KNOWLEDGE, ATTITUDES AND PRACTICES OF POST NATAL MOTHERS ON FAMILY PLANNING IN NYENGA HOSPITAL

ABBREVIATIONS

FP                                : Family Planning

WHO                          : World health organisation

IUCD                          : Intrauterine Contraceptive Device

LAM                           :Lymphangioleiomyomatosis

CPR                             : Contraceptive prevalence rate

PPFP                           : Postpartum Family Planning

DEFINITION OF KEY WORDS

Fertility                       :

CHAPTER ONE:

1.0 Introduction

This chapter presents the introduction of the study, background of the study, problem statement, purpose, specific objectives, research questions and justification of the study.

1.1 Background information

According to Trussell, J.et al (2007), family planning”, means enabling individuals and couples to determine the frequency and timing of pregnancies, through the use of modern and traditional (also called natural) contraceptive methods.

Natural Family Planning (NFP) applies to various methods that have been developed to help women and men determine the fertile and infertile times of a woman’s menstrual (monthly) cycle. These methods can be used to achieve or avoid pregnancy.  All of the methods rely on the interpretation of natural (biological) signs of fertility. The basic assumption of NFP methods is that that couples abstain from intercourse and genital contact during the fertile time of the woman’s cycle if they are avoiding pregnancy.  There are basically five methods natural family planning methods:

Calendar Based Methods (rhythm) which relies on counting cycle length and use of a simple formula to determine the beginning and end of fertility

Basal Body Temperature (BBT) which employs recording of the woman’s daily waking temperature and observing the changing patterns.

The Ovulation Method (OM) which involves observing and recording the patterns and changes of cervical fluids

The Sympto-thermal Method (STM) which consists of combining daily waking temperature, changes in cervical fluid, cycle length and other minor signs of fertility

Hormonal Fertility Monitoring (HFM) uses ovulation test kits and electronic fertility monitors to measure reproductive hormones in the urine

Meanwhile according to McVeigh, R. (2013), artificial family planning method is the process of using artificial birth control to control the growth of a family by preventing unwanted pregnancy. These include The Pill which is a combination of progestin and oestrogen, a condom which is made from synthetic rubber and classified as “barrier” contraception, the diaphragm which is made of rubber and inserted into the vagina with spermicide applied to cover the cervix among others.

Postpartum Family Planning  is the initiation and use of contraceptives during the first year after delivery (McKaig and Dellar, 2006). The first year after delivery is a complex period, during which a woman has to care for her new born child as well as cope with a series of emotional and physical changes and often extreme tiredness (Salway and Nurani, 2007)

Family planningrefers to the factors that may be considered by a couple in a committed relationship and each individual involved in deciding if and when to haveIndeed, postpartum family planning services (PPFPS) are regarded as a basic human right to attain the highest standard of sexual and reproductive health by post-natal mothers, free of discrimination, coercion and violence (UNFPA, 2003). Globally, use of PPFP has risen slightly, from 54% in 1990 to 57.4% in 2014. Regionally, the proportion of post-natal mothers aged 15–49 reporting use of PPFP  method has risen minimally or plateaued between 2008 and 2014. In Africa it went from 23.6% to 27.6%, in Asia it has raised slightly from 60.9% to 61.6%, and in Latin America and the Caribbean it rose slightly from 66.7% to 67.0%.

However, PPFP services are facing a complicated process, entangled in social, political, moral and cultural network in many African countries, including Tanzania (Richey, 2008). For example, Tanzania is among the sub-Saharan African countries with the highest total fertility rate at 5.4 births per woman (TDHS, 2010). Indeed, high percentage of postnatal mothers are sexually active and practice unsafe sex, consequently , the majority of them are highly vulnerable to unwanted pregnancy, immediate conception after child birth unsafe abortions, (TDHS,2010).

Unsafe abortion is a significant problem to post mothers who conceive immediately after birth (Plummer et al. 2008). Nearly a quarter (24%) of sexually active married and unmarried women has an unmet need for PPFP, according to the most recent DHS (Khan and Mishra 2008). Promotion of condoms for disease prevention might be contributing to this unmet need by associating the method with infection and promiscuity (Plummer et al. 2006).

Uganda, an east African nation, shares cultural, social, economic, and demographic characteristics with other African countries, including; rapid population growth mainly characterized by high levels of fertility, generally attributed to low use of PPFP services. There are many reasons why mothers do not use PPFP services during the postpartum period. Lack of access to family planning services and information is often a barrier rural mothers with unmet need for PPFP services during the postpartum period are more likely to conceive immediately after birth than their urban counterparts due lack of access as a reason for not using PPFP .

Among postnatal mothers with unmet need for PPFP, commonly cited reasons for not using FP include personal or partner opposition to use (26%), breastfeeding or having recently given birth (26%) and fear of side effects (22%). These reasons suggest that many postnatal mothers lack accurate information about PPFP, including its mechanisms of action, safety, side effects, efficacy and ease of use.

1.2 Problem statement

According to  ICF International, (2012), Uganda struggles with a low contraceptive prevalence rate (CPR) of 30%, which is lower than that of her neighbours, Kenya, Rwanda, and Tanzania, which have a CPR of 46%, 52%, and 34% respectively, at the time of their last surveys.

Despite the enormous efforts put in place to improve family planning methods, for example by health education, supply of contraceptives in all health facilities and Inter sectoral organizations efforts to improve maternal health services, the use of family planning remains a challenge in Nyenga Hospital due to a low turn up of mothers for post natal services and especially on utilization of postpartum family planning services/methods. With this background this study will aim at determining the knowledge, attitude and practice of its methods among mothers attending post-natal clinic in Nyenga Hospital in order to suggest ways of encouraging its utilization.

1.3

The purpose of the study was to generate information that would contribute towards designing strategies aimed at improving the use of family planning services among mothers attending postnatal clinics.

1.4 Specific objectives of the study

2. To establish the delivery of family planning services/methods to post-natal mothers in  Nyenga Hospital
3. To establish the socio-economic factors associated mothers attending postnatal clinic in Nyenga hospital.

1.5 Research questions.

1. What is the knowledge and attitude of post natal mothers on family planning services in Nyenga Hospital?
2. What are the different family planning services delivered to post-natal mothers in Nyenga Hospital?
3. What are the methods of family planning offered in Nyenga Hospital
4. What are the socio-economic factors associated with post-natal mothers attaining family planning Nyenga Hospital?

1.6 Justification of the study.

This research would aid the Ministry of health and other stake holders to come up with strategies to improve contraceptive use by creating knowledge on its benefits to mothers, their children, families and the country at large.

The study may provide a reference point to  future researchers who will carry similar studies this would also act as a sensitizing tool for all community members on the importance of contraceptive use.

The study would of great help to the nursing profession to develop plans and procedures of managing postnatal mothers’ in relation to their anticipated side effects of contraceptives.

CHAPTER TWO: LITERATURE REVIEW

2.0 Introduction

This chapter presents litereature presented by other scholars, it’s presented according to the study objectives.

2.1 Knowledge and attitude of mothers attending post-natal clinic on family planning

All over the world, sexual behaviour is a complex issue influenced by numerous variables, such as individual desire, social and cultural relationships, environmental and economic dynamics (Njau et al., 2006; Ochieng et al., 2011). Their socio-demographic characteristics (Upreti et al., 2009), perception of Postnatal mothers (Mahat et al., 2006; Puri, 2006), level of knowledge and their attitudes towards their sexual and reproductive health during their post-partum period (Rondini & Krugu, 2009) may impact greatly on whether or not they have sex, the types of sexual relationships they form and utilization of postpartum family planning services (UNICEF, 2006).

Around the world, successful reproductive health programmes among mothers are those that equip post-natal mothers with Knowledge and skills that will keep them safe from getting pregnant during the postpartum period (Paluku et al., 2009).

According to C Mubita-Ngoma, (2010), in his study about Knowledge and use of modern family planning methods by rural post-natal mothers in Zambia, found out that a larger number of Zambians had heard about modern contraceptive methods mainly from a health worker. This study also found out that the most popularly known and used method of contraceptive was a male condom followed by a pill.

In  another study  on contraceptive  use  in  mothers  enrolled  into  preventive  HIV  vaccine  trials reported  insufficient  knowledge  of  certain  methods  to  be  among  the  reasons  for  not  using contraception and that misconceptions related to family planning  methods and their incorrect use, might have led to inconsistent use resulting in undesired pregnancies during the postpatum (Kibuuka et al., 2009)

Another  survey  conducted  in  14  countries  among  7000  mothers irrespective  of  their  HIV  status between 14 and 40 years showed that knowledge gap in family planning methods restricts women’s contraceptive choices and hence use, and that mothers fail to take advantage of new contraceptive methods due to lack of knowledge and stay with the familiar options (Rossella, 2006).

A study carried out in Tanzania also stated that, both users and non-users of family planning often held mixed views of modern FP methods, recognizing both the benefits for limiting and spacing children, but also expressing strong fears and beliefs about contraceptive use such as: caused cancer, weight gain or loss among mothers, continuous bleeding, cessation of periods all together. This is seen as harmful to the post-natal hence not using PPFP. (Plummer et al., 2008)

Also a study carried out in Kenya by Shabiby. et al, (2015), revealed that,  Most participants were aware about modern methods of FP with inject able contraceptives and contraceptive pills being the most commonly known FP methods, followed by IUCD, male condom and implants. Natural FP methods such as Lactation Amenorrhoea (LAM) and rhythm methods were among the least known FP methods and only about a quarter of all participants knew about female sterilisation (Mufida et al., 2015).

According to Nanvubya et al, (2015), in their study about use of Modern Family Planning Methods in Fishing Communities of Lake Victoria, 88%of the respondents knew about modern FP methods, with women and older respondents having more knowledge.

It is also noted the same survey of Uganda Demographic and Health Survey (UDHS) (2011), that Uganda has a young population (52% below age 15, and 17% are age 15-24) and a high total fertility rate (TFR), of 6.2 children per woman.

2. 2 Establish the delivery of family planning services/ methods to post-natal mothers

The days and weeks following childbirth the postnatal period is a critical phase in the lives of mothers and newborn babies WHO. (2014). Major changes occur during this period which determine the well-being of mothers and newborns. Yet, this is the most neglected time for the provision of quality family planning services/methods. Lack of appropriate care during this period could result in pregnancy during the postpartum period. Rates of provision of skilled family planning services are lower after childbirth when compared to rates before and during childbirth. WHO. (2014).

Uganda still struggles with a low contraceptive prevalence rate (CPR) of 30%, which is lower than that of her neighbours, Kenya, Rwanda, and Tanzania, which had a CPR of 46%, 52%, and 34%, respectively, at the time of their last surveys, (ICF International 2012).

While family planning (FP) is important throughout an individual’s and couple’s reproductive life, postpartum family planning (PPFP) focuses on the prevention of unintended and closely spaced pregnancies through the first 12 months following childbirth (Rutstein 2008).

Effective delivery and uptake of modern family planning methods depends a lot on the competency and attitudes of the providers particularly for the long acting and permanent methods Babalola, S. (2012). According to Kasedde S, (2010) some of the constraints observed in postnatal family planning delivery include lack of trained staff or transfer of trained and motivated staff resulting in decrease of commitment of the remaining staff. In addition, there is poor information provision ranging from poor display of education and communication materials, to limited disclosure of methods and counseling about modern postnatal FP methods especially the long term and permanent ones (Kasedde 2010). Also documented are the negative attitudes of service providers, poor accessibility to services, and inadequate family planning supplies at the health facilities (Mbonye 2013). Other service factors that may also hinder FP service utilization include: long waiting times, unofficial fees in the public sector, and limited quantity of information provided during care (Jitta 2011).

Postnatal Family planning services can be made more accessible and convenient to mothers if they take into account other service needs of the potential clients. Integration of postnatal FP services for postnatal mothers who frequently use Maternal and Child Health (MCH) and reproductive services would lower costs to clients and reduce missed opportunities for service delivery (Katherine W 2010). A study conducted in Kumi District, Uganda found out that only about 18% of mothers attending postnatal clinics received messages regarding postpartum family planning services and yet 71% intended to use PPFP in the future (Mbonye 2013).

2.3 The socio-economic factors influencing the use of family planning among mothers attending postnatal clinic

According to Timothy et al, (2011), long distance account partly for the use of contraceptives amongst women in the rural area. Also lack of awareness could be attributed to lack of access to information regarding the services. The inability to access such important information is bound to affect the woman’s ability to make an informed decision on uptake of postpartum family planning services/methods (Timothy et al., 2011).

Kumar et al (2011), in their article about Family planning practices and methods among women of urban slums of Luck now City India, sited that, modern PPFP use by a respondent or their sexual partner was reported in just over a third of the respondents with more females than males reporting use. Short-acting reversible contraceptive methods such as oral contraceptives and Depo-Provera were used by three quarters of the respondents as compared to one quarter who used the long-acting reversible methods such as intra-uterine devices and implant. (Kumar et al., 2011)

In Tanzania, More than half of the respondents who reported knowing about modern PPFP methods were not using them. PPFP use increased with education level, with the lowest use of PPFP reported by those without any formal education and the highest use by those who had attained secondary or higher level of education. Muslims were less commonly using modern PPFP methods despite having knowledge. (Plummer et al., 2006).

According to a study done in Kenya among postnatal mothers , 51 per cent of the respondents were using PPFP services. In the same study, those using the PPFP services  cited  various  reasons  ranging from  managing  the  family, preventing un wanted pregnancies  to   promoting child spacing (Timothy et al., 2011)

Still in Kenya, in terms of methods, the study reveals that the most commonly used PPFP services were condoms, pills, injection and IUD, (Timothy et al., 2011).

In Uganda as in many other countries, major factors associated with PPFP services use are mothers who are educated, and in good socioeconomic status. Ugandan mothers who are more educated and wealthier are more likely to use PPFP services compared with illiterate and less wealthy women, (UBOS and Macro International 2007)

In the  Ugandan  context,  only  10%  of  all  Ugandan  mothers  and  14%  of  married  women  age 15 to 24 is using any contraceptive method, (UBOS and Macro International 2007)

CHAPTER THREE:  METHODOLOGY

3.0 Introduction

This chapter presents the description of the study design, study area, study population, sample size determination, sampling techniques, data collection procedures, study variable, data collection tool, data presentation, data analysis, ethical considerations and quality assurance.

3.1 Study Design

This was a cross sectional descriptive study design employing both qualitative and quantitative methods in which a questionnaire were used to collect data. The   Participants were recruited once in the study and interviewed once during the study to allow completion of the study within the academic schedule.

3.2 Study Setting

The study were conducted at St. Francis Hospital Nyenga, commonly known as Nyenga Hospital which is affiliated to the Roman Catholic Church. Nyenga is located in Buikwe District, approximately 18 Kilometres, by road, north east of Buikwe, the location of the district headquarters; it is also located approximately 7.5 kilometers by road, southwest of Njeru, the largest metropolitan area in buikwe District. The coordinates of Nyengaare 00⁰22’48”N33”09’00”E, in the central part of Uganda. The other towns in the district include, Buike Municipality, Lugazi Municipality, Njeru Municipality, Ngogwe Municipality and Nkonkonjeru Municipality. It provides medical services in paediatrics, maternity/gynaecology, internal medicine, surgery, Public Health, and HIV Care and Treatment.

3.3 Study population

The study was focused specifically on mothers attending postnatal clinic at Nyenga Hospital. Buikwe District Uganda, has many patients to a tune of  300 patients in a day among which 86 are expectant mothers and easily accessed from surrounding towns. The study’s target population was postnatal mothers especially those attending postnatal clinic of Nyenga Hospital.

3.5 Sample Size Determination

The study was consists of a sample size of 30 respondents who will be found in Nyenga Hospital

3.6 Sampling Procedure

The study employed a non-probability convenience sampling approach where the interviewer would administer questionnaires to any available respondents who meet the required inclusion criteria and have consented and accepted to participate in the study.

3.7 Inclusion Criteria.

The study considered all postnatal Mothers, especially those attending postnatal clinic of Nyenga Hospital.

3.7.1    Exclusion Criteria.

This included any mothers who were not attending the post-natal clinic of  Nyenga hospital

3.8 Study Variables

The main variable of interest (dependent variable) was modern contraceptive use, which is binary in nature (non-use or use). Modern methods of family planning refer to safe, effective and legal methods to prevent pregnancy such as the pill, condoms, injectables and the Intra-Uterine Device (IUD).

The explanatory (independent) variables in the study are women’s education, wealth index, exposure to family planning messages on radio, television, or newspapers, desire for children, husband’s education, women’s empowerment, ability to refuse sex, and visited health facility in the past 12 months.

3.9 Research Instruments

The questionnaires were used and comprised of both structured and unstructured questions. The purpose of the study was comprehensively explained to the respondents within the questionnaire.

3.10 Data Collection Procedure

An introductory letter from the school administration was obtained and presented to the Nyenga Hospital Administration for permission to conduct this study. The Questionnaires were be administered to the respondents who will fill them at their time of convenience and then collected after three weeks. During data collection, the rights of individuals were respected.

3.11 Data Management

Data collected was tabulated and calculated into percentages, then, data was presented using frequency tables, graphs and pie charts.

3.12 Data analysis

After collection of data, responses from the questionnaires was studied so as to make sure that the information obtained is complete, consistent, accurate and reliable. Analysis of the data was done using both qualitative and quantitative methods in order to make the findings easy to understand and make conclusion to the stakeholders. Quantitative data was processed by coding and sorting it to ensure that they match with study objectives. After this, it was entered into computer and then analyzed using SPSS and later interpretation derived using mean scores which later was used to interpret the findings. A higher mean score for a positive statement meant that majority of the respondents tended to agree with such a statement and vice versa. For negative statements a lower mean score meant that majority of the respondents agreed to the statement and vice versa.

3.13 Ethical Considerations.

The study was done following guidelines of the Uganda Nurses and Midwives Examination Board standard research guidelines for Diploma Nursing Program Development of the research proposal and the report was under supervision of a staff assigned by Kyambago Public Health Nurses’ College which issued a letter introducing the researcher to Nyenga Hospital. The same letter was taken to the relevant officials for purposes of granting permission to interact with the participants. After getting a later from the college that grants the researcher permission to curry out the research, the researcher went ahead to obtain a concent form from the hospital that allowed the researcher to proceed with collecting data from the respondents. Only respondents who  were willing to take part in the study based on the four “basic” ethical principles of autonomy, justice, benevolence and non-male ficence and related ethical concepts.  Besides, a consent form was designed because a consent form is only signed after through explanation and one accepts to fill and sign. All sources of information was respected and considered vital.

3. 14 Quality Control

Discussion of the research tools were done with the research supervisor and pre-testing of the research tools was done before the questionnaire is adapted for final data collection.

3.15 Limitations of the study

Since research was an expensive exercise, financial resources might be inadequate.

There was also a problem of limited literature specific to the subject under study especially in Buikwe District. The available data is old and out-dated.  Current data had to be obtained from Internet and recent journal articles.

Access to new material on Internet is not easy since some files require one to have a password and username in order to access them and at times not easy to understand

3.16 Dissemination of Results

A report of findings of this study will be compiled, four copies of the report was produced and distributed to the following people; one copy would be handed to the research supervisor at Nyenga Hospital, another to my research supervisor, one to UNMEB and I will retain one.

CHAPTER FOUR

PRESENTATION, ANALYSIS, INTERPRETATION

OF FINDINGS

4.0. Introduction

This chapter presents the results in reference to objectives in chapter one. Gender of respondents, Age of respondents, education level of respondents, Number of years of respondents, To assess the knowledge and attitude of postnatal mothers on family planning services/methods in Nyenga Hospital, To establish the delivery of family planning services/methods to post-natal mothers in Nyenga Hospita, and To establish the socio-economic factors associated mothers attending postnatal clinic in Nyenga hospital.

4.1 Finding on respondents response

4.1.1 Findings on the age category of the respondents

Source: primary data

Source: primary data

According to the results in the study 87% of the respondents assert that they were in the age brackets of 26-35 years of age , while most of the respondents were in the age brackets of 15-25years of age , the results further indicates that only 13% of the respondents were in the age group of 36-45years.

4.1.2 Findings on the Level of education

Source: primary data

Source: primary data

According to the results in the study majority 40% of the respondents had finished secondary school education, while 33% of the respondents were primary school dropouts, , 23% had studied up vocational level of education , the results above therefore indicates that most of the respondents had studies in formal education and therefore they easily understood the topic of study.

4.1.3 Findings on Religious background of the respondents

Source: primary data

The results in the study show that most of the respondents were Muslims and their percentage was 33% , Catholics were 30%, and protestants 26%, born again 6% and only 3% were from other religious backgrounds.

4.1.4 Findings on the marital status of the respondents

Marital status of the respondents

Source: primary data

According to the findings in the study most of the respondents (70%) were married this indicates that most of the respondents in the study had mature minds and therefore they had to give accurate answers during the study.

4.1.5 FINDINGS ON THE OCCUPATION OF RESPONDENTS

Source: primary data

According to findings in the study most of the respondents didn’t have a specific profession and` their percentage was 33%, this shows that most of the respondents had were not employed in the formal sector, 30% of the respondents were health workers, 16% were famers and teachers.

4.2 Knowledge and attitude of mothers attending post-natal clinic on family planning

4.2.1 Findings on how respondents relate with their sexual partner

Source: primary data

According to the results in the study most of the respondents asserted that their sexual partner is caring 84.6% agreed, while 15% asserted that their husbands supports the baby.

4.2.2 Findings on the distance from health facility from the home of the respondents

Source: primary data

According to the results in the study most of the respondents, 53%  asserted that they move 2 to 3 kilometers from their homes to the health facility, , 19% move 0.5 to 1 kilometer and the rest of the respondents asserted that they move 4 to 5 kilometer, these results indicates that the respondents come within the health facility therefore they donot move along distance.

4.2.3 Findings if the respondents pay for the services

Source: primary data

According to the results in the table most of the respondents asserted that they paid for the services 73% , while only 27% asserted that they did not these results indicates that the services of The health facility is paid.

4.2.4 Findings on the amount of money the respondents pay for the health services they receive

Source: primary data

According to the results in the study most of the respondents asserted that they pay 5,000 to 6,000 this was started by 46%, while 31% staterd that they pay 3,000 to 4,000 and only 23% in the income brackets of 1,000 to 2,000.

4.3.0 Establish the delivery of family planning services/ methods to post-natal mothers

4.3.1 Findings on services being provided in the health facility

Source: primary data

According to the findings in the table 34% of the respondents started that they donot know the services being offred in the health facility , while 30% of the respondents started that HIV counseling and testing services are being offered, 30% also shared the view that treatment of other diseases  like STDs.

4.3.2 Findings on services provided to the respondents at the health facility

Source: Primary Data

The results in the study indicates that 50% of the respondents asserted that family planning are provided while only 50% of the respondents further stated that HIV counseling and testing.

4.3.3 Findings on family planning

Source: Primary Data

According to the results in the study majority of the respondents 58% stated that they have ever had about family planning while only 42% of the respondents disagreed.

4.3.4 Findings on were by the respondents heard the information from

Source: primary data

According to the results in the study indicates that most of the respondents assert that 46% of the respondents asserted that friends or colleagues gave them the information, 30% of the respondents health worker and traditional healers 15% and only 8% of the respondents started that their grandmother gave them the information.

4.3.4 Findings on the type of family services received by respondents

Source: primary data

According to the results in the study indicates that 54%  of the respondents were implant, 38% of the respondents were injection and only 8% .

4.3.5 Findings on the results that the method of family planning that the respondents use.

Source: primary data

According to the results in the study indicates that 54% of the respondents asserted that they had the information through counseling, 19% of the respondents decided to choose it alone, 19% of the respondents a friend   and 7% of the respondents were coerced to take it.

4.3.6 Finding on the number of respondents have been tested

Source: primary data

According to the results in the study 54% of the respondents asserted that they have not yet tested while only 46% of the respondents agreed that they have tested for HIV.

4.3.7 Findings on the number of respondents on drugs

Source: primary data

The result in the table above indicates that 61% of the respondents were on drugs, while 39% of the respondents asserted that they were on drugs.

4.3.8 Findings on the reactions of family planning

Source: primary data

The findings in the study indicates that 27% of the respondents asserted that they donot feel any bad reaction after family planning and only 73% of the respondents asserted that they feel bad reaction.

4.3.9 Findings on the type of bad reactions respondents get from using family planning services

Source: primary data

According to the results in the study 77% of the respondents experience heavy bleeding while only 23% of the respondents experience of body itching .

Findings on the respondents need to produce more children

Source: primary data

Findings on the respondents need to produce more children , the findings in the study indicates that 68% of the respondents need to produce children and only 32% of the respondents did not want more children.

Findings on the interval to more produce children by the respondents

Source: primary data

According to the results in the study 65% of the respondents started that they need to produce more children after two years while only 35% of the respondents started after 3 years.

CHAPTER FIVE

DISCUSSION, CONCLUSION, RECOMMENDATIONS AND THE AREAS OF FURTHER RESEARCH

5.0 INTRODUCTION

This chapter includes discussion, conclusion, recommendations and the areas of further research

5.1 Discussions of findings

According to the results in the study most of the respondents asserted that their sexual partner is caring this is also related to (Njau et al., 2006; Ochieng et al., 2011), who states that  All over the world, sexual behaviour is a complex issue influenced by numerous variables, such as individual desire, social and cultural relationships, environmental and economic dynamics, Their socio-demographic characteristics (Upreti et al., 2009), perception of Postnatal mothers (Mahat et al., 2006; Puri, 2006), level of knowledge and their attitudes towards their sexual and reproductive health during their post-partum period (Rondini & Krugu, 2009) may impact greatly on whether or not they have sex, the types of sexual relationships they form and utilization of postpartum family planning services (UNICEF, 2006).

According to (Paluku et al., 2009) , he states that Around the world, successful reproductive health programmes among mothers are those that equip post-natal mothers with Knowledge and skills that will keep them safe from getting pregnant during the postpartum period.

According to the results in the study majority of the respondents  stated that they have ever had about family planning this is also in line with Nanvubya et al, (2015), who statarted that in their study about use of Modern Family Planning Methods in Fishing Communities of Lake Victoria, 88%of the respondents knew about modern FP methods, with women and older respondents having more knowledge while  Uganda Demographic and Health Survey (UDHS) (2011), further started that  Uganda has a young population (52% below age 15, and 17% are age 15-24) and a high total fertility rate (TFR), of 6.2 children per woman.

According to the results in the study indicates most of the respondents were implant, WHO. (2014) who staterted that The days and weeks following childbirth the postnatal period is a critical phase in the lives of mothers and newborn babies, Major changes occur during this period which determine the well-being of mothers and newborns. Yet, this is the most neglected time for the provision of quality family planning services/methods. Lack of appropriate care during this period could result in pregnancy during the postpartum period. Rates of provision of skilled family planning services are lower after childbirth when compared to rates before and during childbirth.

The findings in the study indicates that most of the respondents asserted that they had the information through counseling and others decided to choose the system alone

The findings in the study indicates that majority of the respondents asserted that they donot feel any bad reaction after family planning this is also in line with Rutstein (2008), who states that While family planning (FP) is important throughout an individual’s and couple’s reproductive life, postpartum family planning (PPFP) focuses on the prevention of unintended and closely spaced pregnancies through the first 12 months following childbirth.

This result is also further supported by Babalola, S. (2012), who stated that Effective delivery and uptake of modern family planning methods depends a lot on the competency and attitudes of the providers particularly for the long acting and permanent methods. According to Kasedde S, (2010) some of the constraints observed in postnatal family planning delivery include lack of trained staff or transfer of trained and motivated staff resulting in decrease of commitment of the remaining staff.

The results indicates that majority of the respondents assert that they experience heavy bleeding while only few of the respondents experience of body itching .this is also in line with  Timothy et al, (2011), who states that long distance account partly for the use of contraceptives amongst women in the rural area. Also lack of awareness could be attributed to lack of access to information regarding the services. The inability to access such important information is bound to affect the woman’s ability to make an informed decision on uptake of postpartum family planning services/methods.

While Kumar et al (2011), further asserts that in their article about Family planning practices and methods among women of urban slums of Luck now City India, sited that, modern PPFP use by a respondent or their sexual partner was reported in just over a third of the respondents with more females than males reporting use. Short-acting reversible contraceptive methods such as oral contraceptives and Depo-Provera were used by three quarters of the respondents as compared to one quarter who used the long-acting reversible methods such as intra-uterine devices and implant. (Kumar et al., 2011).

In  reguards to the above (Timothy et al., 2011) further clarifies that according to a study done in Kenya among postnatal mothers , 51 per cent of the respondents were using PPFP services. In the same study, those using the PPFP services  cited  various  reasons  ranging from  managing  the  family, preventing un wanted pregnancies  to   promoting child spacing.

5.2 Recommendations of the study

The study recommends that the mothers should adopt family planning services  to enables them have family sizes that they can manage and improve on their livelihood

The study also recommends the pregnant mothers to test for HIV so that to prevent transmission of mother to child HIV transmission.

5.3 Conclusion of the study

The study also concludes that there should be continued fight of over population by encouraging mothers to go to family planning to help mother  have families that thye can manage to trake care of .

5.4 Areas of further study

• Influence on donor aid on the fight against HIV
• Role of NGOs on the reduction of number of HIV infections
• Influence of government campaigns on the reduction of maternal deaths

REFERENCES

Trussell, J., & Guthrie, K. (2007). Choosing a contraceptive: efficacy, safety, and personal considerations. Hatcher RA, Trussell J, Nelson AL, Cates W, Stewart FH, Kowal D. Contraceptive technology. 19th revised ed. New York (NY): Ardent Media, Inc, 19-47.

McVeigh, R. (2013). Artificial and Natural Forms of Birth Control: A Comprehensive Analysis.

Blanc, A., A.,Tsui,  T.  Croft.,& J.  Trevitt.(2009).Patterns  and  Trends  in  Adolescents’  Contraceptive  Use  and  Discontinuation  in  Developing  Countries  and  Comparisons  with Adult Women. International Perspectives on Sexual and Reproductive Health 35(2)

C Mubita-Ngoma, (2010).Knowledge and use of modern family planning methods by rural women in Zambia: Department of Nursing Sciences, School of Medicine, University of Zambia,

ICF International: (2012). MEASURE DHS STATcompiler.Available at http://www.statcompiler.com.

2009. Park. Park’s Text book of Preventive and Social Medicine, 18th edition, Bhanot publishers 2009.

Kibuuka  H,  Guwatudde  D,  Kimutai  R,  Maganga  L,  Maboko  L,  Watyema  C et al,  2009. Contraceptive use in women enrolled into preventive HIV vaccine trials: experience from a phase I/II trial in East Africa. PubMed – indexed for MEDLINE (online). 4(4):  Available from: http://www.ncbi.nlm.nih.gov/sites/entrez

Kumar et al: Family planning practices and methods among women of urban slums of Lucknow City, Indian Journal of Community Health, Vol. 23, No. 2, July 2011- Dec. 2011

Nanvubya, A., Ssempiira, J., Mpendo, J., Ssetaala, A., Nalutaaya, A., Wambuzi, M., …Kiwanuka, N. (2015). Use of Modern Family Planning Methods in Fishing Communities of Lake Victoria, Uganda.PLoS ONE, 10(10), e0141531. http://doi.org/10.1371/journal.pone.0141531

Plummer, M.L.; Wamoyi, J.; Nyalali, K.; Mshana, G.; Shigong, Z.S.; Ross, D.A.; Wight, D. (2008). Aborting and suspending pregnancy in rural Tanzania. Studies in Family Planning, 39(4):281-292.

Plummer, M.L.; Wight, D.; Wamoyi, J.; Mshana, G.; Hayes, R.J.; Ross, D.A. (2006). Farming with your hoe in a sack: Condom attitudes, access, and use in rural Tanzania. Studies in Family Planning, 37(1):29-40.

Rossella N., (2006). Knowledge Gap Restricts Women’s Contraceptive Choice; Women’s health/gynaecology, (online), Available from: http://www.medicalnewstoday.com/articles/57430.php

S M Joshi, S B Patil, Knowledge & practices of family planning in an urban slum of Mumbai, Indian Journal, Preventive Social Medicine, volume 38, No. 1& 2, Jan to June 2007

Schuler, S., E. Rottach, and M Peninah.(2009). Gender norms and family planning decision making in Tanzania: A qualitative study. Washington, DC: C-Change.

Shabiby, M. M., Karanja, J. G., Odawa, F., Kosgei, R., Kibore, M. W., Kiarie, J. N., &Kinuthia, J. (2015). Factors influencing uptake of contraceptive implants in the immediate postpartum period among HIV infected and uninfected women at two Kenyan District Hospitals. BMC Women’s Health, 15, 62. http://doi.org/10.1186/s12905-015-0222-1

Sileo, Katelyn M., “Determinants of Family Planning Service Uptake and Use of Contraceptives among Postpartum Women in Rural Uganda” (2014).Master’s Theses. Paper 602. http://digitalcommons.uconn.edu/gs_theses/602

Tanzania Journal of Health Research Doi: http://dx.doi.org/10.4314/thrb.v15i1.3 Volume 15, Number 1, January 2013

Timothy C. OkechDr. Nelson W. WawireDr. Tom K. Mburu, (2011). Contraceptive Use among Women of Reproductive Age in Kenya’s City Slums .International Journal of Business and Social Science Vol. 2 No. 1; January 2011

Uganda Bureau of Statistics (UBOS),  and Macro International Inc. 2007. Uganda Demographic and Health Survey 2006. Calverton, MD, USA: UBOS and Macro International Inc.

W (2009) Family planning. Collins English Dictionary, 10th ed: http://www.collinsdictionary.com/dictionary/english/family-planning

WHO (2015)  Family planning. Available from: http://www.who.int/topics/family_planning/en/5.Collins http://www.medical-dictionary.org/definitions-f/family-planning.

APPENDIX I: CONSENT FORM

STATEMENT O F CONSENT

I ………………………………………………have freely consented to participate in the study about Knowledge, attitude and practices of Family planning in Nyenga hospital. This study has been clearly explained to me and has been assured that am free to participate in the study or refuse it and can withdraw anytime. My decision will not affect my rights to any research studies.

In charge Postnatal Clinic………………………………………

Date………………………………..

Place……………………………

APPENDIX II: QUESTIONNAIRE

Introduction and Purpose

My name is Namazzi Pouline a student from Kyambogo School of Health from Kampala district pursuing a diploma in Midwifery.

Tick (√) against the answer of the respondents choice or fill in the blank spaces where applicable.

SECTION A: BIO DATA

1. Age…………………………………………………………………………………………………….
2. Do you know to write and read?
3. Yes
4. No
5. Level of education that you have attained?
6. No formal education
7. Adult education
8. Primary education
9. Secondary education
10. Collage education
11. Religion?
12. Muslim
13. Christian
14. Tribe …………………
15. Marital status?
16. Single
18. Divorce
19. Widow
20. Separated
21. Occupation?
22. House wife
23. Peasant
24. Pastoralist
25. Self employed
26. Employed by Government
27. What is your husband’s Occupation?
28. Peasant
29. Pastoralist
30. Self employed
31. Employed by Government

SECTION B: KNOWLEDGE, ATTITUDE AND PRACTICES OF FAMILY PLANNING USE           

9. Have you ever had of family planning?
10. Yes
11. No
12. If yes, what is the main source of your information on family planning?
13. Over the mass media like newspapers, radio or TV
14. Hospital or health unit
15. From a nurse

SECTION D: ESTABLISH THE DELIVERY OF FAMILY PLANNING SERVICES/METHODS TO POST-NATAL MOTHERS

11. Do attain postnatal family planning services in this health centre?
12. Yes
13. No

16 if yes what postpartum family planning methods are you offered in the postnatal clinic?

1. Pill,
2. Condoms,
3. Injectables
4. Intra-Uterine Device (IUD)
5. Natural methods
6. Other specify

17 How do you receive this family planning information?

1. Through mass media like newspapers, radio or TV
2. Through charts displayed at the health centre.
3. Through counselling
4. From a nurse

SECTION C: THE SOCIO-ECONOMIC FACTORS OF MOTHERS ATTENDING POSTNATAL CLINIC

12. How many children do you have?
13. 1 to 2 children
14. 2 to 3 children
15. 3 to 4 children
16. 4 and above
17. What does your society say about woman having many children?

…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

14. How many people are living with you in your house hold?
15. 4 people
16. 3 people
17. 7 people
18. 9 and above
19. How far is your home from the health facility?
20. ½ a Kilometre to 1 Kilometre
21. 2 to 3 Kilometres
22. 4 and above Kilometres
23. How much transport cost do you spend travelling to the health facility?
24. 500/- to 1000/-
25. 1500/- to 2000/-
26. 3000/- and above
27. How much do you earn in a month?
28. 10,000/- to 20,000/-
29. 25,000/- to 30,000/-
30. 40,000/- and above

What is the quality of health service delivery?

1. Good
2. Very good
3. Fair
4. Poor

APPENDIX III: WORK PLAN

APPENDIX IV: BUDGET