AN EXAMINATION OF THE ACCESSIBILITY, USE, MISUSE, AND EFFECTS OF COMBINED ORAL CONTRACEPTIVES AMONG WOMEN OF CHILD BEARING AGE

AN EXAMINATION OF THE ACCESSIBILITY, USE, MISUSE, AND EFFECTS OF COMBINED ORAL CONTRACEPTIVES AMONG WOMEN OF CHILD BEARING AGE

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BACKGROUND TO THE STUDY

Family planning and contraception are among the major topics being debated throughout the world. The production of as many offspring as possible was a major objective in early human cultures. Today, however, only a few cultures can afford this viewpoint, leading to growing efforts to control and regulate their families' birth rates, which Nigeria is no exception to. The detrimental effects of a high fertility rate on women and their offspring are well established, as are the benefits of fertility control (Dona et. al., 2008).

Africa has the lowest unemployment rate of any emerging area in the world, at 25%. (RAND, 1998; UNFPA, 2001). Around 36 percent of women in West Africa use contraceptives, with rates ranging from 22 percent in Mali to 26 percent in Togo, 32 percent in Burkina Faso, and 33 percent in Nigeria (Dona et. al., 2008, UNDP, 2008). Efforts by the Ministry of Health (MOH) and other organizations to improve contraceptive usage in Nigeria, a nation with many ethnic groups and religious groups, have resulted in a general increase during the previous two decades (Ann et al 2002, UNDP, 2008). In addition, the fertility rate has decreased from 6.4 percent in the 1970s to 4.4 percent in 2005. (UNDP, 2008).

Currently, 33% of married women in the country utilize contraception, despite the fact that 43% of married women want to space their children and another 24% need to restrict their births. The gap in the usage of family planning methods between urban and rural areas, as well as between affluent and poor women, puts many women in the poorest areas at a disadvantage (GSS, 2003). Since 1960, the use of contraceptives has assisted women in preventing around 400 million births globally, saving women's lives from high-risk pregnancies (Izale et al, 2014). Again, contraceptive techniques serve as effective prophylactics (disease preventers), and latex rubber and polyethylene condoms create a barrier against STIs and HIV/AIDS infection, which is spreading at an alarming rate in the nation (Harvey, 2000).

The accessibility, usage, misuse, and impact of combination contraceptives among women of childbearing age are the main concerns. Despite the fact that contraceptives have been widely used to prevent unplanned pregnancies and STIs, most societies do not tolerate their use by women of childbearing age.

CONCEPTS

Knowledge on contraceptives

The purpose of this part is to review information on contraceptive knowledge and awareness. Knowing about contraceptives is seen to be the first step toward instilling a willingness to use them. Takyi claimed in the year 2000 that contraceptive knowledge assessment not only determines the amount of awareness and sensitization, but also gives the context for future evaluation of the service. In this context, evaluation refers to the users' background variables, mostly social, that impact their levels of awareness and sensitization.

Oral contraceptives (OCs) were the most preferred type of contraception among sexually active Canadian women polled in 1998. (Fisher et al, 1998). Seventy-three percent of consumers at the time of the poll said they were very satisfied with the drug, despite widespread misconceptions. Few women were aware that taking the pill after the age of 35 was safe for nonsmokers and that it reduced the risk of some malignancies. Only 4% of those polled strongly thought that taking the pill posed less health risks than childbearing.

There appears to be a large disparity between what clinicians believe they deliver and what consumers appear to get, according to published data on the efficacy of contraceptive counseling and education. According to Rajasekar et al., family planning audit users in Scotland discovered a 30% disparity between the number of women doctors felt they had adequately counseled and the number of patients who really comprehended the education in 1999. In 1994, Oakley et al estimated that up to one-third of women require more tailored counseling to properly utilize oral contraceptives. By spreading the word about the various benefits of oral contraceptives, more women will be able to benefit from their excellent health impacts, which may lead to increased compliance (Jenseen et al 2000, Shulman et al, 2000.) It was observed that Canadian women on the pill's awareness of the pill's dangers, benefits, and side effects was lacking in numerous critical areas, but that counseling improved their knowledge.

Knowledge of family planning was defined operationally as having heard of a method in the current Nigeria Demographic Health Survey, 2003. According to the poll, which employed an interviewer prompt approach, 98 percent of women and 99 percent of men knew about contraception (GSS, 2003), with these proportions representing Nigerians who knew at least one type of contraception. Over the last decade and a half, our understanding of contemporary and traditional contraception has evolved. While the latter was formerly popular among Nigerians, the former is currently, despite the fact that most contraception users still utilize conventional methods (Clemen et al 2004, Hoque, 2007).

Condoms were cited by 43 percent of women in a cross-sectional poll in Kinshasa, Democratic Republic of Congo; the Pill was cited by just 28 percent, injectables 16.2%, IUD 8%, spermicidal foam 2%, and the diaphragm by less than 2%. Teenagers and young adults (15–24 years old) have a limited understanding of current approaches (Kayembe et al, 2003). Condoms, diaphrams, the pill, implant, foam tablet, and lactational amenorrhoea were among the ways often identified by unmarried women with a 100% awareness of their use.

In a study of gender problems surrounding contraceptive usage in Ebo State, Nigeria, Osaemwenkha found that educated and sexually active adolescents had a broad understanding of contraceptives, and that this knowledge correlated with the number of methods known (Osaemwenkha, 2004). Obviously, having a broad knowledge base does not guarantee that a person has had appropriate exposure to contraceptive use, since other factors influencing decision-making might impact whether or not contraceptives are used. Despite the fact that Osaewenkha believed his respondents, 800 university female students, had sufficient information, he observed that even among the enlightened, the male participation component is critical in contraceptive usage decision-making.

Socio-economic Characteristics on decision to use Contraceptives

This section examines the impact of socioeconomic factors on contraceptive use decisions. Prospective users in the nation are debating whether or not to take contemporary contraception. The intensity of the interplay of impacts from strong familial relationships is the source of these challenges. The author Benefo claimed in 2005 that a woman's level of economic dependent on her near relatives influences her decision to use contraception. The sort of employment a woman does and the amount of money she earns have a substantial relationship with contraceptive usage (Baiden, F., 2003; Sign, et al, 2003).

Many experts have pointed out that this is a stolen term from the west that has been adapted to the African context. The impact of close and external relationships on their lives, as well as their socioeconomic status (White, 2002), necessitates a thorough investigation (RAND, 1998; White et al, 2002; Awusabo-Asare, 2004; Solo et, al 2005). Women's educational attainment and socioeconomic situation have been found to have a direct impact on their fertility decisions (White, 2002).

Education has been proven to be the most important contributing factor in various research on modernity and fertility. Because education impacts individuals' attitudes and behavioral habits, it may have a direct impact on fertility. Lactational amenorrhoea, which can last up to three years in some cultures, allows for longer birth intervals, reducing fertility in these women (McNeilly, 1979). The economic value placed on children encourages poor people to have more children. Studies have found a close and significant link between contraceptive use and fertility desires throughout the last few decades. Because there is evidence that fertility behavior differs with diverse cultural environments, Das and Deka (1982) looked at cultural influences in fertility. In 1983, Narayan Dast looked at the socio-cultural factors that influence fertility.

In this period of fast population increase, as Anand (1968) and Chandrasekhar (1972) put it, family welfare programs, their reception, effect, and utility have altered fertility in every country. Because of the government's birth control program, the government makes extensive efforts to disseminate various family welfare measures. The program inputs are responsible for the results produced so far in this approach. Apart from cultural variables such as non-availability and/or lack of knowledge, attitudes toward desired family size, and traditional beliefs and practices, traditional beliefs and practices play an essential role in family planning.

Several KAP studies have been conducted, each focusing on a distinct population group. In their research of rural Rajputs and Scheduled Castes (SCs), Gautama and Seth (2001) discovered that increasing education, in addition to offering awareness about contraceptive techniques, helped to improve acceptability of family control devices. Other investigations in this vein have been conducted among tribal and rural people (Meerambika Mahapatro et al, 1999; Sushmita and Bhasin, 1998 and Varma et al, 2002). However, in terms of family planning, the national program should include group-specific and area-specific interventions. In light of this, the report attempted to investigate the 'knowledge and practice of contraception' among Racha Koyas, an Andhra Pradesh tribal tribe.

In this regard, it's worth noting that, according to the 'National Health Policy,' tribal groups require special care because they are deemed a "unique category." These factors, among others, contribute to the idea that contraception is a human rights problem. This notion not only empowers women to take control of their reproductive lives, but also to build their independence from others in order to secure their own and their children's overall well-being.

Duodo and colleagues suggested that inequitable resource distribution to the disadvantage of rural areas influences contraceptive usage in Offinso, Nigeria, while discussing the allocation of financial resources in connection to AIDS and family planning techniques use (Duodo et al, 1998). Solo and colleagues found that traditional beliefs, men's animist rights, and poverty all affect health decision-making, including the use of contraception, in a research on empowering women in Navrongo and its surrounds, Nigeria (Solo and others., 2005).

Others, however, have found contradictory relationships between contraceptive usage and socioeconomic characteristics. Respondents' age, type of residence, religion, ethnicity, desire for more children, marital duration, availability of electricity in the household, husband's approval of contraception, husband's education, and occupation have no significant effects on current contraceptive use in Nigeria, according to Tawiah's study (Tawiah, 1997).

1.2 Statement of the problem   

Oral contraceptives side effects in Nigeria in the contemporary time have become an issue that casts a gloomy shadow to the entire society especially among women. The case is not different among women in rivers state. During community posting experience in Alu health center, the researcher witness cases of high blood pressure, urinary tract infection, blood clotting, migraines, gall bladder disease, delay in pregnancy and infertility in women which were associated with contraceptives use (Haffiz et al, 2016). Today, Nigeria has one of the highest maternal mortality rates in the world and this has largely been attributed to lack of knowledge of contraceptives use to prevent the potential risks (Stover& Rose 2009). . However, only the women comprehensive knowledge onontraceptive use, risk  will be able to take appropriate  measures to prevent and manage side effect and associated risk. Acquiring knowledge about contraceptives is the best way to prevent potential risk and manage side effects. Women therefore need knowledge to prevent this risks and manage side effects, and make suitable contraceptive choices based on their health status. of contraceptive uses and be able to consider their health status in order to choose an appropriate and suitable Oral contraceptive (Bruce &Rymer, 2009). Deborah, Ikhena, & Julia (2012), observed that the necessity for women to be  exposed to contraceptives options as early as 18.

 Majority of women in Rivers State are facing some health challenges due to some types of contraceptives or after using it especially if women lack knowledge of choosing the right method that is suitable for their body. Some contraceptives increase the risk of developing blood clots, which can result into stroke (Ibisomi, 2014). If a woman has high blood pressure, she needs to take this into consideration before using contraceptives. Other serious potential risks that accompany contraceptives are increased risk of cervical and breast cancer, increased risk of heart attack and stroke, migraines, high blood pressure, gall bladder disease, benign liver tumors, decreased bone density, yeast overgrowth and infection, increased risk of blood clotting and infertility. The dangers for use of oral contraceptives in women above age of 35 includes Smoking, Hypertension, History of thromboembolism, or Stroke (Rebecca, Charles &Norris 2012). Inadequate knowledge and lack of relevant information and education on preventive measure is a major barrier to women of reproductive age. Women often are not fully aware of their contraceptive choices.  

 According to Guttmacher (2008), women may not use contraception consistently because of problem they are facing such as lack of knowledge of their chosen method, infrequent sexual activity, and ambivalence about pregnancy, misperceptions about pregnancy risk, wrong information from friends and family members and lastly, self medication. Addressing these and other barriers to the use of effective contraception through health talks is key to helping women prevent contraceptives risks (Lee, Parisi, Akers, Borrero, & Schwarz, 2011). Currently, there are several entities that want to include health talks on knowledge and prevention of contraceptive risk, despite that contraceptives are used for child spacing, they also have their own side effects, such as increase in cardiovascular event especially in older women and smokers, increase in human papillomavirus (HPV) infection , breast cancer and an increase in cervical cancer, which is the second most common cancer worldwide (Harper, Brown, Foster-Rosales & Raine, 2010). Therefore, oral contraceptives fail the most important test of preventive medicine: they increase the risk of disease instead of decreasing it. Based on the above discoveries, the researcher is motivated to conduct a research among others to assess the awareness of contraceptive side effect and coping strategies used in its management among women in Aluu local government area, Rivers State.

1.3 Objectives of the study

The purposes of this study are to:- topic

1. To identify the types of Oral contraceptive methods practices among women in Aluu local government area, Rivers state.
2. To examine the knowledge on side effects of Oral contraceptives use among women in Aluu local government area, Rivers State;
3. To investigate the management strategies of Oral contraceptives side effects used by women in Aluu local government area, Rivers State;

1.4 Research Questions

1. What are the types of Oral contraceptives methods practices among women in Aluu local government area, Rivers state?
2. What is the knowledge on the side effect of Oral contraceptives among women in Aluu local government area, Rivers State?
3. What are the management strategies of Oral contraceptives methods practices of among women in Aluu local government area, Rivers State?

1.5 Significance of the Study

The finding of the study will be significant in the following ways:

1. Women in Rivers State will have knowledge on the risks of contraceptives due to regular health talks during antenatal and postnatal clinics.
2. It will help women in Rivers State to understand ways of preventing contraceptives side effects after it has been discussed by heath care providers.
3. It will benefit women of different age groups in Rivers State when

Non governmental organizations address the side effects involved in contraceptives uses.

1. It will motivate women of different age groups in Rivers State to take preventive measure while using contraceptives after attending health talks by health care providers and nongovernmental organizations.  
2. It will allow women of different marital status in Rivers State to gain more knowledge on contraceptives side effects through Medias such as radio and televisions.
3. It will encourage women of different marital status in Rivers State to take preventive measure and choose the natural method of contraceptives to prevent all health hazards associated with other artificial contraceptives.

1.6 Scope of the Study

The study will aim at examining the knowledge of the Oral contraceptives side effect and it management strategies in reducing it side effects. The study will focus on women of reproductive age between 15-50 years that were present as at the time the survey was conducted. The study will focus on only the side effect of Oral contraceptives, women who have not used Oral contraceptives will be excluded from the study.

1.7 Operational Definition of Terms

Knowledge of Oral contraceptives side effects; This include the level of awareness or knowledge at which the study population possess on the harmful or side effect of using Oral contraceptives i.e knowing the side effect of the after use of Oral contraceptives.

Management strategies of side effect; It is the coping strategy adopt by women of reproductive age to reduce the side effect of Oral contraceptives.

Women of Reproductive Age; A woman of reproductive age is usually between the ages of 15- and 44-years old. These ages are a guideline and women can have babies earlier and later than the years indicated. A woman of reproductive age is typically considered fertile.

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