|Year : 2015 | Volume
| Issue : 2 | Page : 90-94
Knowledge, attitude and practice of contraceptives among grand multiparous women attending antenatal clinic in a specialist hospital, Kano, Nigeria
Garba Ibrahim, Ayyuba Rabiu, Idris Sulaiman Abubakar
Department of Obstetrics and Gynaecology, Bayero University Kano and Aminu Kano Teaching Hospital, Kano PMB 3011, Nigeria
|Date of Web Publication||10-Nov-2015|
Department of Obstetrics and Gynaecology, Bayero University Kano and Aminu Kano Teaching Hospital,
Kano PMB 3011
Source of Support: None, Conflict of Interest: None
Background: Nigeria is the most populous country in Africa. Worldwide the country has the second highest maternal mortality ratio. The fertility rate is 5.38 children per woman. Grand multiparity with its associated risks contributes to the high maternal mortality ratio. This study was conducted to find out the knowledge, attitude and practice of contraception among grand multiparous women attending the antenatal clinic in a specialist hospital, Kano. Methods: It was a descriptive cross-sectional study conducted among grand multiparous women attending antenatal care clinic at Murtala Muhammed Specialist Hospital, Kano from 1st September to 31st December 2013. All consenting grand multiparous women were recruited within the study period. Data were collected on a predesigned questionnaire and analysed using SPSS version 17 (SPSS Inc., IL, Chicago, USA). The descriptive statistics was used for categorical variables and Chi-square was used for test of significance. A P ≤0.05 was considered statistically significant for inference. Results: Three hundred and thirty four grand multiparas were recruited. The mean age was 37.23 ± 3.17 years. Majority of them (80.20%) got their contraceptive knowledge from the nurses and/or midwives. Up to 88.60% agreed have used contraceptives. The most popular and used contraceptive among the grand multiparous women was oral contraceptive pills (OCP) (89.80%). The major cause of the non-use of contraceptives was the fear of side effects (77.20%). Conclusion: Grand multiparous women mainly obtain their contraceptive knowledge from the nurses/midwives. OCP was the most used methods. Major causes of non-use of contraceptives were the fear of side effects and desire for more children.
Keywords: Attitude, contraception, grand multipara, knowledge, practice
|How to cite this article:|
Ibrahim G, Rabiu A, Abubakar IS. Knowledge, attitude and practice of contraceptives among grand multiparous women attending antenatal clinic in a specialist hospital, Kano, Nigeria. Niger J Basic Clin Sci 2015;12:90-4
|How to cite this URL:|
Ibrahim G, Rabiu A, Abubakar IS. Knowledge, attitude and practice of contraceptives among grand multiparous women attending antenatal clinic in a specialist hospital, Kano, Nigeria. Niger J Basic Clin Sci [serial online] 2015 [cited 2021 Jun 23];12:90-4. Available from: https://www.njbcs.net/text.asp?2015/12/2/90/169277
| Introduction|| |
Grand multiparous women are mothers who have experienced at least five births. Such women are traditionally considered at high risk when pregnant. They are at increased foetal and maternal risk of complications such as mal presentation, abruption placenta, placenta previa, hypertension, diabetes mellitus and postpartum haemorrhage. Severe anaemia, obstructed labour and ruptured uterus are also common complications.
Grand multiparity has almost disappeared in the Western countries due to availability, acceptability and advancement of the family planning methods.
Contraception is defined as the prevention of conception or impregnation by methods other than abstinence from coitus. Various methods of contraceptives exist, each with its own advantages and disadvantages. An ideal contraceptive should be completely effective, forgettable, reversible, convenient, simple, cheap, acceptable and safe. Studies in developing countries have shown low frequencies of contraceptive use despite the high level of awareness. The main reasons for this were a desire for larger family size, pressure from husbands, religious concerns and fear of side effects.,,,
In a study conducted by Ankomah et al. in Nigeria, revealed that while the respondents were aware of various modern methods of contraceptives available, however, they preferred traditional methods of contraceptives which they claimed to be effective also. Therefore, even where most effective contraceptive methods are available, "individuals" religious belief might be a hindrance to utilisation. Another decimating factor to the lack of use of contraceptives is men's negative attitude towards contraceptives. This was shown to be a major reason why some wives failed to use family planning methods.
Nigeria has low contraceptive use prevalence. It is as low as 15% the figure is even lower in the rural areas especially in the Northern Nigeria. Women in the rural areas of Northern Nigeria are 2.7 times less likely to use modern contraceptive methods than their southern counter parts. The major barriers to contraceptive use are affordability and awareness of such modern methods.
The aim of this study was to assess knowledge, attitude and practice of contraceptives among grand multiparous women at Murtala Muhammed Specialist Hospital (MMSH) Kano, with a view of introducing contraceptive educational strategies that will make modern contraceptives more acceptable to these vulnerable women population.
| Methods|| |
This was a descriptive cross-sectional study carried out among grand multiparous women attending antenatal care clinic at MMSH Kano from 1st September to 31st December 2013. All consenting grand multiparous women were recruited within the study period.
Ethical clearance was obtained from the State's Hospital Management Board. Data on socio demographic characteristics, reproductive profile, use of contraceptives and any concern about the use such as religion, side effects and lack of autonomy, etc., were collected on a predesigned questionnaire.
The data obtained were entered into a computer and analysed using SPSS Statistical Software version 17 (SPSS Inc., IL, Chicago, USA). Likert-like scale was used in assessing their attitude towards contraceptives. Descriptive statistics were used to describe categorical variables. Odds ratio was also calculated to find the strength of the relationship between different variables, while Chi-square test was used to test the significance of proportions of variables. A P ≤0.05 was considered statistically significant for inference.
| Results|| |
Three hundred and thirty four women were recruited; their mean age was 37.2 ± 3.2 years. Up to 84.43% were above the age of 34 years [Table 1]. Majority of the respondents (98.20%) were Muslims. Most of them had secondary school education (65.80%) and are home managers (76.00%). Three hundred and two (90.40%) had a parity of 5–8. Hausa/Fulani was the dominant ethnic group (93.40%). Majority of them (98.80%) were married. Over 75% of them were in their first order of marriage. Polygamous marriage was the most common marital setting 206 (61.70%). Monogamous marital setting constituted 128 (38.30%). Sixty percentage of those in polygamous setting were the first wives.
Majority of the husbands had at least secondary school education (78.00%) [Table 2] and most of them were businessmen (64.00%).
Nurses/midwives were the major source of knowledge among the respondents 268 (80.20%) followed by media (56.30%). Doctors contributed only 34.70% of the source of knowledge to the respondents [Table 3].
Oral contraceptives (89.80%) and injectable (84.40%) were the most popular and used contraceptives. Sterilisation and implants were the least popular and used contraceptive methods among the women studied. Up to 296 (88.60%) agreed with contraceptive use. The major cause of the non-use was the fear of side effects 258 (77.20%) and the least was the non-availability of the contraceptives 4 (1.20%). The major side effects reported by the women were mainly weight gain 280 (83.80%), menstrual disturbances 262 (78.40%) and behavioural disturbances 226 (67.70%). There was no statistically significant association between those that practiced contraceptive and their age group, parity, and marital setting (χ2 = 0.318, P =0.573; χ2 = 2.66, P = 1.103; χ2 = 0.025, P =0.874 respectively). Similarly, there was no statistically significant association between those that practiced contraceptives and their occupation, husband's occupation and husband's number of children (χ2 = 2.273, P =0.132; χ2 = 0.002, P =0.807; and χ2 = 4.033, P =0.450 respectively) [Table 4].
|Table 4: Cross tabulation of contraceptive practices to different variables|
Click here to view
| Discussion|| |
The mean age of the respondents was 37.2± 3.2 years. Omole-Ohonsi and Ashimi  found a mean age of 29.7 ± 2.1 among grand multiparous women at Aminu Kano Teaching Hospital. This could probably be attributed to the lower sample size in this study as compared to their study (334 vs. 1213).
Hausa/Fulani was the dominant ethnic group. Ameh and Sule  reported a similar pattern in Zaria, Northern Nigeria. Hausa/Fulani are the main inhabitant of this geo-political zone of Nigeria.
Most of the grand multiparous women were married 330 (98.80%). This finding is in contrast to that of Severinski et al. in Croatia where most of the grand multiparous women were unmarried or divorced. This could be due to the socio demographic characteristics of Kano people the predominant religion are Islam that encourages marriage and polygamy.
Majority of the respondent (80.20%) received contraceptive knowledge from the nurses and/or midwives, Ameh and Sule  reported similar findings at Zaria, Northern Nigeria. Nurses and midwives are the first contact in our health facility and play an important role in health information dissemination.
Oral contraceptive pills and injectable contraceptives were the most used and popular contraceptive methods. Rahman et al. reported similar findings among married women of reproductive age in Dhaka, Bangladesh and is similar to the findings of Ameh and Sule  in Zaria, Northern Nigeria, where injectable contraceptives were the most used methods. This might not be unconnected to the availability and accessibility of these methods and the fact that husbands might not be involved in the decision making, in a situation where they are against the methods of family planning, especially for the injectable contraceptives due to their clandestine nature of administration.
Emphasis should be placed on information dissemination on less popular forms of contraceptive devices such as intrauterine contraceptive devices and Barrier methods since these methods cause less side effects of weight gain. More so, that knowledge of contraception is high among the studied population.
A significant proportion of the women indicated strong desire towards the use of contraceptives despite their high parity. This could be because they used contraceptives for child spacing, but not to limit their family size. This positive effect can be explored in attitudinal change towards acceptance of other modern methods of contraceptives.
Fear of side effect (77.20%) and desire to have more children (73.10%) were the main reasons found in this study for non-use of contraceptives. Rahman et al. in Bangladesh and Jabeen et al. in Pakistan reported similar findings. These were studies conducted in predominantly Muslim communities where early marriage and high parity are very common.
The side effects respondents complained of include afraid of weight gain, menstrual disturbances and behavioural disturbances. Jabeen et al. reported similar pattern.
There was no statistically significant difference between the practice of contraceptive use and age group, parity, marital setting, occupation or number of children. Jabeen et al. however, found a statistically significant association between the contraceptive practice and the age, parity and the educational status of the women. This could be due to the small sample size in our study when compared to the sample size of 900 in Jabeen et al. Study's and the competitive nature among women in the polygamous setting.
| Conclusion|| |
Grand multipara got their contraceptive knowledge from the nurses/midwives. These women have strong desire towards contraceptives usage. The major causes of non-use of contraceptives were fear of side effects and their desire for more children with their present husbands than any of his wives.
There was no statistically significant association between those grand multipara that had practiced contraceptives and the age group, parity, marital setting, occupation, husband's number of children and husband's occupation.
Targeted training and retraining of nurses/midwives on information dissemination on other modern methods of long-term contraception among grand multipara should be encouraged. This should enable the client's desire and expectations of contraceptives to be achieved.
| Limitations|| |
Non-recruitment of all pregnant women regardless of their parity which will have aided us in determining the rate of grand multiparity, smaller sample size.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Opara EI, Zaidi J. The interpretation and clinical application of the word 'parity': A survey. BJOG 2007;114:1295-7.
Agrawal S, Agarwal A, Das V. Impact of grandmultiparity on obstetric outcome in low resource setting. J Obstet Gynaecol Res 2011;37:1015-9.
Shahid R, Mushtaq M. Complications of grand multiparity. Pak Armed Forces Med J 2009;4:2411-8842.
Fuchs K, Peretz BA, Marcovici R, Paldi E, Timor-Tritsh I. The "grand multipara" – is it a problem? A review of 5785 cases. Int J Gynaecol Obstet 1985;23:321-6.
Tindall VR. Contraception. In: Jeffcoate's Principles of Gynaecology. 5th
ed., Vol. 40. London: Butterworth; 1987. p. 598-616.
Droegemueller W, Bressler R. Effectiveness and risks of contraception. Annu Rev Med 1980;31:329-43.
Bibi S, Memon A, Memon Z, Bibi M. Contraceptive knowledge and practices in two districts of Sindh, Pakistan: A hospital based study. J Pak Med Assoc 2008;58:254-8.
Khan T, Khan RE. Fertility behavior of women and their house hold characteristics – A case study of Punjab Pakistan. J Hum Ecol 2010;30:11-7.
Rahman A, Rahman M, Zaman JA. Contraceptive practice among the married women of reproductive age in the garments factory. KYAMC J 2013;3:282-9.
Jabeen M, Gul F, Wazir F, Javed N. Knowledge, attitude and practices of contraception in women of reproductive age. Gomal J Med Sci 2011;9:223-9.
Ankomah A, Anyanti J, Adebayo S, Giwa A. Barriers to contraceptive use among married young adults in Nigeria: A qualitative study. Int J Trop Dis Health 2013;3:267-82.
Nigeria Demographic and Health Survey, 2013. Preliminary Report. National Population Commission Abuja, Nigeria. Measure DHS ICF International Calverton, Maryland USA; October, 2013. p. 10-8.
Omole-Ohonsi A, Ashimi AO. Grand multiparity: Obstetric performance in Aminu Kano Teaching Hospital, Kano, Nigeria. Niger J Clin Pract 2011;14:6-9.
Ameh N, Sule ST. Contraceptive choices among women in Zaria, Nigeria. Niger J Clin Pract 2007;10:205-7.
[Table 1], [Table 2], [Table 3], [Table 4]