Awareness and opinions regarding contraception by women of reproductive age in North-West Nigeria

Introduction North-west Nigeria is a traditionally high fertility setting. Increasing attention is being channeled into scaling up the various interventions that can reduce high fertility, including enhancing contraceptive uptake among women of reproductive age. However, in order to improve demand for contraception, understanding the level of awareness, knowledge and perception of WRA to contraceptive use is essential. This study examines the level of knowledge and perception of WRA to contraceptive use. Methods A descriptive cross-sectional study was carried out in December 2016 in Kebbi and Sokoto states, North-west Nigeria. Semi-structured questionnaires were administered to 500 women between the ages of 15-49 years in 4 randomly selected local government areas across the states. Data analysis included descriptive and bi-variate statistics. Results Only 43.8% claimed to be currently using a modern form of contraception; 82.4% were aware of at least one form of contraception, while health personnel formed the major source of information. The most popular and least common modern contraceptive methods were the male condom (86.8%) and vasectomy (26.6%) respectively. A higher proportion of married respondents (88.8%) than those presently single (68.8%) had good knowledge of contraceptives. Perception of contraceptives was mixed, with majority believing that contraceptives should be made available to every woman, despite stating that it contradicted their religious beliefs. Conclusion These results underline the need for policy makers to focus on improving the knowledge of younger age groups on contraceptives and include other information channels such as peer-to-peer discussions to increase awareness.


Introduction
A breakdown of the global health statistics shows that every year, over 40,000 women in Nigeria die from childbirth and complications arising from pregnancy [1]. Thus, while Nigeria is responsible for only 2.5% of the world's population, it is responsible for 14% of maternal deaths globally every year [1]. These appalling statistics has led to increased interest in improving maternal health in Nigeria.
However, in spite of this interest, not much has been achieved in terms of improving maternal health in the country over the past 15 years [2]. For example, while the 2008 National Demographic and Health Survey (NDHS) reports a maternal mortality rate of 545 per 100,000 live births, the 2013 NDHS reports 576 per 100,000 live births, an increase of 5.6% [3,4]. This contrasts with both the Millennium Development Goal (MDG 5) of 75% reduction in maternal mortality rates and the Sustainable Development Goal (SDG 3) respectively. In order to reverse this negative trend, stakeholders have identified that improving contraceptive uptake among women of reproductive age is critical to any progress Nigeria is to record [5,6]. This is because contraceptive use has been observed to delay onset of child bearing as well as reduce parity among users. In turn, research has shown that such women are less likely to die from childbirth. However, the latest NDHS reports that only 10% of women currently use a modern form of contraceptive.
This figure is further skewed by the North-South divide with the North-west particularly recording worse contraceptive use statistics than other regions in the country [3]. Thus, improving contraceptive uptake among women of reproductive age (WRA) in North West Nigeria is a critical component of improved maternal health in the country [7,8]. Literature has shown that there are 2 main drivers of contraceptive uptake, namely demand and supply [9]. The supply side, which involves the provision of contraceptives at convenient points in order to reduce and if possible eliminate unmet need has been given much attention by both government and nongovernmental organizations [10,11]. However, the demand side for contraceptive demonstrates the willingness to use contraceptives, which will in turn inform decisions about supply [12]. The demand side of contraceptive uptake has received a measure of attention from government, donor programs and other non-governmental organizations through activities such as social mobilization, mass media and other slogans and logos worn at public events [7]. The aim of these activities is to foster dialogue about family planning, increase social approval for family planning and improve knowledge and perceptions of family planning methods [13,14]. While literature has identified socio-cultural factors such as religion, culture and fear of side effects as potential influencers of contraceptive uptake in the region, there is still a paucity of studies that focus on specific perceptions of WRA to contraceptive uptake in the Northwest region of Nigeria. This study aims to provide this information by investigating the awareness, knowledge and perceptions of WRA in the region.  software. Scores were allotted to required questions with correct answers scored as 1 and wrong answers scored as 0. Based on this, respondents with average scores of 50% and higher were classified as having good knowledge while respondents with less than 50% were classified as having poor knowledge. Descriptive statistics such as proportions and frequencies were used to describe the data while chi-square tests were carried to test for statistical associations between dependent and independent variables at 5% level of significance. Chi-square statistic and p-values were recorded for the chi-square tests.

Results
The majority of respondents (84.0%) were married while a similar proportion (84.2%) of respondents were Muslims. The educational attainment of the respondents was more evenly distributed with 14.2% of respondents having completed no form of formal education at all and 13.4% of the respondents completed tertiary education. Less than half (43.8%) of the respondents claimed to be currently using a modern form of contraception. Table 1 shows the comprehensive sociodemographic characteristics of the respondents.  Table   5 shows the perception of the respondents to contraceptives.

Discussion
The level of contraceptive uptake was higher than has been reported in other reports and in the NDHS [15]. The fact that most of the respondents were from urban areas could have played an important part in increasing the level of contraceptive uptake as few of the respondents came from the rural areas. Other studies in urban areas also report higher contraceptive prevalence rates than studies carried out in both urban and rural settings [7,16] Awareness and knowledge of FP and contraceptives were found in this study to be very high indicating that the majority of the with both studies reporting majority of their sample abstaining from contraceptives due to religious reasons. Another controversial aspect of the perception discussion was that using contraceptives would make a woman promiscuous. This view has also been expressed by other researchers who reported similar findings in other African settings and how they impact negatively on the likelihood of using contraceptives [21,22].

Conclusion
This study sought to provide this information on the knowledge and perceptions of women of reproductive age in Northwest Nigeria. The results show that the awareness of contraceptives and FP in the state continue to be on the rise with urban and educated residents being the most captured by awareness campaigns. However, the need to ensure that these campaigns reach the less educated who are more likely to live in rural backgrounds was also highlighted.
Knowledge about contraceptives was also high indicating that channels currently in use may be getting the desired effect. Despite What is known about this topic  Authors have confirmed that the major drivers of contraceptive uptake are demand and supply;  Improving uptake is critical to achieving the sustainable development goals;  Socio-cultural and religious factors are major influencers of contraceptive use.

What this study adds
 This study reveals the specific perceptions of women of reproductive age on contraceptive uptake in North-west geopolitical zone of Nigeria;  Contraception awareness and uptake is age-dependent, with older women of reproductive ages having a broader knowledge on contraception;  Majority perceive contraception as a means to child spacing with only a few believing that it helps to limit family size.

Competing interests
The authors declare no competing interest.

Acknowledgments
The authors wish to acknowledge the support of the United Nations Population Fund who provided funding for the data collection and analysis. Table 1: Sociodemographic characteristics of the respondents (N = 500)