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Review of Related Literature

The continuing growth of the world population has become an urgent global problem.

Most of this growth is occurring in developing countries where the fertility rate is very high.

There is a growing effort in family planning and other fields of public health to modify

technology and programs to fit people, rather than modifying people to fit technology and


Understanding why people do not use family planning is critical to address unmet needs

and to increase contraceptive use. According to the Ethiopian Demographic and Health Survey

2011, most women and men had knowledge on some family planning methods but only about

29% of married women were using contraceptives. 20% women had an unmet need for family

planning. Tizla Tilahun and co. (2013) examined the knowledge, attitudes and contraceptive

practice as well as factors related to contraceptive use in Jimma zone, Ethiopia.. Results of the

study revealed that the concept of family planning was well known in the studied population.

Sex-stratified analysis showed pills and injectables were commonly known by both sexes, while

long-term contraceptive methods were better known by women, and traditional methods as well

as emergency contraception by men. Formal education was the most important factor associated

with better knowledge about contraceptive methods. The study also showed that the high

knowledge on contraceptives did not match with the high contraceptive practice in the study

area. The study demonstrates that mere physical access (proximity to clinics for family planning)

and awareness of contraceptives are not sufficient to ensure that contraceptive needs are met.

Thus, projects aiming at increasing contraceptive use should contemplate and establish better

counseling about contraceptive side effects and method switch. Furthermore in all family

planning activities both wives' and husbands' participation should be considered.

The Government of Kenya, nongovernmental organizations, and donors are dedicated to

promoting and improving easily accessible, affordable, acceptable, and effective family planning

methods. According to a study by Stevie M. Nangendo Institute of Anthropology, December


SERVICES these efforts have apparently paid off as recent demographic, health, and fertility

surveys show that knowledge of contraceptive use is nearly universal, and that over 90% of men

and women are aware of at least one family planning method. However, the unmet need for

contraception remains at approximately 26% in Kenya, suggesting that the right of Kenyan

couples to access sufficient information concerning their preferred birth control method and the

actual use of such methods have not been fully realized. His study focused on a cohort of women

utilizing health facilities in West Yimbo Division, western Kenya. The study suggested that

cultural beliefs that equate family planning methods with interference in fecundity and fertility

may argue against the use of these methods in the long term. Moreover, the desire to give birth

and nurture children, fear of side effects, bride wealth presentations, and disapproval by couples

and others may be stumbling blocks to contraceptive use in the study region.
Average contraceptive prevalence rate in the Nkwanta district of Ghana was estimated to

be 6.2% relative to the national average at the time, of 19%. While several efforts had been made

to improve family planning in the country, the district still had very low use of modern family

planning methods. A case control study to determine socio-economic, socio-cultural and service

delivery factors influencing family planning usage in the Nkwanta district of Ghana was

conducted by Sebastian Eliason1, John K Awoonor-Williams2, Cecilia Eliason3, Jacob

Novignon4,Justice Nonvignon5 and Moses Aikins5 (published August 2014). One hundred and

thirty cases and 260 controls made up of women aged 1549 years were interviewed using

structured questionnaires. A logistic regression was fitted. Results of the study showed

awareness and knowledge of modern family planning methods were high among cases and

controls (over 90%). Lack of formal education among women, socio-cultural beliefs and spousal

communication were found to influence modern family planning use. Furthermore, favorable

opening hours of the facilities and distance to health facilities influenced the use of modern


Ethiopia is the second most populous country in Africa with high fertility and fast

population growth rate. It is also one of the countries with high maternal and child mortality rate

in sub-Saharan Africa Family planning is a crucial strategy to halt the fast population growth, to

reduce child mortality and improve maternal health (Millennium Development Goal 4 and 5).

Mohammed 1 Desalegn Woldeyohannes3, Amsalu Feleke2 and Berihun Megabiaw4 conducted a

study (Published:3 February 2014 Abdurahman) to assess the prevalence and determinants of

modern contraceptive utilization among married women of reproductive age group in North Shoa

Zone, Amhara Region, Ethiopia. Modern contraceptive prevalence rate among currently married
women was 46.9%. Injectable contraceptives were the most frequently used methods (62.9%),

followed by intrauterine device (16.8%), pills (14%), norplant (4.3%), male condom (1.2%) and

female sterilization (0.8%). Multiple logistic regression model revealed that the need for more

children (AOR 9.27, 95% CI 5.43-15.84), husband approve (AOR 2.82, 95% CI 1.67-4.80),

couples discussion about family planning issues (AOR 7.32, 95% CI 3.60-14.86). Similarly,

monthly family income and number of living children were significantly associated with the use

of modern contraceptives. Modern contraceptive use was high in the district. The study

suggested that Couples discussion and husband approval of contraceptives use were

significantly associated with the use of modern contraceptives. Therefore, district health office

and concerned stakeholders should focus on couples to encourage communication and male

involvement for family planning.

Esabella Jobu Michael, BScNMaster of Public Health Dissertation Muhimbili University

of Health and Allied Sciences (November, 2011) conducted a cross-sectional study on

contraceptive methods use among 314 women and 20 service providers in ten wards from ten

health facilities.. Results: Thirty five percent of women in stable marital relations reported to be

using contraceptive methods. Highest (58%) use of contraceptives was reported among women

in formal employment. Factors found to be significantly associated with contraceptive use were:

education level, occupation, traditional cultural beliefs, and support from husband/partners and

access to information while religion, decision maker on desired number of children in the family

were not found to be significantly associated with the use of contraceptive methods. Conclusion:

Prevalence of contraceptive use among women in stable marital relations is 34.5% than that in

the general population of women with the age of 15 -49 years inKahama district (16%, 2011
district report). Socio-demographic factors like education level and occupation were found to

influence the use of contraceptive methods among women in stable marital relations. Moreover,

socio-cultural factors like religious beliefs and husband/partner support were also crucial in

influencing the use of contraceptive methods. Since this study did not involve men, further

studies are needed to determine the extent of use of contraceptive methods among men and


In the Philippines, poverty and reproductive health are headline issues in the Philippines

and were especially prevalent in the May 2010 elections. Candidates often talked about what

they will do for the poor, but expanding access to contraceptives has garnered limited political

support, despite the interrelationship between poor reproductive health and poverty.


AND MCH PORTFOLIO, National government support for FP has been inconsistent over the

last 25 years, with both its level and focus shifting depending on the preferences of the national

leadership. Health devolution dominated the 1990s, and high-level efforts to promote FP were

slowed down by the new and fragmented structure of the health sector. The period of 20012010

was defined by the Governments consistent support for the Catholic Churchs condemnation of

contraception. Instead, natural family planning (NFP) was promoted, and commitment to other

methods was lacking.

Using Multilevel Modeling to Capture Individual, Partner, and Couple-Level Effects

Mariana A. Preciado, Jennifer L. Krull, Jessica D. Gipson University of California, Los

Angeles,(2013) conducted a multilevel modeling of data from 238 couples who participated in

the 2005 Cebu Longitudinal Health and Nutrition Survey in the Philippines to assess the

individual-, partner-, and couple-level influences on mens and womens family planning

knowledge. Preliminary findings indicated that 17% of the total variance in family planning

knowledge across participants was between couples. Individual-level (e.g., female gender and

higher educational attainment) and couple-level variables (e.g., relationship duration, partnership

status, and greater church participation by female partner) were significantly associated with

greater knowledge of family planning methods, as compared to other couples. Subsequent

analyses will assess additional individual and couple-level covariates and cross-level

interactions. Preliminary results indicated that knowledge of family planning methods are

influenced by individual, partner, and relationship characteristics.

In her research Disadvantaged Women in the Philippines Hit Hardest by Lack of

Contraceptives J.M. Ian Salas(August 2013) looked at the gradual phase out of USAID's

contraceptive donations to the Philippines from 2004 to 2008, an action that severely cut the

supply of free contraceptives.4 This action was part of a broader effort by USAID to encourage

country ownership of family planning programs worldwide. Before 2004, more than two-thirds

of the country's modern contraceptive users relied on free supplies from the public sector, which

in turn relied entirely on donations from international aid agencieslargely USAIDfor its

contraceptive supplies. In a policy reversal, the newly installed president of the Philippines
decided not to fill the supply shortage because of her close ties to the local Catholic church,

which opposed the promotion and use of modern contraceptives.

Despite the phase-out of donated commodities, the Philippines' contraceptive prevalence

rate for modern methods (such as the pill and IUD) seemed to have barely moved: about 20

percent for all women and 33 percent for married women. However, the country's birth rate

actually went up three years after the phase-out started. Moreover, provinces that had the biggest

decline in the share of women that had provisions for free contraceptives also had the biggest

increase in provincial birth rates. These contrasting results suggest that because of inadequate

supplies of free contraceptives, some women may have experienced gaps in contraceptive use,

leading to increases in unintended pregnancies and in the birth rate. She tracked the quarterly

distribution of these contraceptive supplies to each province from 2000 to 2008, paying close

attention to possible gaps in availability because of shipment delays, lack of inventory, and

inconsistent delivery sizes; then linked this distribution data to data on women's reproductive

histories. She found that if a woman was poor or had little education, she was more likely to get

pregnant and have an unplanned birth after her province saw unexpected drops in free

contraceptive supplies. This finding implied that, unlike in Indonesia, Filipino women from

disadvantaged backgrounds could not easily cope with such a loss, however temporary, in free

family planning supplies. Research that may offer explanations for why certain groups of women

react differently to lack of subsidized access to contraceptive supplies is underway..

According to the 2011 FHS, the contraceptive prevalence rate (CPR) ranged from 23.5

percent in the Autonomous Region in Muslim Mindanao (ARMM) to 56.3 percent in Davao

Region. Modern or more effective methods were more likely to be used than traditional or less

effective methods in all regions (Table 3.4). ARMM had the lowest prevalence rate for modern

methods (19.1 percent).Educational attainment and contraceptive use are correlated; that is,

women with higher educational attainment are more likely to be using any form of contraception

than less educated women.