to improve the quality and effectiveness of services, policies, and planning with resulting beneficial impacts on health and quality of life of women, children, families, and communities. An important aspect of research in this respect is to explore views and practices of women in the reproductive age with regard to family planning and fertility preferences, so we aimed in this study to assess awareness, attitude, and use of family planning methods among women in urban community at the north of Saudi Arabia.

Study design and the participants

This cross-sectional study was conducted in Hail City, the main urban area in Hail region, at the north of Saudi Arabia, between December 1st, 2019, and May 30, 2020. A maternity hospital and 12 primary health care (PHC) centers were the setting of this study. PHC centers were selected at random among a total of 24 PHC centers serving all neighborhood of Hail City. The eligible subjects were married women, residing in Hail City for at least 1 year, aged 18–49 years, who were sexually active, not in the menopause with no contraindication from getting pregnant. Participants were selected at random from women in the waiting areas, who visited the selected health care facility for any reason and invited to undergo an interview. Sample size was calculated using Cochran’s Sample Size Formula [ 9 ] to comprise 384 participants, assuming 50% of women are using contraceptive methods (to maximize sample size) and 5% margin error within 95% confidence level. However, a successful 400 eligible participants were interviewed. A prior consent was obtained from the participants before the interview. Efforts were maximally taken during recruiting and interviewing eligible participants in the study to avoid any potential selection or information bias.

Data collection and analysis

A pretested, predesigned questionnaire was used by the investigator to interview the selected study participants. The questionnaire included sociodemographic information regarding age, education, family size, and family income, and questions covered awareness with regard to the concept and methods of family planning and attitude towards and practice of family planning. Data obtained was coded, entered into, and analyzed using Epi Info 7.1.3 program (CDC, Atlanta, GA, USA). Descriptive statistical measures as percentages and proportions were used to express qualitative data. Quantitative data were expressed as mean and standard deviation. Data was presented as tables and graphs as relevant.

A total of 400 women completed the interview among 418 women asked to participate in the study (96.7% response rate). Time factor and wouldn’t like to share personal information were most of the reasons mentioned for non-participation.

The mean age of the participants was 32.0 ± 7.5 years. The age-wise distribution of the participants is shown in Table 1 . Most participants received university education (294, 73.5%). More than half (211, 52.8%) of the participants reported family income <10,000 SR, while those who reported high income ≥15,000 SR were 96 (24.0%). The mean living children per woman was 2.9±2.5 children, with about one-third (130, 32.5%) had more than 3 children (Table 1 ).

Table 2 summarizes awareness about and attitude towards family planning among the study participants. About two-thirds 259 (64.8%) perceived family planning concept as a means for pregnancy spacing, while 88 (22.0%) perceived it as a means of pregnancy limitation, the others 53 (13.3%) were not familiar with the meaning of family planning. Almost all participants (399; 99.8%) were familiar with hormonal contraceptive pills, IUDs (387, 96.8%), and withdrawal (396, 99.0%), and most (364, 91.0%) were familiar with condom and breastfeeding (330, 82.5%) as a means of contraception methods. Still, a good percent was familiar with abstinence (307, 76.8%) and injectable hormonal (252, 63.0%) and hormonal patch (245, 61.3%) contraceptives. Less commonly familiar methods were female sterilization (145, 36.3%), female barrier (92, 23.0%), and male sterilization (68, 17.0%). Figure 1 demonstrates sources of knowledge about family planning among participants. Most sources were non-reliable sources, such as family/friends (67.5%), general internet sites (43.8%), and social media (34/0%); meanwhile, only half (50.3%) of the participants reported consulting healthcare workers.

Sources of knowledge about family planning methods (%)

The vast majority (384, 96.0%) were favoring family planning (agree/strongly agree), with almost the same percent mentioned that family planning have multiple benefits. More than two-thirds (282, 70.5%) of the participating women reported husbands’ support with regard to family planning. A small percent (17.0%) desired a small number (1–3) of children; 55.0% desired more than 3 children, while 28.0% would not like to limit their children number and leave it open. More than two-thirds (67.5%) preferred pregnancy spacing for more than 2 years.

Table 3 summarizes family planning practices as reported by participant women. The majority ( n =341; 85.3%, CI= 81.4–88.6) ever used and 266 (66.5%, CI= 61.6–71.1) were currently using contraceptive method/s. Methods currently mostly used were pills ( n =144, 54.1%), withdrawal ( n =58, 21.8%), IUDs ( n =29, 10.9%), hormonal patches ( n =14, 5.3%), and condom ( n =12, 4.5%) (Fig. 2 ).

Contraceptive method currently used among participants (%)

Less than half ( n =144; 44.0%) of the respondents reported that their husbands practice contraception. The frequently used method was withdrawal ( n =147, 36.8%) and to a lesser extent condom ( n =55, 13.8%) and abstinence during ovulation period ( n =32, 8.0%).

More than 60% (121, 60.5%) bought the contraceptive directly from private pharmacies over the counter as a personal choice, others (52, 26.0%) brought the contraceptive method after medical advice in private dispensary/hospital, and few (27, 13.5%) were prescribed after medical advice in a governmental health care facility.

Table 4 summarizes respondent’s views about the important reasons behind the non-use of modern contraceptive methods among some women. Favoring natural contraceptive methods (36.3%), the desire of more children (19.0%), being afraid of health side effects and complications (15.3%). Other mentioned causes were being afraid of difficulty of getting pregnant (6.5%), the misconception that modern contraceptives may cause infertility (6.5%), and the other miscellaneous causes/non-response (16.4%).

A fundamental change has occurred in Saudi society over the last decades. Socioeconomic development, urbanization, and women’s education and work [ 7 , 8 , 10 ] led to changes in fertility beliefs and behaviors. Results of the present study shed light on an urban community in the north of Saudi Arabia, exploring views, attitudes, and practices of women in the childbearing period regarding family planning, fertility preferences, and health-seeking behavior.

In this study, most of the participating women (85.3%) ever used, and 66.5% were currently using any family planning method/s, which is by far higher than the national estimate for Saudi Arabia (18.6%) stated in the United Nations (UN) “World Fertility and Family Planning 2020” report and also higher than the international prevalence average, where, in 2019, 49% of all women in the reproductive age range 15–49 years were using some form of contraception [ 11 ]. Similarly, the prevalence was also higher than the reported figures in surrounding Gulf Arab countries such as the United Arab Emirates (33.4%), Kuwait (35.5%), Bahrain (32.2%), Oman (19.6%), Qatar (29.1%), and other Arab countries such as Egypt (43.2%), Jordan (31.1%), Iraq (35.1%), Syria (31.6%), Tunisia (34.3%), and Morocco (36.7%) [ 11 ]. However, the estimate is fairly similar to rates in Western countries such as the UK (71.7%), France (63.4%), Italy (55.6%), Spain (56.5%), and the USA (61.4%) [ 11 ].

This reported higher rate of family planning methods used in our study population actually concealing a high proportion of couples using traditional unreliable methods, where one in 4 was using these methods compared to <10% internationally [ 11 ].

Almost all (96.0%) of the participants in our study praised the concept of family planning and agreed about the benefits of family planning for maternal and child health and well-being. Furthermore, the majority of the participants (85.3%) were ever used or currently using (66.5%) family planning methods. This finding indicates the high acceptability of the family planning concept and points to the real desire of families to plan for the timing of pregnancy occurrence and space between children. Translation of this high acceptance and the higher prevalence of using contraceptives was not reflected in lower fertility profile or smaller family size in our sample. About one-third (32.5%) were already having more than 3 living children, and 83.0% reported that they still want more children, and half of them (49.2%) reported that they prefer to have more than 3 children. This indicates that the main purpose of using contraceptive methods among the majority of the participants is birth spacing rather than birth limitation. This finding is consistent with previous study conducted in southwestern Saudi Arabia, where 60.0% of contraceptive users were spacer [ 12 ]. This could be explained on the background of cultural factors, religious traditions and customs of an Islamic society as well as personal views.

An important finding in our study is that, the use of contraceptive methods among participants largely depends upon their personal views (55.0%) or family/friends’ experience (23.2%), while only 21.8% of the participants received medical advice before using their current contraceptive method. This might explain the higher number of couples who relied on unreliable contraceptive methods and the considerable percentage (40%) of the participants who reported that their last pregnancy was unplanned for, which might be attributed to failure of the contraceptive method used. This is not surprising when we find that all participants reported unavailability of a family planning clinic in their PHC centers, with only one in three (33.8%) who reported that their PHC centers may provide family planning counseling and just 2.8% who reported accessibility for prescribing family planning methods. This situation indicates that, in spite of the high social necessity for family planning revealed by the high demand on family planning methods, there is no parallel availability of organized health services coping for this unmet need of women in the region. As a consequence, health-seeking behavior is self-guided based on personal information and beliefs and/or unreliable sources such as experience of relatives and friends. This crucial need for family planning services was also reported in other studies in Saudi Arabia [ 12 ]. The availability of family planning services allows couples to meet their desired birth spacing and family size and contributes to improved health outcomes for children, women, and families [ 13 , 14 , 15 ].

Two important consequences might result from choosing a family planning method without medical advice; first, the likelihood of occurrence of avoidable side effects and complications which might affect the users’ beliefs and behavior; second, due to resorting to traditional methods of family planning, high rates of contraceptive failure occurs. Dissemination of information about options for contraception should become a part of the routine counseling in primary health care centers and other health care institutions as any decision about contraceptive use should be based not only on contraceptive risks/benefits, but also on the efficacy of the method, individual’s life situation, and the level of risk particular to the user characteristics and the life consequences of childbearing for the mother and child [ 16 , 17 ].

Our study has a number of inherent limitations. Firstly, it is a cross-sectional study, so relationships between the predictor variables and the dependent variables can only be described as general associations not a causal relationship. Second, as an interview survey, social desirability bias cannot be eliminated, and recall bias for some events might happen. Third, our study participants were completely from the urban population, so the result cannot be extended to the rural population in the region. However, the current study provides insights to policymakers and health care providers about awareness, attitude, and barriers affecting family planning practice among women in the region to offer need-based health services and to guide health awareness efforts.

This study revealed that most women in the urban Hail community, northern Saudi Arabia, were aware about and have a positive attitude towards family planning. The majority of women ever used, and two-thirds of them were currently using any family planning method/s, which is higher than the national estimate for Saudi Arabia. However, only one in five who received counseling for the type of contraceptive method used from healthcare providers. The unavailability of family planning services in primary health care centers impedes getting professional counseling. It is imperious to consider family planning clinics to provide quality family planning services.

Availability of data and materials

Available from the corresponding author on reasonable request.

Abbreviations

Primary health care

Cleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, Innis J (2006) Family planning: the unfinished agenda. Lancet 368(9549):1810–1827. https://doi.org/10.1016/S0140-6736(06)69480-4 PMID: 17113431

Article   PubMed   Google Scholar  

World Health Organization Regional Office for Europe (2000) Definitions and indicators in Family Planning Maternal & Child Health and Reproductive Health used in the WHO Regional Office for Europe. [Cited 2020 August 3]; Available from: https://apps.who.int/iris/handle/10665/108284 .

Kantorová V, Wheldon MC, Ueffing P, Dasgupta ANZ (2020) Estimating progress towards meeting women’s contraceptive needs in 185 countries: a Bayesian hierarchical modelling study. PLoS Med 17(2):e1003026. https://doi.org/10.1371/journal.pmed.1003026

Article   PubMed   PubMed Central   Google Scholar  

World Health Organization. Family planning/contraception methods fact sheet (2020). Updated 22 June 2020. [cited 2020 Aug. 6]; Available from: https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception .

Family Planning Rights and Empowerment Working Group (2014) Family planning 2020: rights and empowerment principles for family planning. [cited 2020 Aug. 23]. Available from: http://ec2-54-210-230-186.compute-1.amazonaws.com/wp-content/uploads/2014/12/FP2020_Statement_of_Principles_FINAL.pdf .

United Nations (2019) World population prospects 2019. [cited 2020 Aug. 13]; Available from: https://population.un.org/wpp/Graphs/Probabilistic/FERT/TOT/682 .

World Health Organization, Regional Office for the Eastern Mediterranean (2013) Country cooperation strategy for WHO and Saudi Arabia 2012 - 2016. [Cited 2020 Aug. 19]; Available from: http://applications.emro.who.int/docs/CCS_Saudia_2013_EN_14914.pdf .

The World Bank (2020) Labor force, female (% of total labor force) | Data [Internet]. [cited 2020 June 21]. Available from: https://data.worldbank.org/indicator/SL.TLF.TOTL.FE.ZS .

Cochran, W. G. (1963) Sampling techniques, 2. Aufl. John Wiley and Sons, New York, London. Preis s. https://doi.org/10.1002/bimj.19650070312 .

al-Nahedh NN (1999) The effect of sociodemographic variables on child-spacing in rural Saudi Arabia. East Mediterr Health J. 5(1):136–140 PMID: 10793791

CAS   PubMed   Google Scholar  

United Nations, Department of Economic and Social Affairs, Population Division (2020) World fertility and family planning 2020: highlights. [Cited 2020 June 27]. Available from: https://www.un.org/en/development/desa/population/publications/pdf/family/World_Fertility_and_Family_Planning_2020_Highlights.pdf .

Alsaleem MA, Khalil SN, Siddiqui AF, Alzahrani MM, Alsaleem SA (2018) Contraceptive use as limiters and spacers among women of reproductive age in southwestern, Saudi Arabia. Saudi Med J 39(11):1109–1115. https://doi.org/10.15537/smj.2018.11.22817 PMID: 30397710; PMCID: PMC6274655

Centers for Disease Control and Prevention (1999) Achievements in public health, 1900–1999: family planning. MMWR Weekly 48(47):1073–1080 [cited 2020 June 18]. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4847a1.htm

Google Scholar  

Sonfield A, Hasstedt K, Gold RB (2014) Moving forward: family planning in the era of health reform. Guttmacher Institute, New York [cited 2020 Aug 3]. Available from: https://www.guttmacher.org/sites/default/files/report_pdf/family-planning-and-health-reform.pdf

Gipson JD, Koenig MA, Hindin MJ (2008) The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plann. 39(1):18–38. https://doi.org/10.1111/j.1728-4465.2008.00148.x PMID: 18540521

National Research Council (US) Committee on Population (1989) Contraception and reproduction: health consequences for women and children in the developing world. National Academies Press (US), Washington (DC) PMID: 25144060

World Health Organization Department of Reproductive Health and Research (WHO/RHR) and Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP), Knowledge for Health Project. Family planning: a global handbook for providers (2018 update). Baltimore and Geneva: CCP and WHO, 2018. [Cited 2020 June 21]. Available from: http://www.who.int/reproductivehealth/publications/fp-global-handbook/en/ .

Download references

Acknowledgements

We thank directors and healthcare staff in maternity hospital and participated PHC centers, Hail City, Saudi Arabia, for facilitating the study. We also thank the participant mothers for their agreement, patience, and allowing the time to carry out the interview.

No funding was received.

Author information

Authors and affiliations.

Family & Community Medicine Joint Program, Hail, Saudi Arabia

Ghzl Ghazi Alenezi

Academic Affairs & Postgraduate Studies, General Directorate of Health Affairs, Najran, Saudi Arabia

Hassan Kasim Haridi

You can also search for this author in PubMed   Google Scholar

Contributions

GA conceived the study idea, participated in development of the data collection tool, carried out all interviews, and participated in interpretation of the study results. HH adapted the study idea, designed the data collection tool, carried out data analysis and interpretation of results, and wrote the manuscript. All authors have read and approved the manuscript

Authors’ information

GA: family medicine senior resident, Family & Community Medicine Joint Program, Hail, Saudi Arabia. HH: Consultant Public Health Medicine; the Designated Institutional Official (DIO) of Academic Affairs & Postgraduate Studies, Health Affairs, Najran; ex Head of the Research Department, Health Affairs, Hail Region, Saudi Arabia.

Corresponding author

Correspondence to Hassan Kasim Haridi .

Ethics declarations

Ethics approval and consent to participate.

The protocol of the study was reviewed and approved by the Regional Bioethics Committee of the General Directorate of Health Affairs, Hail region, with the approval number 2019/22 dated October 6, 2019. Agreed participants signed the study consent form. Participants were guaranteed anonymity, confidentiality of the responses, and voluntary participation, and they can withdraw for any reason and any time, without any implications.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Cite this article.

Alenezi, G.G., Haridi, H.K. Awareness and use of family planning methods among women in Northern Saudi Arabia. Middle East Fertil Soc J 26 , 8 (2021). https://doi.org/10.1186/s43043-021-00053-8

Download citation

Received : 28 October 2020

Accepted : 22 March 2021

Published : 01 April 2021

DOI : https://doi.org/10.1186/s43043-021-00053-8

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Contraceptives
• Family planning
• Saudi Arabia

Evaluating the impact of a family planning programme on women’s outcomes in Nigeria.

--> Adeyanju, Oludamilola Adetomi (2018) Evaluating the impact of a family planning programme on women’s outcomes in Nigeria. PhD thesis, University of Leeds.

Nearly 80% of women in reproductive age (15-49), in Nigeria do not use modern contraceptives and despite the implementation of several family planning (FP) programmes, uptake and use of modern contraception in Nigeria remains constrained by a limited access and weak service delivery especially among the poorest. In 2009, the Nigerian Urban Reproductive Health Initiative (NURHI) was introduced in 6 Nigerian cities. The programme aimed at increasing the use of modern contraceptive in the programme areas. This thesis attempts to evaluate and measure the impact of the NURHI on modern contraceptive use in Nigeria between 2009 and 2014. We use data collected before and after the programme and the Nigerian Demographic and Health Survey(NDHS). We start the analysis by briefly describing our data and then assess the impact of the NURHI programme on two outcomes of interest. We also assess the effects of the programme on three key groups of women in both outcome of interests using a reflexive comparison approach. We then proceed to assessing the changes in modern contraceptive use in programme participants and the contribution of compositional changes to those trends. We use a binary variable adaptation of the Oaxaca decomposition method (Fairlie) and evaluate the contribution of socioeconomic and other individual factors to the changes in contraceptive use over time and finally we apply the difference-in difference (DID) estimation method to evaluate the causal effects of the programme of modern contraceptive use in Nigeria. Results show an increase in modern contraceptive use in the programme areas over time. Our reflexive analysis result also reveal that there is an impact of the programme on the outcomes of interest that we measure in certain groups of women. Our decomposition analysis also show that while wealth and education are important determining factors of modern contraceptive use pre-programme, their contribution post-programme reduces substantially. Pre-programme it is mainly women with higher education who use modern contraception because of greater autonomy, financial ability, social interaction and access to FP services however the programme appears to help close the socioeconomic gaps in modern contraceptive use over time. In particular, the NURHI reduces the strength of the link between contraceptive use, and education and wealth, and increases women’s empowerment and decision-making regarding contraception. Our impact analysis also show that even after account for other family planning and education programmes in Nigeria, the NURHI programme had a positive impact on the changes that we observe in modern contraceptive use in Nigeria. Overall, our findings suggest that the introduction of the programme is positively correlated to the changes in modern contraceptive in Nigeria and findings has certain implications for policy and programme makers in Nigeria and Sub-Saharan especiallyinregardstothefuture designing and implementation of family planning health programmes in the region.

--> Final eThesis - complete (pdf) -->

Filename: PHD APPROVED.pdf

Embargo Date:

You do not need to contact us to get a copy of this thesis. Please use the 'Download' link(s) above to get a copy. You can contact us about this thesis . If you need to make a general enquiry, please see the Contact us page.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List

Perceptions of family planning services and its key barriers among adolescents and young people in Eastern Nepal: A qualitative study

Navin bhatt.

1 B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Bandana Bhatt

2 Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal

Bandana Neupane

3 Nepal Health Sector Support Programme (NHSSP)/DFID/Ministry of Health and Population, Kathmandu, Nepal

Ashmita Karki

4 Central Department of Public Health, Institute of Medicine, Kathmandu, Nepal

Tribhuwan Bhatta

5 Department of Electronics and Computer Engineering, Institute of Engineering, Tribhuvan University, Lalitpur, Nepal

Jeevan Thapa

6 Department of Community Health Sciences, School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal

Lila Bahadur Basnet

7 School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Shyam Sundar Budhathoki

8 Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom

Associated Data

All relevant data are within the manuscript and its Supporting Information files.

Introduction

Family planning methods are used to promote safer sexual practices, reduce unintended pregnancies and unsafe abortion, and control population. Young people aged 15–24 years belong to a key reproductive age group. However, little is known about their engagement with the family planning services in Nepal. Our study aimed to identify the perceptions of and barriers to the use of family planning among youth in Nepal.

A qualitative explorative study was done among adolescents and young people aged 15–24 years from the Hattimuda village in eastern Nepal. Six focus group discussions and 25 in-depth interviews were conducted with both male and female participants in the community using a maximum variation sampling method. Data were analyzed using a thematic framework approach.

Many individuals were aware that family planning measures postpone pregnancy. However, some young participants were not fully aware of the available family planning services. Some married couples who preferred ’birth spacing’ received negative judgments from their family members for not starting a family. The perceived barriers to the use of family planning included lack of knowledge about family planning use, fear of side effects of modern family planning methods, lack of access/affordability due to familial and religious beliefs/myths/misconceptions. On an individual level, some couples’ timid nature also negatively influenced the uptake of family planning measures.

Women predominantly take the responsibility for using family planning measures in male-dominated decision-making societies. Moreover, young men feel that the current family planning programs have very little space for men to engage even if they were willing to participate. Communication in the community and in between the couples seem to be influenced by the presence of strong societal and cultural norms and practices. These practices seem to affect family planning related teaching at schools as well. This research shows that both young men and women are keen on getting involved with initiatives and campaigns for supporting local governments in strengthening the family planning programs in Nepal.

An unmet need for family planning results in unintended pregnancies and illegal abortions. This has major health and social implications and is often the leading cause of maternal and child mortality in low-income countries [ 1 , 2 ]. An estimated 214 million women of reproductive age lack access to contraception resulting in an estimated 67 million unintended pregnancies, 36 million induced abortions, and 76,000 maternal deaths each year [ 3 ]. Family planning (FP) is a key intervention to limit these adverse health outcomes [ 4 – 6 ]. Such interventions can prevent 90% of abortions, 32% of maternal deaths, 20% of pregnancy-related morbidity globally, and reduce 44% of maternal mortality in low-income countries [ 1 , 7 ]. FP reduces adolescent pregnancies, prevents pregnancy-related health risks, and helps to prevent HIV/AIDS [ 8 ]. Access to contraception promotes education, raises the economic status of women, and gradually empowers them resulting in improved health outcomes and better quality of life [ 3 , 5 , 9 , 10 ].

Global data show that only 32% of married women from low-income countries currently use modern contraceptives [ 9 ]. According to the Nepal Demographic Health Survey 2016, the total fertility rate was 2.3 births per woman, which is declining and approaching replacement fertility. This is an important achievement. However, the modern contraceptive prevalence rate (mCPR), which is 43%, is still below the target in Nepal [ 11 ]. Nepal has consistently failed to reach the target of mCPR for the past 20 years. The future projection of mCPR for 2030 is 60% [ 5 ], which may be a distant dream if the barriers and enablers are not identified on time to strengthen the current efforts.

Expanding the coverage and access to effective contraceptive methods are essential to meet the Sustainable Development Goals and to achieve universal access to reproductive healthcare services by 2030 [ 11 , 12 ]. For this, the government of Nepal has started a FP program with a focus on increasing the use of FP services and reducing the unmet need [ 5 , 11 ]. However, various factors negatively influence the delivery of FP services including lack of information, limited awareness of dissemination activities, lack of trained staff, and various cultural and religious factors [ 13 ].

Family planning is a choice for many youth, but they often experience barriers such as negative provider attitudes, long distances to healthcare facilities, and inadequate stock of preferred contraceptives [ 13 , 14 ]. Nepali youth are reluctant to use modern contraceptives due to misconceptions about long-term fertility risks, fear of side effects and overall lack of deeper knowledge [ 15 , 16 ]. Besides, FP decisions are mostly dependent on male household members, including husbands and other elder members [ 17 , 18 ]. Married women whose husbands are away as migrant workers face unique contraceptive challenges. When their husbands return home for a few weeks in a year, these women are not prepared with their contraceptives, which can result in unwanted pregnancies [ 18 ].

The extrapolation of the available literature on FP use among adults from Nepal and elsewhere suggests that youth is an under-researched population when it comes to FP There is also a dearth of evidence on perception and key barriers to the use of FP measures in this population. Hence, this study aims to identify the perceptions of the FP services and barriers to the use of FP among the youth in Nepal to assist policymakers in designing appropriate interventions to strengthen the family planning programs in Nepal.

Material and methods

Ethical considerations.

The study received ethical approval from the Institutional Review Committee of B.P. Koirala Institute of Health Sciences, Dharan, Nepal as per the Undergraduate Research Proposal review process (URPRB/01/015). We obtained informed written consent from all participants aged 18 and above. For minors, we obtained assent from the parents of the participants with the participants’ permission. For those who could not read, the information sheet was read aloud by a volunteer, verbal consent was given, and a thumbprint, in the presence of a witness, was used in place of a signature. To maintain the confidentiality of the information and the privacy of the participants, only selected participants and the moderators attended the sessions. Personal identifiers and locator information were not collected, and any identifying information accidentally mentioned was removed from the text before the analysis.

Study setting

The study was conducted among the participants from Hattimuda village of Morang district in Province One of Nepal. Hattimuda village is a community service area of B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. BPKIHS is a public-funded health sciences university, which follows a teaching district concept adopted as a part of its community-based medical education curriculum. BPKIHS also runs a tertiary hospital service for the population of eastern Nepal [ 19 ]. There is a public health facility in Hattimuda village that provides primary health care services including FP services such as the distribution of contraceptives. The nearest secondary and tertiary levels of healthcare services are available 18 kilometers away in Biratnagar, which is the provincial capital and the headquarters of Morang district. According to the 2017/18 annual report of the Department of Health Services, the contraceptive prevalence rate of Morang district is 54.6% [ 5 ] whereas the unmet need for FP in Province One as per the Nepal Demographic Health Survey 2016 is 25% [ 11 ].

Study design

This was a qualitative study with an exploratory design to gather a deeper understanding of the perception of FP and its barriers. Focus group discussions (FGD) and in-depth interview (IDI) methods were used. The overall study lasted from November 2017 to October 2018.

Study population and sampling technique

Adolescents and young people between 15 and 24 years of age from Hattimuda were included in the study. We used the maximum variation sampling method to enroll participants. Pretesting, including one FGD and four IDIs, was conducted among residents in another village of the same district. The pretesting guided the selection of participants for FGDs and IDIs. Accordingly, FGDs were conducted among adolescents and young people, separately for male and female participants to allow for free expression of views during the discussion of potentially sensitive issues. Moreover, the respondents recommended that people at the forefront of the community such as the village leaders, schoolteachers, community health volunteers, religious leaders, youth leaders, and students be selected for the interviews to gather more information. Along with the recommendations from the pretesting, brainstorming was done with community volunteers to generate a list of people who understood the issues of adolescents and young people. More volunteers were added to the list upon the recommendation of the initial respondents. Thus, participants representing diverse backgrounds in terms of gender, profession, education, and social status, were selected. The IDIs were done among 25 prominent people in the community, which included leaders, school teachers, female community health volunteers, healthcare professionals working at the health post and FP service centers, and youth leaders from youth clubs. Health care providers were included in the interviews as their views would be invaluable due to their experience as FP service providers and as witnessing the health issues faced by youth. The teachers are regarded highly for their knowledge and opinions in Nepali communities. So, they were selected for the IDI to provide more insight into the educational barriers to FP and to help in youth mobilization for FP activities. Considering the vital role of local leaders in influencing the implementation and regulation of population-level activities in the village, they were selected for IDI. Six focus groups were conducted with a total of 48 respondents ( Fig 1 ).

Data collection

The Focus Group Discussions (FGD) and In-depth interviews (IDI) were conducted by the researchers within the team with prior experience in qualitative research methods. The interview team included an undergraduate medical student, two postgraduate resident doctors, a public health graduate, and a public health academic researcher. Before data collection, an orientation session was conducted for the interviewers using the interview schedule and the topic guide. The IDI guidelines and interview schedules were developed from the literature review and were modified after pretesting. Validation of the tools was ensured by using the Item Objective Congruence (IOC) index and consultation with academics with experience in FP research. Using a semi-structured open-ended questionnaire, the participants were assessed on their knowledge and perceptions regarding sexual and reproductive health (SRH) and FP, SRH problems faced by youth, challenges and barriers to use of FP services, the role of youth in combating the perceived challenges, and suggestions for enhancing the use of services. Data were considered to have reached saturation when the responses from participants became repetitive and/or no new responses were received.

Focus group discussions

A representative group of youth from diverse backgrounds who could provide credible information about practices and factors affecting the use of FP in the community was selected. Separate FGDs were held for girls and boys to allow for free expression. A moderator was responsible for guiding the discussion and a note-taker for taking the notes, including recording non-verbal responses and ensuring the audio recording. A total of 6 FGDs, each containing 8 homogenous participants, were conducted. Each individual participated once in the FGD. Every member of the group could make their contribution to any question posed before proceeding to another question. Each FGD lasted for 60–90 minutes on average. The discussion was done in the Nepali language as preferred by participants and later translated into English during transcription.

In-depth interviews

In-depth interviews with the key stakeholders were conducted using the Interview Schedule after obtaining the informed consent and audio-recorded with participant permission. A total of 25 IDIs were conducted for the average duration of 30–45 minutes, at a location convenient to the participant, which included their homes and offices.

Data management and analysis

A framework method of thematic analysis was used. The analysis included stages of transcription, familiarization with the interview, coding, developing a working analytical framework, applying the analytical framework, charting the data into the framework matrix, and interpretation of the data. The data collected from the focus groups and interviews were transcribed verbatim. The notes taken were used as a guide to segregate the responses by different respondents during the discussion. An independent researcher conversant in the Nepali and English languages cross-checked the transcripts for accuracy and preservation of original meaning during translation. Preliminary codes were assigned to the available data and then organized into thematic units that were continually revisited and revised as necessary. To ensure consistency of data and findings, two authors were involved in data analysis and reporting. The recordings were stored and accessed by the research team only and were destroyed after the analysis and final report preparation.

Operational definition

According to UNFPA, all persons within the age of 15–24 years are considered youth [ 20 ].

The baseline characteristics of the participants can be seen in Table 1 .

The responses from the IDIs and FGDs revealed four broad themes. Within each broad theme were several substantive sub-themes that emerged from the data. The themes and subthemes are summarized in Table 2 below.

Theme 1: Knowledge and perceptions of FP

A) knowledge and sources of information on fp.

Participants demonstrated awareness of some form of FP. However, some knew nothing about it. Health workers were commonly referred to as the sources of information, while some also mentioned peers, radio, television, and books. Male participants openly disclosed their sources of information on FP while some female participants were reluctant to share their sources.

b) Perceptions of FP

Perceptions of FP varied among participants. Some male participants inferred FP measures as women’s business and did not show any interest in talking more about it. Some referred to FP as using condoms during intercourse, while others referred to oral pills and injectable hormones as FP. Some female participants looked at FP as a way of avoiding unwanted pregnancies.

“My sister used to say that she has been using injection (Depo-Provera) to control unwanted pregnancy . I think FP is about the same . ”- 19 years Female , FGD participant

Theme 2: Preference for FP methods and decision-making

Some female participants reported preference for traditional methods of contraception such as coitus interruptus and calendar method over modern methods. These people used modern methods of FP to start with, which they discontinued later due to the side effects. Participants also stated that the health facilities that provide FP services were far, and hence they had no alternative other than natural methods. Male participants hardly mentioned visiting any health facilities for FP purposes.

“Most of our clients who come for it (FP) are women. Even condoms are collected by women. Men rarely come alone or as couples for FP services.” - 35 years old Female, FP service provider, IDI participant

Yet husbands were responsible for the decision-making about FP and choices of methods for most couples. Some participants (both male and females) mentioned that women rather than men should use permanent FP measures. They believed that men being the breadwinner of the family, should not undergo sterilization, for example, as it would make them physically weak.

“Though I love my wife and I am concerned about her. But I have no options. I must work in a factory. I need to lift heavy weights there. All the major house chores are also done by me. These things (sterilization) would make me weak. How can I earn my livelihood then?”- 22 years Male, FGD participant

Some female participants expressed their concerns regarding the use of permanent FP methods. They mentioned that they had already been through various phases of pain, be it during menstruation, pregnancy, or delivery which has made them weak. Thus, they prefer their husbands to undertake any measures.

In contrast, unmarried participants stated that they would rather discuss and decide together with their partners regarding which method to choose in the future. Despite this interest, women were not sure how to engage their husbands in discussion. Some female participants said that they could not persuade their future husbands to use contraceptives as it would be disrespectful, whereas a few male participants believed it was a woman’s responsibility to use FP methods.

“It (FP) is stuff to be done by the women . So , there is no doubt about who would be doing it . Moreover , people would laugh at me if I do it -20 years Male , FGD participant “ Women have already gone through much pain in bringing up and taking care of the children and again keeping this stuff (FP) in their head is unjustifiable . As such, in comparison to the female operative procedure, I have heard that the male one is simple, less time consuming, and does not bring many complications . So, why not we men take the lead on this? ” -25 years Male, Youth leader, IDI participant

Theme 3: Barriers and challenges in the use of FP

A) supply-side barriers and challenges.

Participants indicated that contraceptive services are not always accessible nor affordable in rural areas. Health facilities are far, and many people feel reluctant to travel in a hot climate. Participants who were reluctant to travel said they were doubtful that the health facilities would have the methods in stock even if they managed to walk the distance. Others who were reluctant said they would be unable to afford the contraceptives from a private medical store regularly. A few participants raised the issue of privacy and unavailability of all services at the health centers. Similarly, young males from the community complained that the services at the health post were focused only on mothers and married couples, while the boys and the unmarried people were not given much attention. For this, they suggested changing the term to something other than FP because they believed that FP should include not only those who had families.

Participants expressed their frustration that FP and SRH services in their village had not been running well for more than a year. They felt that the government was not doing anything about it either. Some students expressed the need for an integrated curriculum at school covering every aspect of SRH and FP that would ensure adequate and proper knowledge of such crucial subjects. Despite the students’ desire to learn and understand FP, their teachers are often reluctant to talk about FP in detail. The participants also indicated that family members, in general, forbid girls and women from getting involved in FP awareness activities.

“Though we are eager to learn about those lessons (reproductive organs and health), our teacher skips them. They tell us to read it by ourselves.” -18 years Female, FGD participant

b) Demand-side barriers and challenges

A few participants were confused about which method to choose, how to use it properly and did not even know where to seek FP services locally.

“My husband works abroad. Last year, when he came home during Dashain (festival), we had (intercourse). Later, he returned to his workplace. Meanwhile, I came to know that I was pregnant, after 3 months. I was shocked to hear that. We already had 3 children; 2 of them were unplanned. I did not have enough information about contraceptive measures in this situation. Had I known about them; I would have used them. I had serious trouble travelling to get it aborted.” - 24 years Female, FGD participant

Some female participants expressed their reluctance to use FP methods due to their own or other people’s past experiences and the fear of side effects, including vaginal bleeding, spotting, abdominal pain, nausea, vomiting, headache, acne, and infertility. These female participants expressed the need for a single-use FP method with fewer side effects for women which could be used without their husbands’ consent. The male participants were worried about the risk of unwanted pregnancy due to the breaking of condoms and a few participants also expressed concern that they experienced allergic reactions after the use of condoms. Moreover, they were concerned about not having any alternative methods of contraception other than condoms.

“I have a much bitter experience. I was using Depo injection before. But I started having over bleeding for which I was admitted to the hospital for a few days. Later, I was switched to implants but they also did not suit me. In between I also used pills, but they aggravated my acne and I was feeling nauseated every day. Uff…. I am fed up now. I swear, I won’t ever use any methods.” - 19 years Female, FGD participant “I have heard that keeping these things (Copper-T) in the uterus can cause cancer. Better to avoid it.” - 20 years Female, FGD participant “There aren’t many choices for men. I think using a condom during sex is like tying plastic around the tongue and eating food.” - 21 years Male, IDI participant

Religious and ethnic variation affected use of FP. Participants reported that people belonging to upper caste groups used FP measures more than lower caste groups. Likewise, people who had migrated from the hilly areas used FP services, whereas people from the local ethnic community did not use as they were less aware of it. FP decisions among young people seem to be influenced largely by religious beliefs, stigma, and the perceived role of men and women based on existing social norms. Some participants regarded children as a gift from God and denied using any FP methods. Some believed using FP was going against the law of nature, religion, and culture; thus, they would not avoid childbirth, but rather celebrate every birth. Some indicated that if couples did not have children within 1–2 years of marriage, then people would question the woman’s fertility. Most couples preferred sons to daughters as they believed sons would look after them and their property, while the daughters would be married and sent away, resulting in avoidance of FP measures until they have a son. Some couples even wished to have two sons because if anything unfortunate happened to one, the other son would still be with them to carry the generation forward.

“My aunt gave birth to a son after 5 successive daughters. She is pregnant again this time in the hope to have a son. She says that she cannot trust to have only one son because if anything happens to their only son, then she will have no one to pay tribute after her death.”- 22 years Female, FGD participant

Participants also said that people felt shy talking about FP openly. Female participants also felt uncomfortable asking for contraceptives with male health personnel at the health post. Similarly, teachers felt uncomfortable teaching about reproductive health and FP as their children and relatives could be present as students in the classroom. Participants indicated that some students would laugh and smile, making it difficult for the teachers to run the classroom sessions smoothly.

It was reported by a FP service provider that some men opposed their wives using any FP measures as they perceived that the use of FP measures allowed their wives to become promiscuous when they go abroad for work.

“Some husbands working abroad forbid their wives from using any FP measures because they fear the use of FP measures may provoke a sexual relationship with someone else in their absence”- 30 years Female, Health professional providing medical abortion services, IDI participant

Theme 4: Role of youth and suggestions to improve FP

The youth were interested in getting involved in a “peer to peer education” approach to increase awareness among the community about FP use. This approach would include peer training programs, role-plays/dramas, and counseling sessions to break the key barriers linked with such services. Activities ranging from redesigning the school’s curriculum to strengthening FP services in primary care centers, and from launching mobile outreach clinics to facilitating “spousal communication” were intended to change attitudes and support gender equality in sexual and reproductive health. Participants emphasized forming youth centers and collaborating with other youth clubs in the village. Furthermore, they suggested bringing religious leaders, teachers, doctors, and politicians as advisors of the youth centers would be beneficial as they are influential members of the community.

“I feel bad for my sister who is not given much importance from my parents. She got married against her choice due to her parents’ pressure. Now, they are forcing her to have kids. She is just 15 and if she gets pregnant, what will happen to her health and her child, how can she take care of a baby? I had a long debate with my father yesterday. I have now decided to start a youth club to promote awareness regarding FP and preventing early marriage and teenage pregnancies.” - 23 years Male, FGD participant

Male participants indicated that family planning programs are effective only when men prioritize women’s autonomy. Moreover, they expressed disappointment with the local government for not encouraging the involvement of men in FP programs in their village. To help address this issue, they expressed their interest in supporting the local government in bringing inclusive FP programs to their village.

“For a long time, women have been using those (Contraceptives) by hiding. We are always in fear about what others would say if they came to know about us using it. This can be addressed through male involvement and support.” -24 years Female, FGD participant

This qualitative study provides in-depth information on the understanding and perceptions of youth in Eastern Nepal regarding FP. This study generated findings regarding knowledge and perceptions of rural residents regarding FP and its methods; decision-making and preference among participants; supply-side and demand-side barriers and challenges regarding the use of FP measures; steps that can be taken to improve their use; and the role of youth in increasing FP coverage. Although most participants knew something about FP, a few female participants were completely unaware of it. And while some participants agreed that all married couples should be using FP measures, some unmarried male participants believed that those measures should be exclusively for women. These men said that they would let their wives use them after getting married. Current FP methods for men are either coitus-dependent, such as condoms or withdrawal, or permanent, such as vasectomy. Limited choices for men may have resulted in misconceptions that contraceptives are mostly for women.

Men often claimed to be the sole decision-maker of the family on important matters, including those related to family health and contraception. In most circumstances, men solely decide the FP measure to be used without having a discussion with their partner. This might be one of the reasons why women are bound to adopt a FP method that is not necessarily their choice. Besides, this problem is further reinforced by the limited options of FP methods available for men other than condoms and permanent sterilization. These findings are supported by other studies in South Asia, where family planning measures are mostly considered women’s responsibility [ 21 – 24 ]. Health workers, peers, and mass media were the most common sources of information regarding FP similar to prior studies in India [ 21 , 24 ] and Nepal [ 22 ]. Participants in this study seemed to assign FP responsibility to the other gender in terms of using FP. This could mean that there is a gap in communication within the couples when deciding about FP. There is a need for further research to identify ways to improve communication among couples.

Religious and ethnic variation influence FP use. People belonging to privileged ethnic groups used FP measures more than underprivileged groups. This is despite family planning services being free for all citizens in Nepal. In this study, people who had migrated from hilly regions knew about and used FP services more than those belonging to the ethnic community in the local region. This is an area for further research to understand differences in knowledge and perceptions regarding FP between the population groups. This can be argued as a limitation of the current FP promotion programs, which may not have considered the different needs of people from different religious and ethnic backgrounds [ 25 ]. A few participants reported that their holy scriptures forbade them from using FP methods as they viewed children as a gift from God; any artificial process interrupting pregnancy or preventing the possibility of life is a religious offense for them [ 26 ]. Previous studies from Nepal have shown that this belief has long been rooted in some communities [ 27 – 29 ].

Apart from religious beliefs, fear of side effects, having experienced adverse health consequences after using hormonal contraceptives, and fear of potential infertility in the future are reasons for reluctance using FP methods among women [ 30 ]. Besides, we can speculate that language and cultural barriers, and fear of discrimination especially by male counterparts negatively influence the use of FP measures among some women despite their strong interest in using them. The use of IEC materials in raising awareness and empowering married couples for shared decision-making could help generate demand [ 28 , 29 ]. Local cultural taboos restrict open communication about safer sex measures and sexual health in Nepal, prohibiting young girls and boys from receiving adequate information and guidance regarding sexual and reproductive health and FP [ 31 ].

Most of the married women and men stated that the decision-makers of the family are men. The husband decides whether or not to use contraception, or more specifically, whether or not to let their wives use it. However, unmarried participants expressed their willingness to decide mutually with their spouse regarding FP use in the future [ 21 , 32 ]. Most women in this study seemed comfortable letting their male partners decide on contraceptives. This attitude could be explained by the patriarchal dominance in decision-making [ 19 , 33 , 34 ].

Some men mentioned that condoms inhibit their sexual pleasure, which is why they prefer women to use other methods instead. A study conducted in Far West Nepal and another nationwide study reported similar concerns among men [ 31 , 35 ]. Adolescent girls stated that they were not comfortable talking to a male health worker about FP or to a female worker in the presence of a male health worker, which has also been reported elsewhere [ 36 ]. Some women said that their husbands forbade the use of contraceptives because they thought that contraceptives would allow their wives to become promiscuous and that using FP was a sign of infidelity. This issue, however, was not raised by any men in the study. Some women reported violence as a consequence of using contraceptives without their husband’s consent. Prior qualitative studies also reported that women may suffer domestic violence for opposing their husbands. Studies suggest that a multi-sectoral action involving stakeholders from health, women’s rights, and education sectors is imperative to further research and address this issue [ 29 , 36 , 37 ].

Supply constraints (distance to a provider for getting contraceptives, out of stock, limited choices of contraceptives, unaffordable methods, etc.) could aggravate the unmet need for contraception. These constraints are similar to all regular supplies faced by the health system in Nepal. However, supply-side interventions such as increasing the number of health facilities distributing FP services, policy focusing on consistent operating hours, and full stock of a wide variety of FP methods could largely improve uptake and increase contraceptive coverage [ 18 , 38 ].

Most female participants did not speak up when asked about their perception of the role of men in FP. On the other hand, male participants explained that the role of the youth could be disseminating FP information, conducting awareness campaigns, organizing dramas and role-plays to educate people about the religious and cultural barriers of FP use, etc. With appropriate training, the young men said they would be willing to work for FP advocacy in the community.

Reproductive health leaders and planners should identify men who are willing to share decision-making authority with their wives and devise behavioral change interventions [ 39 ]. Male participation could support the FP programs and also help empower women [ 40 ]. The participants in the study expressed the need for the current FP programs to consider the community members as key stakeholders in planning FP programs. There is a need to further explore possible ways of working with the rural, marginalized communities and hard-to-reach or specific ethnic groups to improve their update of FP services [ 41 ]. There is evidence that mass media messages increase the likelihood of FP use, which could be considered by advocacy and dissemination programs [ 42 ]. Evidence from maternal and newborn health care research shows that interventions that engage men result in more equitable couple communication and shared decision-making. This may be a relatable concept to be considered for FP programs as well [ 43 ].

We urge those in charge of the health and sexual education curriculum to find ways to encourage teachers to give equal attention to these topics, including FP education, as they would to any other. It was reported that teachers were reluctant to teach about FP as they perceived the young students felt discomfort around this topic. Further research to identify innovative youth-friendly methods to teach sexual and reproductive health topics to students may be helpful. Youth groups should be regarded as important stakeholders in the redesign of school health curricula, particularly for their insight into culturally sensitive and otherwise effective ways for delivery. Health professionals, members of local organizations, and community leaders pointed to the necessity of addressing unmet FP needs and the stigma associated with FP use through community education approaches that take into account cultural norms and beliefs [ 44 ]. Interventions focusing on reproductive health education curricula involving school teachers could be considered [ 45 ]. Strengthening health systems, bridging service gaps, improving the integration of contraceptive services and counseling with routine health care are important strategies for increasing contraceptive uptake in eastern Nepal [ 22 ].

Among the study’s limitations was the fact that it was conducted in a single village in eastern Nepal. Our findings might differ if the sample had been drawn from other parts of the country. Although participants spoke fluent Nepali, some phrases used in local dialects could not be perfectly translated into Nepali or English. These responses could have been affected by social desirability as the participants may have felt constrained from speaking freely with people from health institutions. To help reduce these obstacles we held open meetings and drop-in sessions with the support of community youth to disseminate the purpose of the study and build rapport with the young people in the village before we approached them for the study. Moreover, participants were assured anonymity and confidentiality, which may have increased their willingness to participate in the research.

Conclusions

There appear to be information and communication gaps between women and men regarding FP services and programs. The information gap could be addressed by exploring ways to increase information uptake in schools through redesigning the curriculum delivery. Mass media may be used to disseminate appropriate health education regarding FP. Health institutions could consider approaches to create FP information and service centers that are male-friendly. The communication gap may be more deeply rooted in the culture and traditions of Nepalese society. In a mostly patriarchal society, further identification of motivations for men to participate in FP related activities could be challenging. However, it is promising that men may be willing to support their partners for FP decision-making and engage in strengthening FP programs through the “peer to peer” approach via youth-led centers and community clubs. Program managers and policy makers need to take into account the fact that youth are willing to contribute to ongoing FP programs. Doing so would help bridge the information and communication gaps between school education and practice. Innovative research to further explore perceived benefits by youth on the uptake of family planning, sexual and reproductive health services is needed.

Supporting information

Acknowledgments.

We extend our sincere thanks and regards to Dr. Agata Parfieniuk, Kirsty Lunney, and Anu Regmi for their invaluable contributions to the manuscript. We acknowledge the support received from Dr. Meika Bhattachan, Dr. Avinash Kumar Sunny, and Dr. Pawan Upadhyaya during data collection. The authors acknowledge the support received from the BPKIHS and participants for their participation in the study. Special thanks to Dr. Bibisha Baaniya, Dr. Garima Pudasaini, Dr. Soniya Gurung, Dr. Shristi Nepal, Bisha Baaniya, and Arshpreet Kaur for their generous support throughout the study.

Abbreviations

Funding statement.

The author(s) received no specific funding for this work.

Data Availability

• Research note
• Open access
• Published: 13 August 2018

Knowledge, attitude and practice towards family planning among reproductive age women in a resource limited settings of Northwest Ethiopia

• Ayele Semachew Kasa   ORCID: orcid.org/0000-0003-3320-8329 1 ,
• Mulu Tarekegn 1 &
• Nebyat Embiale 2  

BMC Research Notes volume  11 , Article number:  577 ( 2018 ) Cite this article

69k Accesses

33 Citations

Metrics details

To assess the knowledge and attitude regarding family planning and the practice of family planning among the women of reproductive age group in South Achefer District, Northwest Ethiopia, 2017.

The study showed that the overall proper knowledge, attitude and practice of women towards family planning (FP) was 42.3%, 58.8%, and 50.4% respectively. Factors associated with the practice of FP were: residence, marital status, educational status, age, occupation, and knowledge, and attitude, number of children and monthly average household income of participants. In this study, the level of knowledge and attitude towards family planning was relatively low and the level of family planning utilization was quite low in comparison with many studies. Every health worker should teach the community on family planning holistically to increase the awareness so that family planning utilization will be enhanced. Besides, more studies are needed in a thorough investigation of the different reasons affecting the non-utilizing of family planning and how these can be addressed are necessary.

Introduction

Family planning (FP) is defined as a way of thinking and living that is adopted voluntary upon the bases of knowledge, attitude, and responsible decisions by individuals and couples [ 1 ]. Family planning refers to a conscious effort by a couple to limit or space the number of children they have through the use of contraceptive methods [ 2 ].

Family planning deals with reproductive health of the mother, having adequate birth spacing, avoiding undesired pregnancies and abortions, preventing sexually transmitted diseases and improving the quality of life of mother, fetus and family as a whole [ 3 , 4 ].

The Federal Ministry of Health (FMOH) has undertaken many initiatives to reduce maternal mortality. Among these initiatives, the most important is the provision of family planning at all levels of the healthcare system [ 5 , 6 ]. Currently, short-term modern family planning methods are available at all levels of governmental and private health facilities, while long-term method is being provided in health centers, hospitals and private clinics [ 6 ].

The study done in Jimma Zone, Ethiopia showed that good knowledge on contraceptives did not match with the high contraceptive practice [ 7 ]. Different researchers showed that the highest awareness but low utilization of contraceptives making the situation a serious challenge [ 8 , 9 ].

Most of reproductive age women know little or incorrect information about family planning methods. Even when they know some names of contraceptives, they don’t know where to get them or how to use it. These women have negative attitude about family planning, while some have heard false and misleading information [ 10 , 11 ] and the current study aimed in assessing the knowledge, attitude and practice (KAP) of FP among women of reproductive age group in South Achefer District, Northwest Ethiopia.

Methods and materials

Study design and setup.

A community-based cross-sectional study was conducted in South Achefer District, Amhara Region, Northwest Ethiopia from March 01–April 01, 2017. Systematic sampling technique was used to recruit the sampled reproductive age women (15–49 years old). Based on the number of households obtained from the Kebele’s (Smallest administrative division) health post, the sample size (389) was distributed to the households. The sampling interval was determined based on the total number of 4431 households in the kebele. The first household was taken by lottery method and if there were more than one eligible individual in the same household one was selected by lottery method.

The data collection questionnaire was developed after reviewing different relevant literatures. The questionnaire, first developed in English language and then translated to Amharic (local language). Pretest was done on 5% of the total sample size at Ashuda kebele. After the pretest, necessary modifications and correction took place to ensure validity.

Those reproductive age women who answered ≥ 77% from knowledge assessing questions were considered as having good knowledge, those women who scored ≥ 90% from attitude assessing questions were considered as having favorable attitude and those women who scored ≥ 64% from practice assessing questions were considered as having good over all practice towards FP [ 7 ].

Data processing and analysis

The collected data was cleaned, entered and analyzed using SPSS version 21 software. Descriptive statistics were employed to describe socio-demographic, knowledge, attitude and practice variables. Chi squared (χ 2 ) test was used to determine association between variables. Associations were considered statistically significant when P-value was, < 0.05.

Socio-demographic characteristics of participants

The response rate in this study was 97.9%. Among 381 participants included, 185 (49%) were from rural villages. About 47% of the participants were illiterate and 52% were completed primary education. The monthly household income of the majority (42.5%) of the participants was between 1000 and 3000 Ethiopian birr. Regarding the family size of the participant’s, majority (48.3%) of them had ≥ 3 children.

The mean age of participants was 29.7 ± 6.4. Two hundred forty six (64.6%) and 133 (34.9%) were house wife’s and farmers respectively by their occupation. Almost two-third (65.4%) of participants were married, 24.9% were divorced by their marital status (Table  1 ).

Knowledge status of participants

All of participants ever heard about family planning methods. The major sources of information were from health workers (57.5%) and radio (41.5%). Regarding perceived side effects of using family planning, 13.1%, 24.9%, 9.7% and 52.2% of participants were responded heavy bleeding, irregular bleeding, an absence of menstrual cycle and abdominal cramp respectively were mentioned as a side effect. Among those who have children; 24.6% gave their last birth at home and 75.5% gave their last birth at the health institution. Regarding the overall knowledge of study participants, 161 (42.3%) had good knowledge towards family planning and the rest 220 (57.7%) had poor knowledge.

Attitude status of participants

The majority (88.5%) of the respondents ever discussed on family planning issues with their partners and wants to use it in the future. About 24.5% of the participants reported that they believe family planning exposes to infertility. Almost 23 (22.8%) of study participants reported that using family planning contradicts with their religion and culture. Regarding the overall attitude, 224 (58.8%) of the participants had favorable attitude and 157 (41.2%) had unfavorable attitude towards family planning.

Practice on family planning

Three fourth (75.3%) of study participants ever used contraceptive methods. The main types were pills (7.4%) and injectable (77.2%). The most common current reasons for not using were a desire to have a child (53.2%) and preferred method not available (46.8%). Almost half (50.4%) of study participants had good practice and the rest 49.6% had poor practice.

Factors associated with family planning practice

Study participants’ religion was not included in the analysis due to lack of variance, since almost all (99.2%) of participants were Orthodox Christians by their religion.

Women who had good knowledge were more likely to practice FP than those who have low knowledge (χ 2  = 117.995, d.f. = 1, P  < 0.001) and women who had favorable attitude towards FP were more likely to practice FP (χ 2  = 106.696, d.f. = 1, P  < 0.001). It was also seen that residence, age, educational status, occupation, marital status, number of children and monthly income of the were significantly associated with the practice of FP [(χ 2  = 69.723, d.f. = 1, P  < 0.001), (χ 2  = 104.252, d.f. = 2, P  < 0.002), (χ 2  = 119.264, d.f. = 1, P  < 0.001), (χ 2  = 41.519, d.f. = 1, P  < 0.001), (χ 2  = 39.050, d.f. = 1, P  < 0.001), (χ 2  = 144,400, d.f = 3, P  < 0.001) and (χ 2  = 179.366, d.f. = 1, P  < 0.002)] respectively (Table  2 ).

Increasing program coverage and access of family planning will not be enough unless all eligible women have adequate awareness for favorable attitude and correctly and consistently practicing as per their need. Increasing awareness/knowledge and favorable attitude for practicing FP activities at all levels of eligible women are strongly recommended [ 6 ].

The results of the present study showed that 42.3% of study participants had good knowledge, 58.8% had favorable attitude, and 50.4% had good practice towards family planning. This finding was lower than a study conducted in Jimma zone, Southwest Ethiopia [ 7 ], Sudan [ 9 ], Tanzania [ 12 ] and another study done in Rohtak district, India [ 13 ]. The difference may be due to; studies done in Jimma zone, Sudan, Tanzania and Rohtak district involve only those coupled/married women. Married women might have good knowledge and attitude for practicing family planning. But in the current study, all women of reproductive age group regardless of their marital status were studied and this may lower their knowledge and attitude.

The current study showed that, 50.4% of reproductive age women were practicing family planning which was almost in line with a study done in Cambodia [ 14 ] and higher than a study done in rural part of Jordan [ 15 ] and India [ 16 ]. But it was lower than studies conducted in Jimma zone, Ethiopia [ 7 ], Rohtak district, India [ 13 ], urban slum community of Mumbai [ 17 ] and in Sikkim [ 18 ] in which 64%, 62%, 65.6% and 62% of participants respectively used family planning. The difference might be due to that study participants in Jimma zone, Rohtak and Mumbi were relatively residing in large city/town and this may help them to have a better access for family planning compared to the study done in South Achefer District.

In the current study, urban residents were more likely to use family planning methods (71.4%) than their rural counterparts (28.1%). This finding was in line with the findings from Ethiopian Demographic Health Survey (EDHS) [ 2 ]. This might be due to the reason that urban residents are more aware of family planning and hence practicing better.

It has also found that women who completed primary & secondary education were practicing family planning than those who were uneducated (77.1% and 20.6%) respectively. This finding was in line with a study done in Jimma, Ethiopia [ 19 ]. This might be due to the fact that women who were able to read and write would think in which FP activities are useful to be economically, self-sufficient and more likely to acquire greater confidence and personal control in marital relationships including the discussion of family size and contraceptive use.

This study showed that, age of the study participants had an association with practicing FP. Those reproductive age women’s whose age > 30 years were practicing family planning better than those whose age < 18 years. This finding was in line with a study done in India [ 20 ]. This might be due to the reason that, when age increases mothers awareness, attitude and practice towards family planning may increase. In addition, as age increases the chance of practicing sexual intercourse increases and as a result they would be interested to utilize family planning in one or another way.

It has also revealed that women’s average monthly household income has an association with their FP practicing habit. Those study participants whose average monthly income < 1000 ETB were using FP better than whose average monthly income > 3000 ETB. This is might be because those relatively who had better income may need more children and those with low income may not want to have more children beyond their income.

The current study also showed that knowledge and attitude of reproductive age women were related to FP utilization. Those reproductive age women who had good knowledge were utilized FP better than from those who were less knowledgeable. Those participants with favorable attitude were practicing better than those who had unfavorable attitude. This is might be due to the fact that knowledge and attitude for specific activities are the key factors to start behaving and maintaining it continuously.

Conclusion and recommendation

The level of knowledge and attitude towards family planning was relatively low and the level of family planning utilization was quite low in comparison with many studies.

Study participant’s residence, marital status, educational level, occupation, age, knowledge, attitude, their family size and their monthly average income were associated with FP utilization habit of reproductive age women.

Every health worker should teach the community on family planning holistically to increase the awareness so that family planning utilization will be enhanced.

Besides, more studies are needed in a thorough investigation of the different reasons affecting the non-utilizing of family planning and how these can be addressed are necessary.

Limitation of the study

As the data were collected using interviewer administered questionnaire, mothers might not felt free and the reported KAP might be overestimated or underestimated.

We do not used qualitative method of data collection to gather study participant’s internal feeling about family planning, so that triangulation was possible. In addition, barriers for utilizing contraception not addressed.

Abbreviations

Ethiopian Demographic Health Survey

Ethiopian birr

Federal Ministry of Health

family planning

knowledge, attitude and practice

World Health Organization. Standards for maternal and neonatal care. Geneva: World Health Organization; 2006.

Google Scholar  

Central Statistical Agency. Ethiopian Demographic and Health Survey 2016 key indicators report. Addis Ababa and Maryland, Ethiopia; 2016.

World Health Organization. Fact sheets on family planning, World Health Organization. https://www.cycletechnologies.com/single-post/2017/02/14/World-Health-Organization-Updated-Family-Planning-Contraception-Fact-Sheet . Accessed 8 Feb 2018.

United Nations. World contraceptive use, 2009 wall chart. New York United Nations Population Division: United Nations; 2009. http://www.un.org/esa/population/publications/contraceptive2009/contracept2009_wallchart_front.pdf . Accessed 3 Mar 2018.

Central Statistical Agency. Ethiopia Mini Demographic and Health Survey 2014. Addis Ababa; 2014. http://www.dktethiopia.org/publications/ethiopia-mini-demographic-and-health-survey-2014 . Accessed 12 Feb 2018.

Federal Ministry of Health. National Guideline for Family Planning Services in Ethiopia; 2011. http://www.moh.gov.et/documents/20181/21665/National+Family+Planning+Guideline_Ethiopia_2011.pdf/ . Accessed 17 Feb 2018.

Tilahun T, Coene G, Luchters S, Kassahun W, Leye E. Family planning knowledge, attitude and practice among married couples in Jimma Zone, Ethiopia. PLoS ONE. 2013;8(4):e61335.

Article   PubMed   PubMed Central   CAS   Google Scholar  

Menhaden AL, Khalil AO, Hamdan-Mansour AM, Sato T, Imoto A. Knowledge, attitudes, and practices towards family planning among women in the rural southern region of Jordan. East Mediterr Heal J. 2012;18(6):1–6.

Handady SO, Naseralla K, Sakin HH, Alawad AAM. Knowledge, attitude, and practice of family planning among married women attending primary health centerin Sudan. Int J Public Heal Res. 2015;3(5):243–7.

Gaur DR, Goel MK, Goel M. Contraceptive practices and related factors among female in predominantly rural Muslim area of North India. Internet J World Heal Soc Polit. 2008;5(1):1–5.

Oyedokun AO. Determinants of contraceptive Usage: lessons from Women in Osun State, Nigeria. J Humanit Soc Sci. 2007;1:1–14.

Lwelamira J, Mnyamagola G, Msaki MM. Knowledge, attitude and practice (KAP) towards modern contraceptives among married women of reproductive age in Mpwapwa District, Central Tanzania. Curr Res J Soc Sci. 2012;4(3):235–45. https://www.researchgate.net/publication/299488265 . Accessed 9 Feb 2018.

Gupta V, Mohapatra D, Kumar V. Family planning knowledge, attitude, and practices among the currently married women (aged 15–45 years) in an urban area of Rohtak district, Haryana. Int J Med Sci Public Heal. 2016;5(4):627–32.

Article   Google Scholar  

Sreytouch Vong. Knowledge, attitude and practice (KAP) of Family planningamong married women in BanteayMeanchey. Cambodia: Ritsumeikan Asia Pacifi c University; 2006.

Mahadeen AI, Khalil AO, Sato T, Imoto A. Knowledge, attitudes and practices towards family planning among women in the rural southern region of Jordan. East Mediterr Heal J. 2012;18(6):567–72.

Article   CAS   Google Scholar  

Quereishi MJ, Mathew AK, Sinha A. Knowledge, attitude and practice of family planning methods among the rural females of Bagbahara block Mahasamund district in Chhattishgarh State, India. Glob J Med Public Heal. 2017;6(2):1–7. http://www.gjmedph.com . Accessed 5 Mar 2018.

Khan MM, Shaikh STSA. Study of knowledge and practice of contraception in urban slum community, Mumbai. Int J Curr Med Appl Sci. 2014;3(2):35–41.

Prachi R, Das GS, Ankur B, Shipra J, Binita K. A study of knowledge, attitude and practice of family planning among the women of reproductive age group in Sikkim. J Obs Gynecol India. 2008;58(1):63–7. https://www.researchgate.net/publication/228480182 . Accessed 16 Apr 2018.

Beekle AT. Awareness and determinants of family planning practice in Jima, Ethiopia. Int Nurs Rev. 2006;53:269.

Article   PubMed   CAS   Google Scholar  

Mohanan P, Kamath ASB. Fertility pattern and family planning practices in rural area in dakshina Kannada. Indian J Com Med. 2003;28:15–28.

Download references

Authors’ contributions

AS: approved the proposal with some revisions, participated in data analysis. MT: wrote the proposal, participated in data collection analyzed the data and drafted the paper. NE: approved the proposal with some revisions, participated in data analysis. All authors read and approved the final manuscript.

Acknowledgements

We are very grateful to all study participants for their commitment in responding to our questionnaires.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

Not applicable.

Consent to publish

Ethics approval and consent to participate.

Ethical clearance was obtained from the Ethical Review Committee of Bahir Dar University, College of Medicine & Health Sciences, and School of Nursing. The objective and purpose of the study were explained to officials at the Woreda and Kebele (smallest governmental administrative division) and a written permission consent was obtained from the study participants. For those study participants whose age is below 18 years consent to participate in the study was obtained from their parent during the data collection time.

No fund was received.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Author information

Authors and affiliations.

Department of Nursing, College of Medicine & Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia

Ayele Semachew Kasa & Mulu Tarekegn

Department of Surgery, School of Medicine, College of Medicine & Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia

Nebyat Embiale

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Ayele Semachew Kasa .

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Cite this article.

Semachew Kasa, A., Tarekegn, M. & Embiale, N. Knowledge, attitude and practice towards family planning among reproductive age women in a resource limited settings of Northwest Ethiopia. BMC Res Notes 11 , 577 (2018). https://doi.org/10.1186/s13104-018-3689-7

Download citation

Received : 28 June 2018

Accepted : 06 August 2018

Published : 13 August 2018

DOI : https://doi.org/10.1186/s13104-018-3689-7

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Family planning

BMC Research Notes

ISSN: 1756-0500

• Submission enquiries: [email protected]
• General enquiries: [email protected]

Engineering student works to improve water infrastructure

Tolulope odunola is driven to make an impact in developing communities.

After earning her bachelor's degree in civil engineering at a premier university in Nigeria, Tolulope Odunola became fascinated by the world of hydrology and water systems and set off to continue her education in environmental engineering.

She came to the University of Cincinnati for her master's degree, and the experience left such an impact she stayed for her doctorate, working under the guidance of Patrick Ray, associate professor of environmental engineering.

Odunola was named Graduate Student Engineer of the Month by the College of Engineering and Applied Science. 

Why did you choose UC?

My journey to the University of Cincinnati was quite an interesting one. I grew up in Nigeria and after earning a bachelor's degree in civil engineering, I was convinced that I needed both the exposure and improved skillset that an overseas graduate education would provide. The University of Cincinnati was not on my list initially, but upon recommendation, I browsed through the school's website and faculty profiles in my program of choice. 

After I arrived at UC, I was captivated by the beautiful architecture on campus and the diversity of nationalities represented here.

Tolulope Odunola, Graduate Student Engineer of the Month

Tolulope Odunola

My quick survey of the university revealed that UC held much promise for my development academically and careerwise, so I did not delay in submitting my application for a master's degree in environmental engineering .

I applied to UC a few days before the deadline in 2019 and I am so glad I made the right choice. After I arrived, I was captivated by the beautiful architecture on campus and the diversity of nationalities represented here. 

Why did you choose your field of study?

I am pursuing my doctorate in environmental engineering after obtaining my master's degree in the same program in 2022. I have a bachelor's degree in civil engineering, and the little story of how I ended up in the field of engineering begins when I was in high school. Back then, I enjoyed science and mathematics, but I also loved fine arts and technical drawing, so I wanted a discipline that combined both innovative creativity and computation prowess. I explored the field of environmental design first and considered architecture, but I eventually decided on civil engineering, in part due to the broader scope of the field. 

As an undergraduate student, I learned about the environmental aspects of civil engineering. With time, water and environmental engineering began to stand out to me amongst other areas of specialization. I observed that there was still much room to contribute to the practice of environmental engineering in Nigeria, as well as to improve the standards, management, and sustainability practices of water resources and waste management systems. By the final year of my undergraduate program, I decided I would go onto graduate school to learn more about environmental engineering and gain skills in the area. This is how I ended up at UC in the Water Systems Analysis group under the supervision of Dr. Patrick Ray. 

Briefly describe your research work. What problems do you hope to solve?

Under the guidance of Dr. Patrick Ray, Tolulope Odunola has presented her research at several conferences, including the American Geophysical Union Fall Meeting.

My research is focused on improving the economic evaluation of water resource projects under changing climate conditions.

My goal is to make significant contributions to decision science. The design, planning and operation of water projects like irrigation dams and water supply networks is affected by climate change because the amount of water that will be available in the future for such projects is uncertain.

While climate science has advanced in recent years, there is still room for improvement to standard economic evaluation using climate vulnerability assessment methodologies.

My research aims to provide decision makers in water resources engineering with robust analysis frameworks, tools, and decision metrics for confident investment decisions under climate uncertainty. I am also exploring spatial and distributional equity considerations in economic evaluation under climate change.

Odunola is advised by Associate Professor of Environmental Engineering, Patrick Ray.

Research at UC has been positively demanding and rewarding. I am thankful for my adviser, Patrick Ray , who introduced me to the world of development projects planning, climate vulnerability assessment and decision science.

I have enjoyed working on practical projects, learning new skills, and collaborating with multidisciplinary project teams. For instance, I was funded by the Millennium Challenge Corporation for three years which introduced me to the work culture in a typical development agency.

I have learned to present my research to a non-technical audience and to understand and be considerate of different perspectives of water engineering systems modeling under climate change. I have had to think like an economist, an urban planner and an agronomist while building my hydrological models and approaching scenario analysis under climate change, for example.

I would say this is one of the blessings of graduate school — it eliminates myopic approaches to anything in life, research included. 

What are some of the most impactful experiences during your time at UC?

I have been privileged to attend and present at the American Geophysical Union fall meeting several times as well as the American Society of Civil Engineers' EWRI Congress. These conferences inspired and encouraged me to work harder on my research and make significant contributions to both science and industry. There was also the additional advantage of visiting and touring new cities during the conferences. 

Traveling for work and presentation sessions at the Millennium Challenge Corporation office in Washington, D.C., had a huge impact on me. I once toured D.C. with my family as a teenager. To return almost a decade later for work as a graduate student was amazing, to say the least. As you can expect, I took a selfie with a caption of my thoughts on the busy morning streets of D.C. and shared it with my family back home in Nigeria. 

What are a few of your accomplishments of which you are most proud?

Winning the Outstanding Student Presentation Award for the Hydrology Section at the AGU Fall Meeting in 2023, and the 2024 People's Choice Award at the University of Cincinnati's three-minute thesis competition are definitely at the top of my list.

I also have been a two-time recipient of the American Water Works Association Ohio Chapter Graduate Scholarship. Recently, I was awarded the Graduate Student Government Research Fellowship.

I am deeply grateful for the honor that accompanies these feats, but equally important and impactful was the process leading up to these awards during which I developed my research dissemination, writing, and presentation skills. 

When do you expect to graduate? What are your plans after earning your degree?

I aim to graduate within the next year and my plan is the same as it was in the fall of 2019 when I arrived at UC: to make an impact in human communities, one sustainable water resource project at a time. I look forward to being employed in the water industry as a water resource analyst and planner, and specifically I hope to work in an international development or foreign aid agency to provide developing countries with water infrastructure that is robust to uncertainties such as climate change. 

Do you have any other hobbies or involvements you'd like to share?

Outside of research, I enjoy reading historical fiction novels, creative writing, and exploring the beauty of nature. UC has also afforded me many leadership opportunities.

First, with the Nigerian Students' Association where I served as Secretary and three-time Electoral Committee Chairperson. Also, I have served for two tenures as the Vice President of my department's Graduate Student Association.

Plus, I had growth, leadership, and ministry opportunities by serving with Every Nation here at UC. I will always be grateful for the relationships I have made as a graduate student at UC; my church family, research group colleagues, Nigerian friends who made Cincinnati a home away from home, and several others too numerous to mention!

Featured image at top:  Tolulope Odunola is studying ways to improve the infrastructure that provides clean drinking water. He was named UC's Graduate Student Engineer of the Month by the College of Engineering and Applied Science. Photo/Pixabay

Interested in becoming an engineering Bearcat?

Check out the graduate programs offered by the College of Engineering and Applied Science. 

• Student Experience
• College of Engineering and Applied Science
• Chemical and Environmental Engineering
• Civil and Architectural Engineering and Construction Management

Related Stories

Engineering students showcase capstone projects at ceas expo.

May 6, 2022

Graduating engineering undergraduates from the University of Cincinnati’s College of Engineering and Applied Science gathered for the inaugural CEAS Expo in April to showcase their senior capstone projects to more than 500 attendees, including faculty, staff, alumni and industry representatives. The event, organized by the college and CEAS Tribunal student government, was held in downtown Cincinnati at the Duke Energy Convention Center.

Engineering students present senior capstone projects digitally

April 24, 2020

Engineering students present at third annual Expo

April 24, 2024

This spring, senior students at the University of Cincinnati's College of Engineering and Applied Science came together to present their final capstone projects at the third annual CEAS Expo. College faculty, staff, alumni and industry professionals attended the event to witness the innovation that is created at CEAS.