INTRODUCTION

1.1. Background Information

Family planning is one of the most ―health-promoting and cost-effective activities in public health promotion and has the potential to avert approximately 30% of maternal and 10% of child deaths. Thus, FP contributes to achieving the Millennium Development Goals (MDGs) through healthier birth spacing and by reducing mortality and morbidity associated with pregnancy. Decades of research and investment in family planning programmes have resulted in dramatically improved programme coverage and biomedical technologies as well as significant (although uneven) increases in contraceptive uptake throughout most of the developing world. Contraceptive options—not all of which are available in many developing countries; include a variety of hormonal regimens and modes of delivery for women (e.g., pills, injectables, implants, patches, vaginal rings, medicated intrauterine devices) as well as improved male and female condoms, spermicides, cervical caps and other vaginal barriers, post-coital (emergency) contraception, improved fertility awareness-based methods, and simpler and more effective surgical techniques for tubal ligations and vasectomies.

Nevertheless, Demographic and Health Surveys (DHS) reveal that in many countries- including some with quite high rates of contraceptive prevalence -40% or more of women who recently gave birth reported that the pregnancy was wanted later or not at all. Proportions of married women with an unmet need for contraception also range up to 30 to 40% or more in a number of countries.6 Both of these situations reflect, to variable degrees, programme- and method-related inadequacies, including contraceptive failures due to a variety of reasons, as well as personal and situational factors such as partner’s opposition or women’s experiences or fears of side-effects that need to be addressed.  Contraceptive information, needs and motivations evolve through  the life course as male and female adolescents become sexually active before marriage or cohabitation (perhaps with several partners) or at the time of their marriage, and as couples decide if and when to begin childbearing (if they have not already accidentally done so); accumulate experiences with contraception (or its absence) and with pregnancy and childbearing; think about spacing and stopping; and are potentially faced with 10 or 20 more reproductive years at risk. Some women and men will divorce, remarry and decide to have another child; others will bear children (wanted or unwanted) outside of marriage or be motivated to avoid it. The environmental and contextual scenarios are many; the individual trajectories even more diverse. The challenge for educational and health sectors is to meet these changing needs with comprehensive information about pregnancy risks, acceptable contraceptive options, and correct and consistent use. Interventions include countering beliefs in ineffective methods and overcoming unrealistic fears about contraceptive side-effects that adolescents may already have acquired.

Family planning is an important preventive measure against maternal and child morbidity and mortality. It is an essential component of primary health care and reproductive health. It plays a major role in reducing maternal and neonatal morbidity and mortality. It confers important health and development benefits to individuals, families and communities and the nation at large. It helps women to prevent unwanted pregnancies and limit the number of children, thereby enhance reproductive health. By this, it contributes towards achievement of Millenium Development Goals (MDGs) and the Target of the Health for all Policy. The MDGs call for 75% reduction in maternal mortality and two-thirds reduction in child mortality between 1990 and 2020. As such effective utilization of family planning services is critical for the attainment of these goals thus improving health and accelerating development across the regions. Access to family planning also has the potential to control population growth and in the long run reduce green gas house emission with it associated risk. Similarly it has been estimated that  preventing unwanted pregnancies by the use of family planning would avert a total of 4.6million Disability Adjusted Life Years.16 Despite the importance and benefits of family planning, it has been estimated that about 17% of all married women globally would prefer to avoid pregnancy but are not willing to use any form of family planning. As a result, 25% of all pregnancies are unintended particularly in developing region of the world. This results to an estimated 18million abortion taking place each year, thereby contributing to high maternal morbidity and injuries. Sub-Saharan Africa which is home to only 10% of the world’s women, contributes annually, 12million unwanted or unplanned pregnancies and 40% of all pregnancy related deaths worldwide.

The contraceptive prevalence in sub-Saharan Africa is low, estimated at 13%, in spite of the evidence of the pivotal role of family planning, while in Nigeria the estimation is 8.0% with 17% unmet need for family planning. This greatly contributes to the high rate of unintended pregnancies leading to induced abortion with its consequent complications. Despite the fact that Nigeria constitutes only 2% of the world’s population, it has being shown to account for 10% of the world’s maternal deaths. There is relatively high fertility rate in suburban and rural Nigeria despite the efforts of government and other non-governmental family planning services providers. Even though the fertility rate is high, acceptance and utilization of modern family planning methods has been low due to various reasons. In Africa, provision of family planning services is hindered by poverty, poor co-ordination of the programme and dwindling donor funding. Additionally, traditional beliefs favouring high fertility, religious barriers, fear of side effect and lack of male involvement have contributed significantly in weakening family planning interventions.