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ORIGINAL ARTICLE
Year : 2022  |  Volume : 25  |  Issue : 2  |  Page : 37-40

Pattern of contraceptive choice among clients attending a tertiary health institution in Ogbomoso, Southwestern Nigeria


1 Department of Community Medicine, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, Nigeria
2 Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, Nigeria

Date of Submission28-Jan-2020
Date of Decision03-Mar-2021
Date of Acceptance14-Apr-2021
Date of Web Publication22-Aug-2022

Correspondence Address:
Prof. Adewale Samson Adeyemi
Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/smj.smj_5_20

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  Abstract 


Background: There is no ideal contraceptive method; therefore, likelihood of method choice shifts among clients from time to time. Aim: The aim of this study is to determine the most chosen modern contraceptive method, and the factors influencing that choice among clients attending a relatively new tertiary health institution in Southwestern Nigerian. Methods: A retrospective review of the case records of clients attending the family planning clinic of Ladoke Akintola University of Technology Teaching Hospital Ogbomoso, southwestern Nigeria, from January 2012 to December 2017. Results: Six hundred and twenty-nine clients accessed modern contraceptive methods during the study period. Their age ranged between 15 and 50 years with a mean of 33.0 ± 12.93. Most of the clients were married 616 (97.9%), had postsecondary education 405 (64.4%), and were of Christian faith 460 (73.1%). Progestogen-only injectable was the mostly chosen by the clients 228 (36.2%), and this is followed by intrauterine contraceptive device 186 (29.6%). Child spacing was the most common reason for contraception by the clients 357 (56.8%). Parity, postpartum contraception, previous contraceptive use, outcome of last delivery, mode of delivery of antecedent pregnancy, and educational status were all significantly associated with the mostly chosen method. Conclusion: Progestogen-only injectable contraceptive is the mostly chosen method among the clients, and this is a shift from what is obtained in southwestern Nigeria where intrauterine contraceptive device used to be the modern contraception method of choice.

Keywords: Choice, contraceptives, factors, Southwestern Nigeria


How to cite this article:
Aworinde OO, Adekanle DA, Ilori O, Adeyemi AS. Pattern of contraceptive choice among clients attending a tertiary health institution in Ogbomoso, Southwestern Nigeria. Sahel Med J 2022;25:37-40

How to cite this URL:
Aworinde OO, Adekanle DA, Ilori O, Adeyemi AS. Pattern of contraceptive choice among clients attending a tertiary health institution in Ogbomoso, Southwestern Nigeria. Sahel Med J [serial online] 2022 [cited 2022 Oct 2];25:37-40. Available from: https://www.smjonline.org/text.asp?2022/25/2/37/354188




  Introduction Top


Family planning is one of the most cost-effective ways of preventing maternal, infant, and child morbidity and mortality. It can reduce mortality by reducing the number of unintended pregnancies, the number of abortions, and the proportions of births at high risk.[1] It has been estimated that meeting women's need for modern contraceptives would prevent about one-quarter to one-third of all maternal deaths.[2] Nigeria, being one of the most populous countries in sub-Saharan Africa remains a focus for increasing contraceptive use.[2] Despite the high awareness of contraceptives, use prevalence still remains low among women of reproductive age.[3],[4] Although the contraceptive prevalence rate (CPR) has progressively increased from the 15% in 2013[5] to 17% in 2018,[6] relatively little progress has been made over almost two decades as current CPR is 16% in 2016.[7] In view of the foregoing, the Nigerian government through the Federal Ministry of Health developed the Nigeria Family Planning Blue Print (Scale-Up Plan) to achieve a CPR of 36% by 2018. It has been estimated globally that 200 million women want to use safe and effective family planning but are unable to do so, leading to unwanted pregnancies.[7] In Nigeria, unmet need for contraceptive is 27.6%.[8] There is no ideal contraceptive method, and this may be one of the reasons for the unmet need for contraception, and why contraceptive users do shift from one method to another. The intrauterine contraceptive device has been the most used modern contraceptive method in Southwestern Nigeria. [9],[10],[11],[12] The aim of this study, therefore, is to determine trends in the contraceptive choice among acceptors in Ogbomoso, a semi-urban town in Southwestern Nigeria.


  Methods Top


A retrospective study of case records of clients attending the family planning clinic of Ladoke Akintola University of Technology Teaching Hospital (LAUTECH), Ogbomoso, between January 1, 2012, and December 31, 2017. All patients attending the family planning clinic during this period were included with no exception. Ladoke Akintola University of Technology Teaching Hospital (LAUTECH), Ogbomoso is one of the two teaching hospitals of LAUTECH, Ogbomoso established in 2011. It is a 1000-bedded hospital; however, 400 have been activated for use. The Obstetrics and Gynecology department of the hospital runs the family planning clinic, Monday to Friday every week. The clinic provides family planning counseling and contraceptive services. The modern methods available for the clients includes: intrauterine contraceptive device (copper T), progestogen-only injectables (Depot and Noristerat), implants (Jadelle and Implanon), combined oral contraceptive pills, progestogen-only pills (mini pills), barrier methods (male and female condoms, diaphragm, and cervical cap), male and female surgical sterilization.

A pro foma was designed to collect the information from the client's record; information retrieved included: age, last confinement, interval between last confinement and access of contraceptive, parity, previous contraceptive use, and contraceptive method chosen. The data were analyzed using SPSS version 20 (IBM Corp., Armonk, NY). Test of association was done using Pearson Chi-square test where applicable, a P ≤ 0.05 was considered significant.

Ethical approval to carry out the retrospective study and share the data for research purposes was gotten from the ethical committee of LAUTECH Teaching Hospital, Ogbomoso on October 10, 2019 with protocol number LTH/OBG/EC/2019/182.


  Results Top


Six hundred and twenty-nine clients accessed the modern contraceptive method during the study period. The clients' age ranged between 15 and 50 years with a mean of 33 ± 12.93. Most of the clients were married 616 (97.9%), while single and separated were 9 (1.4%) and 2 (0.3%), respectively. Christians formed the majority of the clients, 460 (73.1%), and 527 (83.8%) had secondary and above educational status [Table 1].
Table 1: Socio-demographic characteristics of the clients

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Many of the clients, 357 (59.3%), had previously used a modern contraceptive method. Child spacing was the reason for accessing contraceptive method in 362 (56.8%) of the clients, while terminal fertility control was the reason by 237 (37.7%) clients, and 2 (0.3%) was for emergency contraception.

Progestogen-only injectable was the most chosen method by the clients, 228 (36.2%); this is followed by intrauterine contraceptive device 186 (29.6%), implants 178 (28.3%), condoms 19 (3.0%), combined oral contraceptive pills 13 (2.1%), mini pills 3 (0.5%), and emergency contraception 2 (0.3%) [Figure 1].
Figure 1: Contraceptive Method Chosen by the Clients

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Most of the clients had postpartum contraception 414 (65.8%).

Factors influencing progestogen injectable as the most chosen method were parity (P ≤ 0.01), outcome of antecedent pregnancy (P ≤ 0.00), postpartum contraception (P ≤ 0.04), previous contraceptive use (P ≤ 0.01), mode of delivery of antecedent pregnancy (P ≤ 0.00), and educational status (P ≤ 0.01).


  Discussion Top


Progestogen-only injectable contraceptive (POIC) is the most chosen modern contraceptive method by the clients in the present study. This is a shift from the usual in Southwestern Nigeria where Intrauterine Contraceptive Device (IUCD) was the most used modern contraceptive method.[9],[10],[11],[12] The proportion of the clients that chose progestogen-only injectable contraceptive was 36.2%, compared with 29.6% that chose IUCD. This is a great deviation from the previous studies from the region where over 70% of the clients made IUCD their contraceptive method of choice.[9],[10] POIC being the most chosen method by the acceptors in this study agreed with what obtained from Southeastern Nigeria,[13] South southern Nigeria,[14] and Northwestern Nigeria.[15] This study also agrees with the finding of the National survey which showed that POIC is the most used modern contraceptive method by women of reproductive age.[16]

Studies have shown that menstrual disruption is the most common side effect of POIC, and that is the reason for discontinuation and a major obstacle to their widespread use.[14],[17],[18] Women tolerating this drawback and making POIC their most chosen method may be as a result of better counseling by the service providers, since providers' bias has been found to influence client's choice of method.[12] Ease of administration may also be a factor associated with increase choice for POIC.[12] The present study shows that postpartum contraception significantly contributed to the choice of POIC. POIC does not inhibit milk production, unlike estrogen-containing contraceptive, hence its choice by lactating mothers who wants to have postpartum contraception.

The proportion of clients choosing condoms and contraceptive pills remained low in this hospital-based study as in previous studies; [9],[10] the reason for this may be because these methods can be gotten without prescription and they are provider independent. Condom is also said to be popular among students and adolescent populations.[19]


  Conclusion Top


Progestogen-only injectable contraceptive is the mostly chosen method among theclients, and this is a Shift from what is obtained in southwestern Nigeria where intrauterine contraceptive device used to be the moderncontraception method of choice.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hasan LE, Yamashita-Allen K. Global trends in fertility, contraceptive use and unintended pregnancies. in fertility regulations behaviors and their costs: Contraception and unintending pregnancies in Africa and eastern Europe & Central Asia. In: Lule E, Singh S, Chowdhury SA, editors. Health, Nutrition and Population Discussion Paper. Washington, DC: World Bank; 2007. p. 8-39.  Back to cited text no. 1
    
2.
Singh S, Darroch JE. Adding It Up: Costs and Benefits of Contraceptive Services: Estimates for 2012. New York: Guttmacher Institute; 2012.  Back to cited text no. 2
    
3.
Adeyemi AS, Olugbenga-Bello AI, Adeoye OA, Saluwu MO, Aderinoye AA, Agbaje MA. Contraceptive prevalence and determinants among women of reproductive age group in Ogbomoso, Oyo State, Nigeria. Open Acc J Contracept 2016;7:33-41.  Back to cited text no. 3
    
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NPC. Nigeria and ICE International, NDHS. Abuja: NPC; 2014.  Back to cited text no. 4
    
5.
National Population Commission (NPC) [Nigeria] and ICF International. Nigeria Demographic andHealth Survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International 2014. p. 92.  Back to cited text no. 5
    
6.
National Population Commission (NPC) [Nigeria] and ICF. Nigeria Demographic and Health Survey 2018. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF. 2019. p. 130.  Back to cited text no. 6
    
7.
UNFPA. Costs and Benefits of Investing in Contraceptive Services in Sub-Saharan Africa. New York: Guttmacher Institute and UNFPA; 2012.  Back to cited text no. 7
    
8.
National Bureau of Statistics (NBS) and United Nations Children's Fund (UNICEF). Multiple IndicatorCluster Survey 2016-17, Survey Findings Report. Abuja, Nigeria: National Bureau of Statistics and United Nations Children's Fund. 2017. p. 149.  Back to cited text no. 8
    
9.
Ijarotimi AO, Bakere B, Badjoko OO, Fehintola AO, Loto OM, Orji EO, et al. Contraceptive uptake among women attending family planning clinic in a Nigerian tertiary health facility: A 6-year review. Int J Reprod Contracept Obstet Gynecol 2015;4:721-4.  Back to cited text no. 9
    
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Adeyemi AS, Adekanle DA, Komolafe JO. Pattern of contraceptives choice among the married women attending the family planning clinic of a tertiary health institution. Niger J Med 2008;17:67-70.  Back to cited text no. 10
    
11.
Ogedengbe OK, Giwa-Osagie OF, Ola R, Fasan MO. Contraceptive choice in an urban clinic in Nigeria. J Biosoc Sci 1987;19:89-95.  Back to cited text no. 11
    
12.
Akadri AA, Odelola OI. Progestogen-only injectable contraceptive: Acceptor prevalence and client experience at Sagamu, Nigeria. Niger Postgrad Med J 2017;24:178-81.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Chigbu B, Onwere S, Aluka C, Kamony C, Okoro O, Feyi-Waboso P. Contraception choices of women in rural Southeastern Nigeria. Nig J Clin Pract 2010;13:195-9.  Back to cited text no. 13
    
14.
Ojule JD, Orji VK, Okongwu C. A five year review of the complication of progestogen only injectable contraceptive at the University of Port-Harcourt Teaching Hospital. Niger J Med 2010;19:87-95.  Back to cited text no. 14
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Ameh N, Sule ST. Contraceptive choices among women in Zaria, Nigeria. Niger J Clin Pract 2007;10:205-7.  Back to cited text no. 15
[PUBMED]  [Full text]  
16.
National Population Commission, ICF International. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International; 2014. p. 97.  Back to cited text no. 16
    
17.
Baird DT, Galasier AF. Menstrual bleeding patterns and contraceptives. IPPF Med Bull 1991;25:1-2.  Back to cited text no. 17
    
18.
Adeyemi AS, Adekanle DA. Progestogen only injectable contraceptive: Experience of women in Osogbo South western Nigeria. Ann Afr Med 2012;11:27-31.  Back to cited text no. 18
[PUBMED]  [Full text]  
19.
Arowojolu AO, Ilesanmi AO, Roberts OA, Okunlola MA. Sexuality, Contraceptive Choice and AIDS awareness among Nigerian undergraduates. Afr J Reprod Health 2002;6:60-70.  Back to cited text no. 19
    


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