Knowledge and factors influencing long acting reversible contraceptive use among women of reproductive age in Nigeria

Introduction

The rising use of contraception in Nigeria has given women the ability to choose the number and spacing of their children. It has also presented them with various remarkable life-saving benefits, such as reduction in maternal and infant mortality, good child spacing and better postpartum health outcomes. Recently, the expansion in choice of contraceptives available has given women the option of adopting the use of Long-acting reversible contraceptives (LARCs) which are implant and intra-uterine device contraceptive methods that are highly effective and convenient with an added advantage of being long-lasting, require little or no maintenance. It has much better compliance rates than other hormonal methods and is also cost effective. LARCs are ideal pregnancy prevention options for many women compared with shorter-term and user-dependent methods, both of which increase the risk of non-compliance related method failure^1–4.

Long-acting devices, when initiated, provide at least 3 years of continuous pregnancy protection for women, and can give up to 10 years of protection. These devices are 99% effective because they are not subject to errors in use, unlike short-acting methods². Also LARC methods have the ability to reduce the gap between “typical use” and perfect use” failure rates¹. Approximately 48% of unintended pregnancies occur as a result of contraceptive failure around the world⁵, which is largely due to incorrect use, poor adherence and/or technology failure. This can be avoided with the use of LARC methods, because they are not dependent on compliance with a pill-taking regimen, remembering to change a patch or ring, or arranging an appointment with physicians^6,7.

Several studies have established that women in sub-Saharan Africa are often unable to obtain or use modern contraception, particularly the long acting methods, for many reasons associated with both supply and demand side^8,9. Nigeria is not particularly exempted with Long Acting Contraceptive Prevalent use of 3.1%¹⁰.

Nigeria’s total fertility rate (5.5) is one of the lowest in sub-Saharan Africa and globally. This is due largely to her high unmet need for family planning of (21.8%). Use of contraception is relatively low (17.1%) and this also reflected in the number of women that subscribed to LARC despite being the most cost-effective contraceptives. In Nigeria, knowledge about LARC in terms of intrauterine device (IUD) and implant shows that 36.8% of women have knowledge of IUD and 49.5% of implants^11,12 which is also low.

Despite the efficacy and safety of LARC, the use is not widespread among women of reproductive age in Nigeria. Hence, this paper examined the relationship between women’s knowledge of LARC and factors influencing the use of LARC among women of reproductive age in Nigeria in order to guide policy makers’ decisions.

This research paper sought to identify the relationship between knowledge and factors influencing the use of LARC among women of reproductive age in Nigeria.

Methods

Results

Table 1 shows the distribution of respondents that are currently using of contraception by selected socio-demographic characteristics. A total of 1,927 females were found to be currently using of contraception in the study. The mean age of respondents was 31.3 years and more than 40% of the current users fell within the age range of 25–34 years. Concerning the level of education, almost half (49.7%) of females had attended secondary education and whilst 24.1% had higher education. Marital status shows that majority (76.6%) of the respondents were currently married at the time of interview. More than half (59%) of the respondents reside in urban areas while 41% reside in rural areas. Regarding wealth index, the table shows that 43.1% were from rich households, 35.6% from poor household and 21.3% were from middle household. More than half (52.6%) of the respondents had 1–4 children before they started using of contraception. Raw data are available on OSF¹⁴.

The method mix of the respondents and percentage distribution is shown in Figure 1. Respondents included those who were married to or living with a man at the time of the survey and were currently using contraception.

Figure 1. Method Mix of current user.

Table 2 presents the confidence interval showing respondents rate of using LARC. A total observation of 1927 were considered with 0.15 mean, 0.0081 standard error and confidence interval of 0.0081 - 0.1638

Table 3 presents respondent’s contraceptives awareness and knowledge of LARC methods. The table shows that 28.5% read about family planning in newspaper/magazine, 49.7% heard about it on television and 67.2% heard on radio. Concerning awareness at health facility and from health worker, 53.6% of the respondents reported that they were talked to about family planning at the health facility and only 18.5% heard about family planning when visited by health worker in the last 12 months. Knowledge about LARC shows that 70.3% of women in the study had knowledge of the contraceptive implant and 55.5% female had knowledge of the IUD.

Table 4 presents practice of contraceptives among female who are currently using any method of contraception. The table shows that (76.5%) female that are currently using any method of contraception were using modern contraceptives (e.g. condoms, hormonal pill), and 14.8% of respondents were using LARC.

Table 5 presents pattern of LARC use among current user of contraceptive by selected socio-demographic characteristics. The table showed that LARC use increases as the respondent’s reproductive age increases. More women who reside in urban areas were using LARCs compared to those in rural areas. More women with secondary education used LARC methods compared to women with no education, primary and higher education. Marital status shows that married women prefer LARC compared to divorced/separated, widow and never married. With respect to the household wealth index, the table shows that more women from poor households subscribed to LARC method compared to women from middle and rich household. Lastly, number of children at the time respondent started using contraceptive shows that more women that had 1–4 children subscribed to LARC methods compare to women with no child and women with more than four children.

Table 6 presents the association between knowledge of LARC and use of LARC methods among women that are currently using contraception. The table showed that at both levels of analyses (binary and multivariable logistic regression) there is a significant relationship (P<0.05 and P=0.00, respectively) between knowledge of LARC and it uses in this study. This means that the use of LARC can be influenced by knowledge of it among women of reproductive age in Nigeria.

Logistic regression was employed to assess the net effect of selected variable theoretically related to use of LARC methods in Table 7. The result of logistic regression showed that women who were 25 years and above, women with secondary and higher education, currently married and widow, women from rich household and women with one or more children were significantly associated with use of LARC methods.

Women who fall between the ages of 25 and 34 years were 1.67 times more likely to use LARC methods than those who aged 15–24 years, and those women that 35 years and above were 1.73 times more likely to use LARC methods than those aged 15–24 years.

Level of education shows that women with secondary school education were 2.64 times more likely to use LARC methods than those that never attended school and those women with higher education were 3.30 times more likely to use LARC methods than those that never attended school in the study. Concerning marital status, the results show that married women were 4.61 times more likely to use LARC methods than those that never married and widowed women were 7.16 times more likely to use LARC methods than those that never married.

With respect to household wealth index, women from rich households were 0.57 times less likely to use LARC methods than women from poor households. In addition, women with 1–4 children at the time of contraceptive use were 4.28 times more likely to use LARC methods than women with no child and women with more than 4 children at the time of contraceptive use were 6.08 times more likely to use LARC methods than women with no child. Lastly, women who heard about family planning at health facility were 1.38 times more likely to use LARC methods than those that heard it elsewhere.

Discussion

This paper assessed knowledge of LARC and factors influencing the use of LARC among women that are currently using contraception in Nigeria. The study showed that LARCs were largely under-used among women that are currently using any contraception. To properly harness socio-economic opportunities and better child spacing the low use of LARC should be tackled because of its integral benefit of meeting women’s reproductive needs in a context where woman are redefining their reproductive life style^4,15.

This study shows that there was an association between women’s knowledge of LARCs and use of LARCs among women that are currently using contraception. This is because women’s knowledge about the efficacy and safety of LARC methods may strongly influence both the selection and decision to continue to use the selected method over time. These findings were in line with previous studies that say women will opt for LARC methods as their contraceptive method of choice when they have knowledge of the method^{3,6,7,16–20}. Another study also affirmed that women reproductive life plans are being altered as result of misinformation and this prompt woman to adopt methods not suitable for themselves²¹.

In addition, level of education was found to be associated with the use of LARC. The possibility of women with atleast secondary school education to control her reproductive need is very high. The higher the education of women the higher the propensity that they will adopt the use of LARC. Previous studies also corroborate this point that better educated women have access to information on modern contraceptive which may trigger their interest in the use of LARC^{6,18,19,22–26}.

Women aged 25 years and above were more likely to use LARC methods as compared to women aged 15–24 years. This result is in line with previous studies, which reported that age of mothers was found to be associated with the use of LARC because the prevalence of LARC use increased with age^3,4,23,24,26.

Number of living children at the time of contraceptive use was significantly associated with LARC use. Suggesting that women wanted to space or limit childbirth as the number of surviving children increases. The higher the number of living children the higher the possibility of adopting LARC. The desire to limit the number of children will automatically come to play when women believe they have sufficient numbers of children so rather than adopting short-lasting, long-lasting methods will be preferred^4,22,23,27.

Furthermore, women from rich households were less likely to use LARCs. This is in contrary with other studies, which found that household wealth has a positive association with the use and wealthier women were more likely to use LARC than poorer women^4,23,24.

Lastly, the study found that married women were more likely to use LARC methods. This is consistent with previous studies that showed that married women have good attitudes towards using LARC methods^17,24,28.

Conclusions

In conclusion, findings from this study showed that 14.8% of women in Nigeria that are currently using contraception were using LARC. Additionally, level of education, age of women, household wealth and number of living children as at the time of contraceptive use were significantly associated with the use of LARC. Also, knowledge of LARC was significantly associated with LARC use. To effectively control the childbearing in Nigeria women with lower education, high wealth index and high number of living children should be the target audience among the women of reproductive age in Nigeria. Also, there is need for a communication strategy that would provide correct information about LARC safety and effectiveness among women of reproductive age. Lastly, when discussing contraception with women, health care practitioners should discuss the risks and benefits of LARC with women of all ages and recommend them as a first-line method.

Data availability