WOMEN'S EMPOWERMENT AND FAMILY PLANNING: A REVIEW OF THE LITERATURE

Affiliations.

  • 1 *Bixby Center for Population,Health and Sustainability,University of California,Berkeley,USA.
  • 2 †University of California,San Francisco,USA.
  • 3 ‡Fielding School of Public Health,University of California,Los Angeles,USA.
  • 4 §University of Southern California Keck School of Medicine,Los Angeles,USA.
  • 5 ¶UCSF/UC Hastings Consortium on Law,Science and Health Policy,San Francisco,USA.
  • 6 #University of California,San Francisco,USA.
  • PMID: 28069078
  • PMCID: PMC5503800
  • DOI: 10.1017/S0021932016000663

This paper reviews the literature examining the relationship between women's empowerment and contraceptive use, unmet need for contraception and related family planning topics in developing countries. Searches were conducted using PubMed, Popline and Web of Science search engines in May 2013 to examine literature published between January 1990 and December 2012. Among the 46 articles included in the review, the majority were conducted in South Asia (n=24). Household decision-making (n=21) and mobility (n=17) were the most commonly examined domains of women's empowerment. Findings show that the relationship between empowerment and family planning is complex, with mixed positive and null associations. Consistently positive associations between empowerment and family planning outcomes were found for most family planning outcomes but those investigations represented fewer than two-fifths of the analyses. Current use of contraception was the most commonly studied family planning outcome, examined in more than half the analyses, but reviewed articles showed inconsistent findings. This review provides the first critical synthesis of the literature and assesses existing evidence between women's empowerment and family planning use.

Publication types

  • Communication
  • Contraception Behavior
  • Decision Making
  • Developing Countries*
  • Family Characteristics
  • Family Planning Services*
  • Gender Identity*
  • Needs Assessment
  • Power, Psychological*
  • Women's Rights

Grants and funding

  • K01 HD067677/HD/NICHD NIH HHS/United States
  • K01 HD077064/HD/NICHD NIH HHS/United States
  • KL2 RR024130/RR/NCRR NIH HHS/United States
  • 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

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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.

figure 1

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 ).

figure 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

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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/ .

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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.

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Ghzl Ghazi Alenezi

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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

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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.

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Correspondence to Hassan Kasim Haridi .

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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.

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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

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  • Contraceptives
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literature review on family planning

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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

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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.

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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.

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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.

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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

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literature review on family planning

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A narrative review of evidence to support increased domestic resource mobilization for family planning in Nigeria

  • Chinyere Ojiugo Mbachu 1 , 2 ,
  • Ifunanya Clara Agu   ORCID: orcid.org/0000-0001-9048-064X 1 ,
  • Chinazom N. Ekwueme 1 , 2 ,
  • Anne Ndu 2 &
  • Obinna Onwujekwe 1 , 3  

BMC Women's Health volume  23 , Article number:  235 ( 2023 ) Cite this article

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Family planning (FP) is an important public health intervention that is proven to reduce unplanned pregnancies, unsafe abortions, and maternal mortality. Increasing investments in FP would ensure stability and better maternal health outcomes in Nigeria. However, evidence is needed to make a case for more domestic investment in family planning in Nigeria. We undertook a literature review to highlight the unmet needs for family planning and the situation of its funding landscape in Nigeria. A total of 30 documents were reviewed, including research papers, reports of national surveys, programme reports, and academic/research blogs. The search for documents was performed on Google Scholar and organizational websites using predetermined keywords. Data were objectively extracted using a uniform template. Descriptive analysis was performed for quantitative data, and qualitative data were summarized using narratives. Frequencies, proportions, line graphs and illustrative chart were used to present the quantitative data.

Although total fertility rate declined over time from 6.0 children per woman in 1990 to 5.3 in 2018, the gap between wanted fertility and actual fertility increased from 0.2 in 1990 to 0.5 in 2018. This is because wanted fertility rate decreased from 5.8 children per woman in 1990 to 4.8 per woman in 2018. Similarly, modern contraceptive prevalence rate (mCPR) decreased by 0.6% from 2013 to 2018, and unmet need for family planning increased by 2.5% in the same period. Funding for family planning services in Nigeria comes from both external and internal sources in the form of cash or commodities. The nature of external assistance for family planning services depends on the preferences of funders, although there are some similarities across funders. Irrespective of the type of funder and the length of funding, donations/funds are renewed on annual basis. Procurement of commodities receives most attention for funding whereas, commodities distribution which is critical for service delivery receives poor attention.

Nigeria has made slow progress in achieving its family planning targets. The heavy reliance on external donors makes funding for family planning services to be unpredictable and imbalanced. Hence, the need for more domestic resource mobilization through government funding.

Peer Review reports

More than 200 million women in developing countries want to avoid or delay pregnancy. Yet, they lack access to effective and safe family planning services [ 1 ]. In Nigeria, fewer than two out of every ten married women use modern contraceptives, and 19% of women have an unmet need for family planning [ 2 ]. The reasons for this include supply-side issues such as unavailability of FP services and information, and demand-side issues such as lack of funds and poor support from partners or communities [ 2 ]. Limited access to FP services prevents women of reproductive age from delaying pregnancy, limiting family size and safe spacing [ 3 , 4 , 5 , 6 ].

In order to address the socio-cultural issues that limit access to family planning services, the Federal government designed a strategy for engaging with stakeholders to discuss issues about large family size, religious beliefs, and women's power to make decision about their sexual and reproductive health [ 7 ]. This approach has been effective in addressing some of the cultural barriers to contraception and the increase in contraceptive use in some communities in Nigeria has been attributed to the involvement of community leaders to promote family planning [ 8 ].

Family planning (FP) is an important public health intervention that is proven to improve maternal and child health outcomes by reducing unplanned pregnancies and unsafe abortions [ 9 , 10 , 11 , 12 , 13 ]. To ensure progressive improvements in maternal and child health outcomes through family planning, there is need for sustained and dedicated funding of family planning programmes [ 14 , 15 ]. Evidence from the United States international family planning assistance in 2014 showed that investments in family planning services and contraceptive supplies saves millions of lives [ 16 ]. Through improving access to contraceptives for 30 million women and couples, 7 million unintended pregnancies, 2 million unsafe induced abortions and 13 thousand maternal deaths were averted [ 16 ].

In Nigeria, the national budget for family planning was cut short by 90% in 2019, owing to lack of counterpart funding to match grants from donors [ 17 ]. This resulted in the stock-out of contraceptive commodities in the primary health centers, and worsened access to family planning services for women [ 18 ]. Moreover, with the withdrawal of donor funds, domestic resource mobilization (DRM) for family planning services and contraceptive supplies became an urgent need for the Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) program in Nigeria to improve [ 2 ]. Granted that increasing investments in FP would ensure stability and better maternal health outcomes in Nigeria, evidence is needed to make a case for more domestic investment in family planning.

Evidence generation is a critical component of the National and State roadmaps for improved domestic resource mobilization for family planning in Nigeria [ 19 ], and reliable evidence is needed to motivate policymakers and domestic funders to allocate more resources towards family planning services and contraceptive supplies. Therefore, we undertook a literature review to determine the unmet needs for family planning and analyze the funding landscape in Nigeria, with a view to highlight the need for increased domestic funding of family planning services. The findings will be invaluable to policymakers and family planning program officers in advocating for domestic funding for family planning interventions .

We undertook a narrative review of literature from February to May 2022 to generate evidence that showcases the need to allocate more domestic funds to family planning services in Nigeria.

Our review sought to answer two key questions,

What is the unmet need for family planning in Nigeria?

How is the family planning programme in Nigeria funded, and what does this imply for reliability and predictability of funding?

To answer these questions, we analyzed the trends in fertility rate and contraceptive prevalence rate from 1990 to 2018 and estimated the gaps in wanted and actual fertility. Then we undertook a funding landscape analysis using the bespoke framework that highlights the types and characteristics of funding organizations (in terms of reliability and predictability), as well as their interests or areas of funding.

Document search

Electronic search was performed on Google Scholar, organizational websites and blogs to source for relevant documents, such as peer-reviewed articles, reports from national surveys, and reports from family planning programmes and interventions.

The reports from the Nigeria Demographic and Health Survey (NDHS) were collated from 1990 to 2018, while the reports for the Multiple Indicators Cluster Survey (MICS) were collated for 1999 to 2016. Peer-reviewed journal articles and website articles that were published in English language from January 2008 to June 2021 were included in the review, and the scope of the review was limited to Nigeria only. The search for articles was performed using various combination of key terms including, “family planning”, “contraceptives”, “fertility rate”, “contraceptive prevalence rate”, “financing”, “funding landscape”, “funders”, “unmet need”, “unwanted pregnancy”, “family planning investment”.

A total of 30 documents were reviewed including, 16 journal articles, ten web blogs, and six national survey reports [ 2 , 7 , 8 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ].

Data extraction and synthesis

Data were objectively extracted by two independent researchers using a uniform template that was designed in Microsoft Excel.

The template was structured according to themes, including a description of the article under review, and the findings from the review were synthesized according to the thematic areas, namely,

Fertility rates

Contraceptive prevalence rates

Variations in fertility and contraceptive prevalence rates

Nature of funding, including

◦ Name and type of funding organization

◦ Interest of funding organization (areas/aspects of family planning services that are funded)

◦ Type of funding (e.g., grant, loan)

◦ Duration of funding

◦ Funding route (e.g., third party financing, direct facility financing, etc.)

◦ Conditions of funding (e.g., counterpart funds, results-based)

Narrative summaries are presented for the qualitative data. Proportions are reported for quantitative data.

Trends in fertility rates

Figure  1 shows that the total fertility rate in Nigeria has gradually declined over time from 6.0 children per woman in 1990 to 5.3 in 2018, and that the wanted fertility rate has decreased from 5.8 children per woman in 1990 to 4.8 per woman in 2018 [ 2 , 20 , 21 , 22 , 23 , 24 ].

figure 1

Trends in total fertility rates and wanted fertility rates in Nigeria from 1990 to 2018

However, the gap between wanted fertility and actual fertility has increased over time from 0.2 in 1990 to 0.5 in 2018. This signifies that a Nigerian woman has 0.5 more children than she wants to have.

Trends in contraceptive prevalence rate and unmet need for family planning

As shown in Fig.  2 , modern contraceptive prevalence rate (mCPR) improved from 3.5% in 1990 to 12.0% in 2018, which indicates an increase of 8.5% in 28 years [ 2 , 20 , 21 , 22 , 23 , 24 ].

figure 2

Trends in modern contraceptive prevalence rate among currently married women and all women in Nigeria from 1990 to 2018

This translates to a yearly increase of 0.3%, which if sustained will not result in the achievement of the country’s mCPR target of 27% by 2024 [ 19 ].

Even though mCPR is traditionally reported for currently married women, it is noteworthy that mCPR among all women decreased from 11.1% in 2013 to 10.5% in 2018.

Figure  3 shows that the unmet need for family planning among currently married women reduced by 3.9% in 2003 and increased by 3.3% in 2008; and has since followed the pattern of falling and rising. Between 2013 and 2018, unmet need for family planning increased by 2.8% [ 2 , 21 ].

figure 3

Trend in percentage of currently married women with unmet need for family planning from 1990 to 2018

Geographic variations in fertility and contraceptive prevalence rates

Over time, total fertility rate has been consistently higher in the rural areas compared to the urban areas, whilst mCPR has been higher in urban areas than in rural areas, expectedly.

Wide variations in TFR are also seen across geopolitical zones, with the northern zones having substantially higher rates than the south. It is noteworthy that over the years, the southern zones have consistently had lower fertility rates than the national average. Women in the north-east and north-west geopolitical zones reported having an average of two more children than their counterparts in the south.

Regarding contraceptive prevalence, there are wide regional variations in mCPR across the geopolitical zones and the States. The northern zones have consistently reported lower mCPR than the south, and the north-east and north-west geopolitical zones have had the lowest mCPR in the north.

These geographic disparities in fertility rates and mCPR are summarized in Tables 1 and 2 , respectively.

Funding landscape for family planning in Nigeria

Federal government budgetary allocation to family planning (2015 to 2020).

Family planning was not an item in budgets before 2015. Allocation by federal government to FP was on the increase from 2015 when line listing for family planning commenced in the national budget. However, there was a sharp decline in 2019 due to the removal of counterpart funding to match grants from international donor agencies which was budgeted for in 2018. See Table 3 below.

Typologies of funding organization

Funding for family planning services in Nigeria comes from both external and internal sources in the form of cash (grants or loans) or commodities. Internal sources of funding include the Federal and State governments, while external sources include multilateral and bilateral international organizations, and international Non-Governmental Agencies.

The key international and donor agencies that fund family planning services in Nigeria are shown in Fig.  4 , and the size of the circle indicates the relative contribution of the funder to family planning services in Nigeria.

figure 4

External sources of funding for family planning in Nigeria

UNFPA is the major funder of family planning services in Nigeria, followed by the USAID. UNFPA provides family planning assistance in 19 States plus the Federal capital territory (FCT), while USAID partners with a variety of non-governmental and community-based organizations across the 36 States and the FCT [ 31 ].

Nature of funding (type, duration, routes and conditions for funding) for family planning

The nature of external assistance for family planning services depends on the preferences of funders, and whether the funding is in form of cash or commodities. External assistance in the form of grants and loans are typically provided to only Federal or State governments, while commodities are provided to public and/or private health facilities through government agencies or implementing partners.

Table 4 shows some similarities and variations among funding agencies in funding for family planning services. With the exclusion of the Saving One Million Lives Programme for Results (SOML PforR), government funding for family planning has been in the form of annual budgetary allocations. Whereas funding from external donors has been in the form of grants. Irrespective of the type of funder and the length of funding, donations/funds are renewed on annual basis.

Various funding routes are employed by external donors, notably the supply of family planning commodities through the State governments or through implementing partners.

Counterpart funding and output-based financing are the two most common conditions for funding.

Interests of funding organization (areas/aspects of family planning services that are funded)

The areas or aspects of family planning services that are funded by international organizations and non-government agencies include, (i) procurement of commodities; (ii) distribution and supply chain management (SCM); (iii) training of health workers; (iv) demand creation and community mobilization; (v) other advocacy interventions; and (vi) research. Whereas, government funding is used to procure and distribute commodities, and pay the salaries of health workers.

Table 5 shows that procurement of commodities receives the most attention for funding, while demand creation and research receive the least attention. It is also noteworthy that although State governments are primarily responsible for the distribution of commodities, many States do not allocate or release funds for this purpose. Hence, it can be said that this critical aspect of family planning services is very poorly attended to in Nigeria, and this may well explain the problems of unavailability of commodities at service points.

The Nigerian government maps out funds for the procurement and distribution of FP commodities to States. About US$4 million was approved in 2021 for the procurement of family planning commodities [ 32 ].

The UNFPA is primarily involved in the procurement of family planning commodities for the public sector. It also provides technical assistance to focus States in the form of training of health workers [ 26 ].

The U.S. Agency for International Development (USAID) is a bilateral organization that partners with NGOs to provide FP commodities to both public and private healthcare providers. It also funds programs that seek to improve the quality of FP services and to hold State governments’ accountable to ensuring that FP commodities reach the last mile [ 25 , 26 ]. The efforts of the USAID-funded Health Policy Plus’ advocacy to Cross-River State government resulted in the allocation of $600,000 for the distribution and security of FP commodities in 2013 and 2014 [ 25 ].

The (UK) Department for International Development (DFID) provides the majority of the FP commodities that are supplied to private healthcare providers in Nigeria [ 27 ].

Society for Family Health (SFH) and DKT International are social marketing organizations that provide and distribute FP commodities to private facilities [ 25 , 27 , 30 ] . They are also involved in advocacy and training of health workers with primary focus on private providers [ 26 , 30 ] .

Marie Stopes International offers a wide range of sexual and reproductive health services including FP to communities in urban locations, and it has become a major provider of long acting and permanent contraception in health facilities. The organization delivers FP services through static clinics, mobile outreach teams and social franchising [ 46 , 47 ].

The Gates Foundation focuses on the public sector, and its donations have been used to procure FP commodities [ 26 ]. Through the funding that was provided for the Nigeria Urban Reproductive Health Initiative (NURHI), access to FP commodities and services increased in the six intervention cities, resulting in an increase of mCPR by 20% in three years [ 8 , 26 , 29 ].

Conclusions

Ensuring that every sexually active woman in Nigeria has access to high-quality family planning and contraceptive services is imperative as it save lives and promotes positive maternal health outcomes. Our review highlights that Nigeria’s progress in achieving the targets of family planning has been slow and inconsistent, owing to poor government funding of family planning services. Additional to inadequate government funding of family planning intervention in Nigeria, there is a very wide gap between the estimated cost and the actual allocation of funds for procurement and distribution of family planning commodities [ 37 ]. For instance, between 2012 and 2016, the Federal government fulfilled only 11% of its FP2020 pledge to provide US$3 million annually for the procurement of family planning commodities [ 37 ].

According to the 2016 Appropriation Act, the government is referred to as provider of “counterpart” funding for family planning [ 37 , 48 ]. This means that while donors serve as principal sources of funds, the government serves as a secondary funder of family planning intervention. However, with the ongoing withdrawal of donors and decline in donor contributions, there is a need for government to take on the role of principal funder of family planning in Nigeria [ 49 , 50 ].

Although the Federal government prioritizes family planning interventions by making provisions in the annual budget and earmarking funds through special interventions (such as the SOML-PfR), the funding landscape for family planning interventions at the subnational level is dominated by external donations which are short-lived, unpredictable (in terms of amount and timing), and focused on a single area which is the procurement of commodities [ 51 ]. The nature of external funding influences subnational planning and effective implementation of family planning services. Program managers find it difficult to make or execute plans when they cannot rely on the amount of money or quantity of commodities that will be available. Moreover, the only guarantee that family planning commodities will reach the last mile of distribution is that State governments honor their commitments to funding the distribution and supply chain management system.

Currently, State governments feature minimally in the funding for family planning services, as service delivery is primarily driven by the commodities supplied by external donors and the fee-for-service payments that are made by clients [ 37 ]. The health budgets of many States in the country lump family planning intervention with reproductive health, and this increases the likelihood that family planning services will be overlooked in the budgetary allocations. The ongoing global advocacy for programme-based budgeting as a tool for increasing transparency, accountability and data-driven decision making, provides an opportunity for family planning to be categorized as a stand-alone programme.

Evidence from this review validates the need for the Federal and State governments, particularly, to step-up and take on a greater share of the responsibility for financing family planning intervention, including the procurement and supply of commodities, and service delivery. The advent of the Basic Health Care Provision Fund in Nigeria in which one percent of consolidated revenue fund is earmarked for provision of health services at the primary health care level provides an opportunity for further earmarking a percentage of this fund for family planning at the primary and local government levels. Domestic funding of FP can further be improved by earmarking at least one percent of the annual health budget to funding of FP programs.

However, this is a review article, and the findings may have been influenced by the following factors, (i) the personal viewpoints of the reviewers; (ii) the omission of relevant research due to literature search procedures; and (iii) errors in the translation of data from the primary source. Moreover, the estimates presented in this paper should be interpreted with caution since some of them are based on older available data.

In conclusion, Nigeria has made slow progress in achieving its family planning targets. Over a period of 28 years, total fertility rate declined by 0.7 children per woman, wanted fertility rate decreased by 1, and the gap between wanted fertility and actual fertility increased by 0.3. Over a five-year period, mCPR decreased by 0.6%, and unmet need for family planning increased by 2.5%. Nigeria still relies heavily on external donations for family planning intervention. This makes funding for family planning services to be unpredictable and imbalanced. This highlights the need for increased budgetary allocation and actual release of funds for FP interventions at national and subnational levels. Improving domestic resource contributions to family planning would contribute to improvements in service delivery, because more funds will be available to ensure procurement and uninterrupted supply of sufficient amounts of contraceptive commodities to the last mile. These findings are invaluable to policymakers and family planning program officers for advocating for more funding for family planning interventions . A detailed financial analysis is required to identify opportunities to leverage within the fiscal space to mobilize resources for family planning. Family planning programme managers will also require capacity building on how to use evidence to advocate for more domestic resources for family planning.

Availability of data and materials

The study dataset is available on request.

Abbreviations

Family Planning

Modern Contraceptive Prevalence Rate

Domestic resource mobilization

United Nations Fund for Population Activities

Saving One Million Lives Programme for Results

United States Agency for International Development

Department for International Development

Society for Family Health

Family planning. [ https://www.unfpa.org/family-planning ]

National Population Commisison (NPC) [Nigeria], ICF Macro. Nigeria Demographic and Health Survey 2018. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF; 2019.

Google Scholar  

Sinai I, Omoluabi E, Jimoh A, Jurczynska K. Unmet need for family planning and barriers to contraceptive use in Kaduna, Nigeria: culture, myths and perceptions. Cult Health Sex. 2020;22(11):1253–68.

Article   PubMed   Google Scholar  

Girma Garo M, Garoma Abe S, Dugasa Girsha W, Daka DW. Unmet need for family planning and associated factors among currently married women of reproductive age in Bishoftu town, Eastern Ethiopia. PLoS One. 2021;16(12):e0260972.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Phiri M, Odimegwu C, Kalinda C. Unmet Need For Family Planning Among Married Women. In: Sub-Sahara Africa: A Meta-Analysis of DHS Data (1995–2020). 2022.

Pasha O, Goudar SS, Patel A, Garces A, Esamai F, Chomba E, Moore JL, Kodkany BS, Saleem S, Derman RJ, et al. Postpartum contraceptive use and unmet need for family planning in five low-income countries. Reprod Health. 2015;12(2):S11.

Article   PubMed   PubMed Central   Google Scholar  

FP2020: Over 6.5 million women now use a modern method of contraception in Nigeria. . In. Abuja, Nigeria; 2019. Accessed from: https://www.familyplanning2020.org/news/over-65-million-women-now-use-modern-method-contraception-nigeria

Krenn S, Cobb L, Babalola S, Odeku M, Kusemiju B. Using behavior change communication to lead a comprehensive family planning program: the Nigerian Urban Reproductive Health Initiative. Glob Health Sci Pract. 2014;2(4):427–43.

Aliyu AA: Family planning services in Africa: The successes and challenges. Family Planning 2018, 69.

Perry HB, Rassekh BM, Gupta S, Wilhelm J, Freeman PA: Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 1. rationale, methods and database description. J Glob Health 2017, 7(1):010901

Brown W, Ahmed S, Roche N, Sonneveldt E, Darmstadt GL. Impact of family planning programs in reducing high-risk births due to younger and older maternal age, short birth intervals, and high parity. Semin Perinatol. 2015;39(5):338–44.

Winikoff B, Sullivan M. Assessing the role of family planning in reducing maternal mortality. Stud Fam Plann. 1987;18(3):128–43.

Article   CAS   PubMed   Google Scholar  

Tsui AO, McDonald-Mosley R, Burke AE. Family planning and the burden of unintended pregnancies. Epidemiol Rev. 2010;32(1):152–74.

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

Osotimehin B. Family planning save lives, yet investments falter. The Lancet. 2012;380(9837):82–3.

Article   Google Scholar  

Guttmacher Institute. Just the Numbers: The Impact of U.S. International Family Planning Assistance. 2014.

Advance Family Planning: Nigeria’s national family planning allocation cut by 90%. Baltimore: Johns Hopkins University; 2017a. Retrieved from https://www.advancefamilyplanning.org/nigerias-national-family-planning-allocation-cut-90 .

USAID: Ensuring Access to Family Planning in Nigeria. Health Policy Project; March, 2015. Retrieved from: https://2012-2017.usaid.gov/results-data/success-stories/ensuring-sustainable-access-family-planning-cross-river-state-nigeria .

Federal Ministry of Health (FMOH): Nigeria family planning blueprint 2020–2024. Abuja, Nigeria: FMOH. 2020. Retrieved from https://www.health.gov.ng/doc/Final-2020-Blueprint.pdf .

National Population Commission (NPC) [Nigeria] and ICF Macro. Nigeria Demographic and Health Survey 2008. Abuja: National Population Commission and ICF Macro; 2009.

National Population Commission (NPC) [Nigeria], ICF International: Nigeria Demographic and Health Survey 2013. In. Abuja, Nigeria, and Rockville, Maryland, USA; 2014.

National Population Commission (NPC) [Nigeria]. Nigeria Demographic and Health Survey 1999. Calverton, Maryland: National Population Commission and ORC/Macro; 2000.

National Population Commisison (NPC) [Nigeria], ORC Macro. Nigeria Demographic and Health Survey 2003. Calverton, Maryland: National Population Commission and ORC Macro; 2004.

National Bureau of Statistics, United Nations Children’s Fund, United Nations Population Fund. Nigeria Multiple Indicator Cluster Survey 2011 Main Report. In. Abuja, Nigeria; 2013. Retrieved from: https://www.unicef.org/nigeria/reports/nigeria-multiple-indicator-cluster-survey-mics-2011 .

USAID: Ensuring Access to Family Planning in Nigeria. . In., vol. 2021; Information released online from June 2012 to September 2017. Accessed from: https://2012-2017.usaid.gov/results-data/success-stories/ensuring-sustainable-access-family-planning-cross-river-state-nigeria

Akutson SK, Zubair AK, Akutson L. Business Case Framework for Investment in Reproductive Health in Nigeria. J Glob Econ Bu. 2020;1(2):1–16.

Marie T, Ness S, Amanyeiwe U, Adinma E, Ebenebe U, Nweje A: Nigeria: Reproductive Health Commodity Security Situation Analysis. . In., vol. Task Order 1. Arlington, Va: USAID | DELIVER PROJECT; 2009 https://docplayer.net/22229105-Nigeria-reproductive-health-commodity-security-situation-analysis.html

Speizer IS, Guilkey DK, Escamilla V, Lance PM, Calhoun LM, Ojogun OT, Fasiku D. On the sustainability of a family planning program in Nigeria when funding ends. PLoS One. 2019;14(9):e0222790.

Fotso JC, Ajayi JO, Idoko EE, Speizer I, Fasiku DA, Mberu B, Mutua M. Family planning and reproductive health in urban Nigeria: levels, trends and differentials. Chapel Hill: Measurement, Learning & Evaluation (MLE) Project [UNC, USA] and National Population Commission (NPC)[Nigeria]; 2011. 201(1). Retrieved from: https://www.researchgate.net/publication/262640101_Family_Planning_and_Reproductive_Health_in_Urban_Nigeria_Levels_Trends_and_Differentials#fullTextFileContent .

Nigeria: DKT International [ https://www.dktinternational.org/country-programs/nigeria/ ]

Partnerships and Projects [ https://www.usaid.gov/global-health/health-areas/family-planning/partnerships-projects ]

Ihejirika PI, Ibeh R: Nigeria: Donor Funding for Family Planning Declines By $10m in 3 Years. In: Leadership. Abuja, Nigeria; 2022. Accessed from: https://allafrica.com/stories/202203160045.html

Changing attitudes to contraception. In: The New Humanitarian. 2011. Accessed from: https://www.thenewhumanitarian.org/report/93340/nigeria-changing-attitudes-contraception

Marie T, Ness S, Amanyeiwe U: Nigeria: Reproductive Health Commodity Security Situation Analysis: Kano. Arlington, Va: USAID | DELIVER PROJECT, Task Order 1; 2008. https://pdf.usaid.gov/pdf_docs/PA00MKKB.pdf

Nigeria Health Watch. The Gates Foundation and UNFPA pledge US3.1bn towards widening access to life-saving family planning at the global event to mark the next decade of the FP2030 partnership. Nov. 19, 2021. Accessed from: https://nigeriahealthwatch.com/the-gates-foundation-and-unfpa-pledge-us3-1bn-towards-widening-access-to-life-saving-family-planning-at-the-global-event-to-mark-the-next-decade-of-the-fp2030-partnership/

BILL & MELINDA GATES foundation. Family Planning. Accessed from: https://www.gatesfoundation.org/our-work/programs/global-development/family-planning

Jurczynska K. Evidence and Advocacy: Unlocking Resources for Family Planning in Nigeria. In: Policy brief. Washington, DC: Palladium, Health policy plus (HP+); 2017.

Odusina E, Ugal D, Olaposi O. Socio-economic status, contraceptive knowledge and use among rural women in Ikeji Arakeji, Osun State. Nigeria Afro Asian J Soc Sci. 2012;3:1–10.

Oluwaseun OJ, Babatola B, Gbamisola A. Determinants of Contraceptives among female adolescents in Nigeria. Department of demography and social statistics: Federal university, Oye-Ekiti, Nigeria; 2016.

Ogboghodo E, Adam V, Wagbatsoma V. Prevalence and determinants of contraceptive use among women of child-bearing age in a rural community in southern Nigeria. J Commun Med Prim Health Care. 2017;29(2):97–107.

Adebowale SA, Adeoye IA, Palamuleni ME. Contraceptive use among Nigerian women with no fertility intention: interaction amid potential causative factors. Afr Popul Stud. 2013;27(2):127–39.

Unumeri G, Ishaku S, Ahonsi B, Oginni A: Contraceptive use and its socio-economic determinants among women in North-East and North-West Regions of Nigeria: a comparative analysis. African Population Studies 2015, 29(2).

Solanke BL. Factors influencing contraceptive use and non-use among women of advanced reproductive age in Nigeria. J Health Popul Nutr. 2017;36(1):1–14.

Johnson OE. Determinants of modern contraceptive uptake among Nigerian women: evidence from the national demographic and health survey. Afr J Reprod Health. 2017;21(3):89–95.

Ononokpono DN, Odimegwu CO, Usoro NA. Contraceptive use in Nigeria: does social context matter? Afr J Reprod Health. 2020;24(1):133–42.

PubMed   Google Scholar  

Duvall S, Thurston S, Weinberger M, Nuccio O, Fuchs-Montgomery N. Scaling up delivery of contraceptive implants in sub-Saharan Africa: operational experiences of Marie Stopes International. Global Health Sci Pract. 2014;2(1):72–92. https://doi.org/10.9745/GHSP-D-13-00116 .

Marie Stropes Nigeria: https://www.mariestopes.org.ng/

Federal Government of Nigeria. 2016 Appropriation Act In. Abuja, Nigeria; 2016. Retrieved from: https://www.budgetoffice.gov.ng/pdfs/2016app/Works%20Power%20Housing.pdf .

Sathar Z. Best Bets: Additional Funding for Family Planning—International evidence on financing of family planning. Islamabad, Pakistan: Population Center; 2020.

Book   Google Scholar  

Centre for Research Evaluation Resources and Development, Bayero University Kano. Family Planning Brief. In. September 26, 2018. Retrieved from: https://www.pmadata.org/sites/default/files/data_product_results/PMA2020-Nigeria-Taraba-R3-FP-Brief.pdf .

Mbachu C, Agu I, Ekwueme C, Eze I, Obayi C, Onwujekwe O. Identifying Innovative Approaches to Increase Domestic Resource Mobilization and Financing Contributions for Family Planning in Nigeria. North Carolina: University of North Carolina; 2022. p. 25.

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The project leading to the literature review has received funding from the Data for Impact (D4I) associate award 7200AA18LA00008, which is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill with the support of the United States Agency for International Development (USAID). The funder did not participate in the literature review, data analysis, or writing and reviewing the manuscript. The views presented in this manuscript belong solely to the authors and do not necessarily represent the funders’ views.

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Mbachu, C.O., Agu, I.C., Ekwueme, C.N. et al. A narrative review of evidence to support increased domestic resource mobilization for family planning in Nigeria. BMC Women's Health 23 , 235 (2023). https://doi.org/10.1186/s12905-023-02396-y

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

Roles Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

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

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Roles Conceptualization, Data curation, Formal analysis, Methodology, Writing – original draft, Writing – review & editing

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

Roles Data curation, Formal analysis, Writing – original draft, Writing – review & editing

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

Roles Formal analysis, Writing – original draft, Writing – review & editing

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

Roles Data curation, Formal analysis, Writing – review & editing

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

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

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

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Methodology, Project administration, Resources, Supervision, Validation, Writing – original draft, Writing – review & editing

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

  • Navin Bhatt, 
  • Bandana Bhatt, 
  • Bandana Neupane, 
  • Ashmita Karki, 
  • Tribhuwan Bhatta, 
  • Jeevan Thapa, 
  • Lila Bahadur Basnet, 
  • Shyam Sundar Budhathoki

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  • Published: May 26, 2021
  • https://doi.org/10.1371/journal.pone.0252184
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Fig 1

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.

Citation: Bhatt N, Bhatt B, Neupane B, Karki A, Bhatta T, Thapa J, et al. (2021) Perceptions of family planning services and its key barriers among adolescents and young people in Eastern Nepal: A qualitative study. PLoS ONE 16(5): e0252184. https://doi.org/10.1371/journal.pone.0252184

Editor: Mary Hamer Hodges, Helen Keller International, SIERRA LEONE

Received: June 27, 2020; Accepted: May 12, 2021; Published: May 26, 2021

Copyright: © 2021 Bhatt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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

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

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: BPKIHS, B. P. Koirala Institute of Health Sciences; FP, Family Planning; FGD, Focus Group Discussion; IDI, In-Depth Interview; mCPR, Modern Contraceptive Prevalence Rate; SRH, Sexual and Reproductive Health

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 ).

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https://doi.org/10.1371/journal.pone.0252184.g001

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 .

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https://doi.org/10.1371/journal.pone.0252184.t001

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.

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https://doi.org/10.1371/journal.pone.0252184.t002

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

https://doi.org/10.1371/journal.pone.0252184.s001

https://doi.org/10.1371/journal.pone.0252184.s002

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.

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  • Google Scholar
  • PubMed/NCBI
  • 5. Department of Health Services. Annual Report. DoHS. 2019. Available from: https://dohs.gov.np/wp-content/uploads/2019/07/DoHS-Annual-Report-FY-2074-75-date-22-Ashad-2076-for-web-1.pdf
  • 8. World Health Organizaton. Family planning/Contraception. WHO. 2018. Available from: https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception
  • 12. United Nations Department of Economic and Social Affairs Population Division. Family Planning and the 2030 Agenda for Sustainable Development: Data Booklet. (ST/ESA/ SER.A/429). 2019.
  • 31. Dahal G., Hennink M. & Hinde A. Risky sexual behaviour among young men in Nepal. Southampton Statistical Sciences Research Institute, University of Southampton, Southampton. 2005. Available from; http://eprints.soton.ac.uk/id/eprint/14213

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Family Planning, New Research - Literature Review

A monthly summary and review of significant recent research papers

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Title of published paper

Date paper reviewed

Measuring family planning quality and its link with contraceptive use in public facilities in Burkina Faso, Ethiopia, Kenya and Uganda

Adolescents and long-acting reversible contraception: lessons from Mexico

Knowledge and acceptability of long-acting reversible contraception among adolescent women receiving school-based primary care services

Who's that girl? A qualitative analysis of adolescent girls' views on factors associated with teenage pregnancies in Bolgatanga, Ghana

Effects of relationship context on contraceptive use among young women

Knowledge and use of emergency contraception among students of public secondary schools in Ilorin, Nigeria

Emergency contraception in Albania: A multi-methods qualitative study of awareness, knowledge, attitudes, and practices

Postpartum intrauterine device placement: a patient-friendly option

ACOG Committee Opinion No. 735: Adolescents and long-acting reversible contraception: implants and intrauterine devices

Married women's autonomy and post-delivery modern contraceptive use in the Democratic Republic of Congo

Effect of self-administration versus provider-administered injection of subcutaneous depot medroxyprogesterone acetate on continuation rates in Malawi: a randomised controlled trial

Factors associated with removal difficulties of etonogestrel-containing contraceptive implants (Nexplanon®)

Influence of age on tolerability, safety and effectiveness of subdermal contraceptive implants

Client satisfaction and decision making amongst females visiting family planning clinics in Hyderabad, Pakistan

February 2018

Recommendations for contraception: examining the role of patients' age and race

Developing mHealth messages to promote postmenstrual regulation contraceptive use in Bangladesh: participatory interview study

January 2018

Pill Magic - The Economist

Factors associated with non-adherence to instructions for using the Nestorone®/ethinyl estradiol contraceptive vaginal ring

Effects of immediate postpartum contraceptive counseling on long-acting reversible contraceptive use in adolescents

December 2017

Knowledge and opinions of postpartum mothers about the lactational amenorrhea method: the Turkish experience

MyLARC: a theory-based interactive smartphone app to support adolescents' use of long-acting reversible contraception

A retrospective chart review of contraceptive use among adolescents with opioid use disorder

Texting to increase contraceptive initiation among adolescents in the emergency department

November 2017

Interest in multipurpose prevention technologies to prevent HIV/STIs and unintended pregnancy among young women in the United States

Pregnancy outcomes associated with extended use of the 52-mg 20μg/day levonorgestrel-releasing intrauterine system beyond 60months: A chart review of 776 women in Brazil

Increasing contraceptive access for hard-to-reach populations with vouchers and social franchising in Uganda

October 2017

Family physicians and provision of immediate postpartum contraception: A CERA study

Contraceptive counseling among pediatric primary care providers in Western Pennsylvania: A survey-based study

Residents perceive limited education on family planning and contraception for patients with severe and persistent mental illness

Optimization of contraceptive dosage regimen of centchroman

September 2017

When doctors deny drugs: sexism and contraception access in the medical field

Contraceptive use and unplanned pregnancy among female sex workers in Zambia

Manual vacuum aspiration (MVA) – A safe option for evacuation of first trimester miscarriage in cardiac patients

August 2017

Adolescent reproductive and contraceptive knowledge and attitudes and adult contraceptive behavior

Uterine perforation by intrauterine devices: a 16-year review

Postabortion contraception

A randomized trial of motivational interviewing and facilitated contraceptive access to prevent rapid repeat pregnancy among adolescent mothers

Emergency contraceptive pill users' risk perceptions for sexually transmitted infections and future unintended pregnancy

Evaluation of two intervention models on contraceptive attitudes and behaviors among nulliparous women in Shanghai, China: a clustered randomized controlled trial

Effect of male partner's support on spousal modern contraception in a low resource setting

A survey regarding acceptability of oral emergency contraception according to the posited mechanism of action

Missed pills: frequency, reasons, consequences and solutions

Experience from a multi-country initiative to improve the monitoring of selected reproductive health indicators in Africa

Contraceptive counselling for women with multiple unintended pregnancies: the abortion client's perspective

Family planning and Zika virus: need for renewed and cohesive efforts to ensure availability of intrauterine contraception in Latin America and the Caribbean

Factors influencing unintended pregnancy and abortion among unmarried youth in Vietnam: a literature review

Contraceptive non-use and emergency contraceptive use at first sexual intercourse among nearly 12 000 Scandinavian women

Febuary 2017

Healthcare provider attitudes regarding contraception for women with obesity

Contraception for adolescents with chronic rheumatic diseases

Intrauterine contraception after medical abortion: factors affecting success of early insertion

January 2017

Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke

Key role of drug shops and pharmacies for family planning in urban Nigeria and Kenya

Postpartum uptake of contraception in rural northern Malawi: A prospective study

December 2016

Etonogestrel-releasing contraceptive implant for postpartum adolescents: a randomized controlled trial

Motivational interviewing to promote long-acting reversible contraception in postpartum teenagers

Improving the quality of postabortion care services in Togo increased uptake of contraception

November 2016

Barriers and myths that limit the use of intrauterine contraception in nulliparous women: a survey of Brazilian gynaecologists

A prospective cohort study of the feasibility and acceptability of depot medroxyprogesterone acetate (DMPA) administered subcutaneously through self-injection

Pediatricians' attitudes and beliefs about long-acting reversible contraceptives influence counseling

October 2016

Influence of contraceptive choice on vaginal bacterial and fungal microflora

Immediate postpartum intrauterine contraceptive device insertions in caesarean and vaginal deliveries: a comparative study of follow-up outcomes

Adolescent female text messaging preferences to prevent pregnancy after an emergency department visit: a qualitative analysis

Factors associated with short inter-pregnancy interval in women who plan postpartum LARC: a retrospective study

September 2016

Comparing effectiveness of active and passive client follow-up approaches in sustaining the continued use of long acting reversible contraceptives (LARC) in rural Punjab: a multicentre, non-inferiority trial

Accessible contraceptive implant removal services: an essential element of quality service delivery and scale-up

Is HPV vaccination in pregnancy safe?

August 2016

Access to the copper IUD as post-coital contraception: results from a mystery caller study

Postpartum contraception and interpregnancy intervals among adolescent mothers accessing public services in California

WHO MEC Wheel: WHO medical eligibility criteria wheel for contraceptive use

WHO: Health worker roles in providing safe abortion care and post-abortion contraception

Use of effective contraception six months after emergency contraception with a copper intrauterine device or ulipristal acetate – a prospective observational cohort study

Postpartum contraception: An exploratory study of lactation consultants' knowledge and practices

Sexual behavior, satisfaction, and contraceptive use among postpartum women

Postpartum contraception: a missed opportunity to prevent unintended pregnancy and short inter-pregnancy intervals

Aspiration abortion with immediate intrauterine device insertion: comparing outcomes of advanced practice clinicians and physicians

An evaluation of a family planning mobile job aid for community health workers in Tanzania

The impact of balanced counseling on contraceptive method choice and determinants of long acting and reversible contraceptive continuation in Nepal

Compliance and use behaviour, an issue in injectable as well as oral contraceptive use? A study of injectable and oral contraceptive use in Johannesburg.

February 2016

Use of emergency contraception in Nigeria: An exploration of related factors among sexually active female university students

Effect of a mobile phone-based intervention on post-abortion contraception: a randomized controlled trial in Cambodia

January 2016

Risk of HIV infection in depot-medroxyprogesterone acetate (DMPA) users: A systematic review and meta-analysis

Maintenance of ovulation inhibition with a new progestogen-only pill containing drospirenone after scheduled 24-h delays in pill intake

Emergency contraception: sources of information and perceptions of access among young adults

December 2015

Integration of family planning with maternal health services: an opportunity to increase postpartum modern contraceptive use in urban Uttar Pradesh, India

The safety of hormonal contraceptives for women living with HIV and their sexual partners

November 2015

Health worker roles in providing safe abortion care and post-abortion contraception

Impact of bodyweight/body mass index on the effectiveness of emergency contraception with levonorgestrel: a pooled-analysis of three randomized controlled trials

The effect of early menarche on the sexual behaviors of Korean female adolescents

Service provider perspectives on post-abortion contraception in Nepal

October 2015

Provision of intrauterine contraception in association with first trimester induced abortion reduces the need of repeat abortion: first-year results of a randomized controlled trial

Medical Eligibility Criteria for Contraceptive Use

Ectopic pregnancy with use of progestin-only injectables and contraceptive implants: a systematic review

September 2015

The effectiveness of an adolescent reproductive health education intervention in Uganda

Impact of male partner's awareness and support for contraceptives on female intent to use contraceptives in southeast Nigeria

Knowledge and usage of emergency contraceptives among university students in Ghana

Unsafe abortion requiring hospital admission in the Eastern Highlands of Papua New Guinea – a descriptive study of women's and health care workers' experiences

Contraceptive prevalence and preference in a cohort of south-east Nigerian women

Non-contraceptive benefits of hormonal and intrauterine reversible contraceptive methods

Postpartum contraceptive use and unmet need for family planning in five low-income countries

Men's perspectives on their role in family planning in Nyanza Province, Kenya

Improving Male Involvement in Family Planning in Rural Southeastern Nigeria

Fertility Awareness in Adolescents in Sub-Saharan Africa: Evidence From Demographic and Health Surveys

Measuring Adherence to Birth Control Pills Among College Women

Unmet need for contraception among married women in an urban area of Puducherry, India

Combined hormonal versus nonhormonal versus progestin-only contraception in lactation

Immediate postabortion initiation of levonorgestrel implants reduces the incidence of births and abortions at 2-years and beyond

Potential public sector cost-savings from over-the-counter access to oral contraceptives

Simulated Clients Reveal Factors That May Limit Contraceptive Use in Kenya

Demand Generation Activities and Modern Contraceptive Use in Urban Areas

Young women’s access to and use of contraceptives: the role of providers’ restrictions in urban Senegal

February 2015

Place of persistence trouble during oral contraception and subsequent use of emergency contraception

Effect of body weight and BMI on the efficacy of levonorgestrel emergency contraception

Multicenter study of contraceptive vaginal ring (NuvaRing(®)) in normal daily practice in Indian women

January 2015

Hormonal contraception--habits and awareness female students of the University of Novi Sad, Vojvodina, Serbia

Consumer attitudes towards and satisfaction with emergency contraception counselling: experience from clinic and retail pharmacy settings

Cycle-related changes in mood, sexual desire, and sexual activity in oral contraception-using and nonhormonal-contraception-using couples

December 2014

Same-day intrauterine device placement is rarely complicated by pelvic infection

Fertility awareness online: the efficacy of a fertility education website in increasing knowledge and changing fertility beliefs

Informed push distribution of contraceptives in Senegal reduces stockouts and improves quality of family planning services

October 2014

Emergency contraception (EC) in Senegal: Challenges and opportunities

Building on safety, feasibility, and acceptability: the impact and cost of community health worker provision of injectable contraception

Home-based contraceptive dispensing become a routine part of public health nurse practice

September 2014

Risk factors for unplanned and unwanted teenage pregnancies South African women

Knowledge of emergency contraception among adolescents in public and private Brazilian high schools

A tiered analytical approach for investigating poor quality emergency contraceptives

August 2014

An assessment of the quality of advice provided by patent medicine vendors to users of oral contraceptive pills in urban Nigeria

Continuous or extended cycle vs. cyclic use of combined hormonal contraceptives for contraception

The burden of unintended pregnancies in Brazil: a social and public health system cost analysis

Postabortal and postpartum contraception

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

Ayele semachew kasa.

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

Mulu Tarekegn

Nebyat embiale.

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

Associated Data

Not applicable.

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 ).

Table 1

Socio-demographic characteristics of study participants, South Achefer District, North West Ethiopia, 2017 (n = 381)

The current currency exchange rate ($ 1 = 27.50 ETB)

ETB Ethiopian birr

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 ).

Table 2

Chi Square analysis result on FP practice and selected characteristics of participants, South Achefer district, 2017 (n = 381)

* Significant P-value

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.

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

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.

Abbreviations

Contributor information.

Ayele Semachew Kasa, Email: [email protected] , Email: moc.liamg@42uyaetonif .

Mulu Tarekegn, Email: moc.oohay@ngekeratulum .

Nebyat Embiale, Email: moc.liamg@uritelaibme .

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