Contraceptive choices among grand multiparous women at Murtala Mohammed Specialist Hospital, Kano.

BACKGROUND: Grand multiparity is known to be associated with pregnancy complications. Nigeria with a contraceptive prevalence of <15% and culture of early marriage in the northern part of the country, many women get to grand multiparity early in their obstetric carriers. These women contribute significantly to the bad obstetric performance indices in the country. The present study was to explore the contraceptive choices among grand multiparous women.
METHODS: This study was a descriptive cross-sectional study among grand multiparous women attending an antenatal clinic. Data were collected on sociodemographic characteristics, contraceptive choices, and factors that influence such choices. The data were analyzed using Statistical Package for the Social Sciences version 18.
RESULTS: There were 219 respondents. The mean age was 33.05 ± 3.17, and the mean parity was 6.48 ± 1.83. Most of the respondents (208, 95.50%) were aware of modern contraceptive methods, and oral contraceptive was the method of most of the respondents (197, 90.00%). Only 92 (42.00%) were currently using a modern contraceptive method. Being convenient for the lifestyle was the reason for the choice of a contraceptive method by many of the respondents (42, 19.10%).
CONCLUSION: There was high awareness of modern contraceptive methods; however, there was low use prevalence among respondents, and the desire for more pregnancy was the reason for the nonuse.

Introduction

Contraception is defined as “the Intentional Prevention of Conception by Artificial or Natural Means.”[1] The current prevalence rate of contraceptive usage in Nigeria is 10% for modern methods and 15% for any method.[2]

Grand multiparity constitutes a greater risk of pregnancy due to increases in maternal and neonatal complications.[3] Grand multiparity has significantly reduced in developed nations with an incidence of 3–4%[4] but in sub-Saharan Africa, poor acceptance of contraceptive methods coupled with a preference for a large family size, low age at marriage, polygamy and child mortality, grand multiparity is still not uncommon.[5] In Nigeria, the incidence of 5.1–18.07% of grand multiparity has been reported.[6789]

Not all contraceptive methods are appropriate for all situations, and the most suitable method of contraception depends on so many conditions such as the age of the client, parity, desire for more children, frequency of sexual activity, and her overall health status.[10] WHO in 2004 have shown that contraceptive choices depend upon consideration of advantages and disadvantages of a method based on individual perception and interpretations.[11] However, the choice of contraceptive method is determined by both the number of contraceptive methods offered on a reliable basis and their intrinsic variability.[12]

A study by Araoye et al.[13] among adolescents showed that males prefer contraceptive methods that prevent them against sexually transmitted infections in an unstable sexual relationship while females opt for any method, provided it is efficacious in preventing pregnancy irrespective of sexual relationship. The injectable contraceptive method was the most preferred method of birth control among women of reproductive age group in Warri, South-South and South-Eastern Nigeria.[1415] Injectable contraceptive was also the method of choice among women seeking terminal fertility control in South-western Nigeria.[16] Contrary to the foregoing, intrauterine contraceptive device was the most chosen method in 74.60% of the married women attending family planning clinic of a tertiary institution in Osogbo, Nigeria.[17]

The aim of the present study was to determine the contraceptive choices of grand multiparous women, and the reasons for such choices.

Methodology

The study was a descriptive cross-sectional study among grand multiparous women attending the antenatal clinic at Murtala Mohammed Specialist Hospital, Kano, over a 3 months period from September 2013 to November 2013. Ethical approval was obtained from the Hospital Ethical Committee. Informed consent from the clients after adequate counseling with respect to the purpose of the study was sought and obtained. Participation of clients in this study was voluntary, and respondents were assured of confidentiality.

A pretested structured questionnaire was designed to know the contraceptive choices among grand multiparous women attending the clinic. The questionnaire consisted of 2 parts including the patient's bio data, contraceptive choice, and the reason for the choice. Data were entered into a computer and analyzed using Statistical Package for the Social Sciences version 18 computer software (SPSS Inc., IL, Chicago, USA). Comparison of categorical variables was done using Chi-square while P values of 0.05 or less were considered significant.

Results

There were 219 respondents. The mean age was 33.05 ± 3.17, and the mean parity was 6.48 ± 1.83 [Table 1].

Table 1

Sociodemographic characteristics

	Frequency (%)
Age group
20-29	69 (31.50)
30-39	114 (52.10)
>40	36 (16.40)
Total	219 (100.00)
Parity
5-8	189 (86.30)
>8	30 (13.70)
Total	219 (100.00)
Level of education
Primary	83 (37.90)
Secondary	63 (28.80)
Tertiary	37 (16.90)
None	36 (16.40)
Total	219 (100.00)
Marital status
Single	0 (0.00)
Married	216 (98.60)
Divorced	1 (1.00)
Separated	2 (1.40)
Total	219 (100.00)
Occupation
Home managers	162 (74.00)
Civil servant	47 (21.50)
Business woman	11 (4.60)
Total	219 (100)
Religion
Islam	218 (99.50)
Christianity	1 (5.00)
Total	219 (100.00)

The majority of the respondents were married (216, 98.60%) and mainly Muslims (99.50%). Many of the grand multiparous women 83 (39.90%) had primary school level of education, 63 (28.8%) had secondary, and 37 (16.9%) had a tertiary education while 6 (16.4%) had no formal education.

Most of the clients (162, 74.00%) were home managers. Almost all the clients (208, 95.50%) were aware of modern contraceptive methods. Most of the women were aware of oral contraceptive pills 197 (90.00%) and injectable 196 (89.50%). Other forms of contraceptives were not popular among the respondents [Table 2]. Of the 219 respondents, only 92 (42.00%) were currently using a modern contraceptive method. Being convenient for the respondents’ lifestyle (42, 19.10%) and husbands’ choice (35, 15.90%) were the most given reasons for the choice of the method among those currently on a modern method of contraceptives [Table 3]. The desire for more pregnancy (94, 42.70%) and husbands’ choice (37, 16.80%) were the most cited reasons for the nonuse of contraceptive methods by the respondents [Table 4].

Table 2

Awareness of various contraceptive methods

Awareness of contraceptive methods
Methods	Frequency (%)
Natural methods	18 (8.20)
Oral pills	197 (89.50)
Injectable	196 (89.10)
IUCD	40 (18.20)
Barrier methods	48 (21.80)
Sub-dermal implants	57 (25.90)
Permanent methods	33 (15.00)
Traditional methods	36 (16.40)

n=219, awareness of methods not mutually exclusive. IUCD=Intrauterine contraceptive device

Table 3

Reasons for using chosen contraceptive methods

Reasons	Frequency (%)
Effectiveness	25 (11.40)
Husband's choice	35 (15.90)
Less side effect	21 (9.50)
Convenient for my lifestyle	42 (19.10)
Health worker chose it for me	17 (7.70)
Other reasons	9 (4.10)

Responses are not mutually exclusive

Table 4

Reasons for not using any form of contraceptive method

Responses	Frequency (%)
No reason	51 (19.20)
Husband's choice	37 (16.80)
Stopped due to side effect	35 (15.90)
Desire for more pregnancy	94 (42.70)
Thinking of another form to substitute	2 (0.90)

A response does not preclude another

Majority of the grand multiparous women (173, 74%) strongly thought it was important to use contraception while others did not. Only 101 (46.00%) of the respondents had used contraceptives in the past.

Table 5 shows the associations between the contraceptive practices and different variables. There was no statistically significant association between those that practiced contraceptive and the age group and education (χ2 = 0.781, P = 0.377; χ2 = 0.781 P = 0.377, respectively). However, there appeared to be a significant association between contraceptive use with parity and occupation (χ2 = 10.709 P = 0.001, χ2 = 22.065, P = 0.000).

Table 5

Cross-tabulation of CP to different variables

Variable	CP+	CP0	χ2	P
Age
≤34	54	82	0.781	0.377
>34	38	45
Parity
5-8	87	100	10.709	0.001
>8	5	27
Educated
Formal	112	92
Nonformal	15	0
Occupation
Home managers	52	82	22.065	0.000
Other occupations	38	45

CP=Contraceptive practices

Discussion

In this study, the mean age of the grand multiparous women was 33.05 ± 3.17. Ogedengbe and Ogunmokun[18] found the similar mean age of grand multiparous patients who delivered at Lagos University Teaching Hospital, Nigeria. Attainment of higher educational level among northern women could be the reasons for the late age of grand multiparity similar to other regions of the country. The mean parity of 6.48 in this study was also similar to the finding in Lagos.[18] These similar findings could be attributed to the similarities of sociodemographic characteristics of grand multiparous women in the studies.

Almost all the respondents were married (98.6%), and this is not surprising as marriage is a prerequisite in our environment that has Islamic dominated culture which encourages marriage and large family size. This finding is similar to that of Njiru et al.[19] where 98.0% of the grand multiparae were married.

Primary school was the highest educational status by many of the grand multiparous women in this study, unlike in Osogbo, South-Western Nigeria where the secondary school was the highest educational status attained by grand multiparous women.[20]

This could not be unrelated to the low level of patronage of western education in our environment when compared to the southern parts of the country. Besides, most of the grand multiparous women in our study were home managers.

Oral contraceptive pills (90.00%) and injectable contraceptives (89.50%) were the most known contraceptive methods among grand multiparous women. Rahman et al.[21] reported similar findings among married women of reproductive age group in the garment factory of Dhaka, Bangladesh. Injectable contraceptives have a greater and a peculiar advantage among women in our environment. Where the husband is ambivalent about modern family planning methods, the wife could receive the injections at a nearby health care facility without his awareness. Contraceptive usage was low (42.00%) in this study. This was comparable to the findings of Agbo et al.[22] in Plateau State, Nigeria, where there was the low uptake of contraceptives among rural community. This could not be unrelated to the desire of a larger family size in our environment.

Majority of the grand multiparous women's choice of contraceptive methods were based on the method's convenience for their lifestyle and their husbands’ influence. A study on contraceptive choices of women in rural southeastern Nigeria showed that the attitude of the women to the various methods of contraceptives as an important factor in influencing their choices.[15] In our study, apart from the attitude of the women, the husband's influence also played a major role. This is strongly related to the Islamic culture where women are encouraged to be submissive to their husbands.

The major reasons for not using any contraceptive method were the desire for more pregnancy and fear of side effects. Rahman et al.[21] revealed a desire for more children among married women in Dhaka as their main reason for nonuse of contraceptive. Similar findings were reported by Jabeen et al.[23] in Pakistan.

Side effects reported in this study were mainly weight gain, menstrual disturbances, and behavioral disturbances. Jabeen et al.[23] reported similar patterns.

In this study, there was no statistically significant difference between those that practiced contraceptives and the age group and education. Oyedokun[24] reported a significant association between educational level and the use of modern contraceptive methods in Osun, South-Western Nigeria. Furthermore, Jabeen et al.[23] reported a significant association between the age, educational status of the women and contraceptive practice. A Smaller sample size of this study may attribute to the findings. Besides, this study recruited only grand multiparous women unlike in the Jabeen et al.,[23] study.

Conclusion

There was high awareness of contraceptive methods among grand multiparous women; however, there was low use prevalence. Oral contraceptive pills, followed by injectable contraceptives were the most used methods, and husband were important in these choices. Therefore, health education should be directed to couples, rather than to women only. Major causes of nonuse of contraceptives were a desire for more pregnancy and fear of side effects.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.