The study was carried out in Tororo municipality, Tororo district with the aim of establishing the effectiveness of oral contraceptive pill as a method of family planning. The specific objectives of the study were; to determine the advantages of using oral contraceptive pill as a method of family planning; to investigate the side effects of using oral contraceptive pill as a method of family planning; to assess the factors that influence the use of using oral contraceptive pill as a method of family planning. In order to fulfill the research objectives, a cross sectional research design was used with the help of qualitative approach of data collection on a sample of 20 respondents who include married men and women, local leaders, health workers and youths. The study found out that using contraceptive pill as a method of family planning as helped women to space children, reduces the level of blood pressure in women. The study also found out that long term use of the pill may lead to breakthrough bleeding, increase depression in already depressed women, risk of stock, change in weight and swelling of ankle/feet. The factors that influence the use of contraceptive pill include no access to the pill, lack of sensitization and long term effects, followed by attitude about western methods, illiteracy, availability of facilities (methods) and skilled personnel. The study recommended that the government should give out contraceptives freely because most women don’t have financial power to buy and health education talks and public sensitization should be improved to help women to get informed and get rid of the myths they have about family planning services.

CHAPTER ONE

1.1 Background to the study

The widespread adoption of family planning represents one of the most dramatic changes of the 20th century. The growing use of contraception around the world has given couples the ability to choose the number and spacing of their children and has tremendous life saving benefits. Yet despite the impressive gains, contraceptive use is still low and the need for contraception high in some of the world’s poorest and most populous places (Smith, 2009).

Contraceptive use in the United States is virtually universal among women of reproductive age: 98 percent of all women who had ever had intercourse had used at least one contraceptive method. In 2002, 90 percent had ever had a partner who used the male condom, 82 percent had ever used the oral contraceptive pill, and 56 percent had ever had a partner who used withdrawal [Mosher et al, 2002].

The modern contraceptive prevalence rates (that is, the proportion of women of reproductive age who are using a modern contraceptive method) vary widely across the African region. Among women of reproductive age, CPRs for modern methods ranged from 1.2 percent in Somalia to 60.3 percent in South Africa. Countries in Southern Africa reported the highest levels of contraceptive use, followed by countries in East Africa. With a few exceptions, West and Central African countries report very low rates of family planning use. Some of the lowest contraceptive prevalence rates in the world exist in these two sub regions of Africa [UN, 2009].

Family planning refers to practices that help couples to avoid unwanted child birth, to regulate the intervals between pregnancies and to determine the number of children in the family. It is also the process of controlling the number of children you have by using family planning methods. According to Bankole et al. (2006), the role of family planning methods is to help women and men reconcile their sexual lives and their desire for children.

The oral contraceptive pill (COCP), often referred to as the birth control pill or colloquially as “the pill”, is a birth control method that includes a combination of an estrogen (estradiol) and a progestogen (progestin). When taken by mouth every day, these pills inhibit female fertility (with reversibility). They were first approved for contraceptive use in the United States in 1960, and are a very popular form of birth control. They are currently used by more than 100 million women worldwide and by almost 12 million women in the United States. As of 2012, 16% of U.S. women aged 15-44 reported being on the birth control pill, making it the most widely used contraceptive method among women of that age range. Use varies widely by country, age, education, and marital status. One third of women aged 16–49 in the United Kingdom currently use either the combined pill or progestogen-only pill, compared with only 1% of women in Japan (WHO, 2010).

The estimated probability of pregnancy during the first year of perfect use of the pill is 0.3%, and the estimated probability of pregnancy during the first year of typical use of the pill is 9%. The perfect use failure rate is based on a review of pregnancy rates in clinical trials, the typical use failure rate is based on a weighted average of estimates from the 1995 and 2002 U.S. National Surveys of Family Growth (NSFG), corrected for underreporting of abortions.

1.2 Problem Statement

The oral contraceptive pill provides effective contraception from the very first pill if started within five days of the beginning of the menstrual cycle (within five days of the first day of menstruation). If started at any other time in the menstrual cycle, COCPs provide effective contraception only after 7 consecutive days use of active pills, so a backup method of contraception must be used until active pills have been taken for 7 consecutive days. COCPs should be taken at approximately the same time every day. However, some users may not be able to follow those instructions leading to side effects (For example the most common side effect is breakthrough bleeding) and making the method not effective. Thus, this study sought to assess the effectiveness of oral contraceptive pill as a method of family planning

1.3 Purpose of the study

The study aimed at establishing the effectiveness of oral contraceptive pill as a method of family planning. A case study of Tororo municipality, Tororo district.

1.4 Specific objectives

To determine the advantages of using oral contraceptive pill as a method of family planning.
To investigate the side effects of using oral contraceptive pill as a method of family planning.
To assess the factors that influences the use of using oral contraceptive pill as a method of family planning.

1.5 Research Questions

What are the advantages of using oral contraceptive pill as a method of family planning?
What are the side effects of using oral contraceptive pill as a method of family planning?
What factors influence the use of using oral contraceptive pill as a method of family planning?

1.6 Scope of the study

The study aimed at establishing the effectiveness of oral contraceptive pill as a method of family planning. The study was carried out in Tororo municipality, Tororo district for period of four month February – May, 2017.

1.7 Significance of the study

The results of the study would provide a benchmark that can be used in assessing the effectiveness of the oral contraceptive pill as a method of family planning.

This study would provide a foundation for future researches as this would serve as a motivation for many researchers to further examine other aspects of the subject matter.

1.8 Limitation and delimitation of the study

Some of the respondents were reluctant to give responses due to personal reservations; however this was solved by explaining to them that the information provided would be used purely for academic purpose and would be kept confidential.

Some respondents were not cooperative because they suspected the researcher to be an agent from a government agency. However the researcher begun by first introducing herself to the respondents and later explained the purpose of the research.

CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

This chapter describes the literature related to the subject based on the specific research objectives.

2.1 The advantages of using oral contraceptive pill as a method of family planning.

The pills can sometimes improve conditions such as pelvic inflammatory disease, dysmenorrhea, premenstrual syndrome, and acne, reduce symptoms of endometriosis and polycystic ovary syndrome, and decrease the risk of anemia. Use of oral contraceptives also reduces lifetime risk of ovarian cancer.

COC decreased the risk of ovarian cancer, endometrial cancer, [23] and colorectal cancer. Two large cohort studies published in 2010 both found a significant reduction in adjusted relative risk of ovarian and endometrial cancer mortality in ever-users of OCs compared with never-users.

The use of oral contraceptives (birth control pills) for five years or more decreases the risk of ovarian cancer in later life by 50%. Oral contraceptive use reduces the risk of ovarian cancer by 40% and the risk of endometrial cancer by 50% compared with never users. The risk reduction increases with duration of use, with an 80% reduction in risk for both ovarian and endometrial cancer with use for more than 10 years. The risk reduction for both ovarian and endometrial cancer persists for at least 20 years.

Bradykinin lowers blood pressure by causing blood vessel dilation. Certain enzymes are capable of breaking down bradykinin (Angiotensin Converting Enzyme, Aminopeptidase P). Progesterone can increase the levels of Aminopeptidase P (AP-P), thereby increasing the breakdown of bradykinin, which increases the risk of developing hypertension.

Combined oral contraception decreases total testosterone levels by approximately 0.5 nmol/l, free testosterone by approximately 60%, and increases the amount of sex hormone binding globulin (SHBG) by approximately 100 nmol/l. Contraceptives containing second generation progestins and/or estrogen doses of around 20 –25 mg EE were found to have less impact on SHBG concentrations. Combined oral contraception may also reduce bone density.

2.2 The side effects of using oral contraceptive pill as a method of family planning.

It is generally accepted that the health risks of oral contraceptives are lower than those from pregnancy and birth and “the health benefits of any method of contraception are far greater than any risks from the method”. Some organizations have argued that comparing a contraceptive method to no method (pregnancy) is not relevant—instead, the comparison of safety should be among available methods of contraception.

Different sources note different incidences of side effects. The most common side effect is breakthrough bleeding. A 1992 French review article said that as many as 50% of new first-time users discontinue the birth control pill before the end of the first year because of the annoyance of side effects such as breakthrough bleeding and amenorrhea. One study found that women using birth control pills blinked 32% more often than those not using the contraception.

On the other hand, the pills can sometimes improve conditions such as pelvic inflammatory disease, dysmenorrhea, premenstrual syndrome, and acne, reduce symptoms of endometriosis and polycystic ovary syndrome, and decrease the risk of anemia. Use of oral contraceptives also reduces lifetime risk of ovarian cancer.

Nausea, vomiting, headache, bloating, breast tenderness, swelling of the ankles/feet (fluid retention), or weight change may occur. Vaginal bleeding between periods (spotting) or missed/irregular periods may occur, especially during the first few months of use.

Oral contraceptives increase the risk of venous thromboembolism (including deep vein thrombosis [DVT] and pulmonary embolism [PE]).

COC pills with more than 50 µg of estrogen increase the risk of ischemic stroke and myocardial infarction but lower doses appear safe. These risks are greatest in women with additional risk factors, such as smoking (which increases risk substantially) and long-continued use of the pill, especially in women over 35 years of age.

The overall absolute risk of venous thrombosis per 100,000 woman-years in current use of combined oral contraceptives is approximately 60, compared with 30 in non-users. The risk of thromboembolism varies with different types of birth control pills; compared with combined oral contraceptives containing levonorgestrel (LNG), and with the same dose of estrogen and duration of use, the rate ratio of deep venous thrombosis for combined oral contraceptives with norethisterone is 0.98, with norgestimate 1.19, with desogestrel (DSG) 1.82, with gestodene 1.86, with drospirenone (DRSP) 1.64, and with cyproterone acetate 1.88. In comparison, venous thromboembolism occurs in 100–200 per 100.000 pregnant women every year.

One study showed more than a 600% increased risk of blood clots for women taking COCPs with drospirenone compared with non-users, compared with 360% higher for women taking birth control pills containing levonorgestrel. The U.S. Food and Drug Administration (FDA) initiated studies evaluating the health of more than 800,000 women taking COCPs and found that the risk of VTE was 93% higher for women who had been taking drospirenone COCPs for 3 months or less and 290% higher for women taking drospirenone COCPs for 7–12 months, compared with women taking other types of oral contraceptives.

Based on these studies, in 2012 the FDA updated the label for drospirenone COCPs to include a warning that contraceptives with drospirenone may have a higher risk of dangerous blood clots.

A systematic review in 2010 did not support an increased overall cancer risk in users of combined oral contraceptive pills, but did find a slight increase in breast cancer risk among current users, which disappears 5–10 years after use has stopped.

A report by a 2005 International Agency for Research on Cancer (IARC) working group said COCs increase the risk of cancers of the breast (among current and recent users), cervix and liver (among populations at low risk of hepatitis B virus infection). A 2013 meta-analysis concluded that ever use of birth control pills is associated with a modest increase in the risk of breast cancer (relative risk 1.08) and a reduced risk of colorectal cancer (relative risk 0.86) and endometrial cancer (relative risk 0.57). Cervical cancer risk in those infected with human papilloma virus is increased. A similar small increase in breast cancer risk was seen in other meta analyses.

A 2011 Cochrane systematic review found that studies of combination hormonal contraceptives showed no large difference in weight when compared with placebo or no intervention groups. The evidence was not strong enough to be certain that contraceptive methods do not cause some weight change, but no major effect was found. This review also found “that women did not stop using the pill or patch because of weight change.”

COCPs may increase natural vaginal lubrication. Other women experience reductions in libido while on the pill, or decreased lubrication. Some researchers question a causal link between COCP use and decreased libido; a 2007 study of 1700 women found COCP users experienced no change in sexual satisfaction. A 2005 laboratory study of genital arousal tested fourteen women before and after they began taking COCPs. The study found that women experienced a significantly wider range of arousal responses after beginning pill use; decreases and increases in measures of arousal were equally common.

A 2006 study of 124 pre-menopausal women measured sex hormone binding globulin (SHBG), including before and after discontinuation of the oral contraceptive pill. Women continuing use of oral contraceptives had SHBG levels four times higher than those who never used it, and levels remained elevated even in the group that had discontinued its use. Theoretically, an increase in SHBG may be a physiologic response to increased hormone levels, but may decrease the free levels of other hormones, such as androgens, because of the unspecificity of its sex hormone binding.

A 2007 study found the pill can have a negative effect on sexual attractiveness: lapdancers found that women who were in estrus were received much more in tips than those who weren’t, while those on the oral contraceptive pill had no such earnings peak.

Low levels of serotonin, a neurotransmitter in the brain, have been linked to depression. High levels of estrogen, as in first-generation COCPs, and progestin, as in some progestin-only contraceptives, have been shown to lower the brain serotonin levels by increasing the concentration of a brain enzyme that reduces serotonin. These observations, along with some small research studies have inspired speculation that the pill causes depression. In 2016, a large Danish study of one million women showed that use of COCPs, especially among adolescents, was associated with a statistically significantly increased risk of subsequent depression, although the sizes of the effects are small (for example, 2.1% of the women who took any form of oral birth control were prescribed anti-depressants for the first time, compared to 1.7% of women in the control group).

Progestin-only contraceptives are known to worsen the condition of women who are already depressed. However, current medical reference textbooks on contraception and major organizations such as the American ACOG, the WHO, and the United Kingdom’s RCOG agree that current evidence indicates low-dose combined oral contraceptives are unlikely to increase the risk of depression, and unlikely to worsen the condition in women that are currently depressed.

2.3 Factors influence the use of using oral contraceptive pill as a method of family planning

According to Byarugaba (2009), Contraceptives are available both in private clinics and government health centres but there are some challenges faced by women in accessing it, hence some reasons for low turn up of women for services like they have worries of the side effects. For example injecta-plan method, many women suffer the consequences of chronic bleeding without ceasing or at times it cause obesity. Other beliefs such as religious affiliation for example Catholic have a negative attitude about Family Planning methods, they don’t use it but prefer bearing children till it is no more. The duration of the methods such Norplant method which after insertion, lasts for 5 years to expire and another one like Copper T-coil some expire after 10 years. Hence hinders the turn up of women for services. Ignorance of both spouses is a challenge to access the service in the area.

Byarugaba further noted that some health centres have the services but they do lack skilled personnel for example, he once missed clients in his private clinic, who had come for Norplant method and was away and all the nurses were unskilled to take on the procedure. However, future research that covers that determinates of perceptions of both community level and individual level quality could provide key insights for developing effective and efficient Family Planning programs.

World Health Organization (WHO, 2009) further stated that, reasons for unmet need are many and they are attributed to limited services and supplies, fear for social disapproval of partner’s opposition pose formidable barriers, worries of side effects and health concerns hold some people back, others lack knowledge about contraceptive options and their use.

In the traditional understanding, Family Planning was not an issue to be considered because a large number of children were seen as a blessing, security for the future and guarantee for continuity of lineage and clan. The more children a man had, the more he was respected and the more children a woman had, the more she was valued in the clan. If she is married to therefore the introduction of the new Family Planning practices was concerned as a plan to stop women from bearing children which is interference to the plan of God as seen in some Kiganda expression, like “Muzaalemwale” meaning you can produce as many as possible.

According to International Conference on Family Planning (2009), an estimated 41% of Ugandan Women who would like to stop having children have no access to Contraceptives. However, this has resulted into unintended pregnancies and bigger families. It further stated that in Uganda a woman will give birth to an average of 6 – 7 children in her life time. Such large families in developing countries are linked to poverty, poor nutrition, low education levels and even health dangers, for example a woman is at risk of maternal mortality increase with each birth.

According to the Uganda National Family Planning strategy (2005 – 2010), March, 2005, Development by the Ministry of Health over two thirds of Ugandan women and men say that they want to space children or limit children bearing (71% of women and 67% of men). However, they face many challenges which include the social, cultural, religious values which have strong influence on reproductive choices for women in Uganda. Early frequent child bearing and large Family size reflect long standing societal norms among most segments of population.

According to the 1980’s law, further controversy emerge when social and religious conservatives began alleging that the very availability of Contraceptives promoted promiscuity and abortion, and that the provision of confidential services to teenagers encouraged the disrespect of parental authority (The Development Office of the Kenya Catholic Secretariat). The Catholic Church and some societies have always preached against use of Contraceptives saying that it’s a sin and against Gods command that is to say “Go, subdue and fill the world”.

According to the MoH, (2009), The levels of understanding and acceptance of Contraceptives is also a big challenge. According to the study of working women and non-working women in Bargladesh 59% of the working group who had acquired some education were employing contraceptives compared to 41.4% of non working group who had acquired less or no education at all. 45.1% of the non working group had never used contraceptives compared to 23.9% of working women. 55.9% of the working women participated in Family Planning decision making with their spouses as compared to 23.5% of the non working women. The level of understanding here influences acceptance that is to say the more people understanding the importance of Family Planning, the more they will be lured to adopt.

The rising costs of some contraceptives and of state of the art medical technology complicated the delivery of Contraceptives to the existing and at the same time, Contraceptives (methods are inadequate). They’re just few (2 – 3) methods only in per Health centre out of different methods available in hospitals.

According to the Family Planning Global Handbook for providers (2008), some women find it very hard to discuss their desires to use condoms or any other method of Family Planning. (To access the Contraceptives). Men give different reasons why they stop their women to access Contraceptives, therefore you find out that women with low bargaining power end up being oppressed and exploited by their partners through convincing them to access Family Planning methods.

African Union Commission (2009), states that high fertility is directly related to child and early marriages. other factors related to this are unmet needs for contraceptive services, lack of sexuality information and lack of Contraceptives for the prevention of pregnancy. All these conditions make birth spacing difficult to manage and increase incidents of unwanted pregnancies. Hence may lead to MMR is IMR.

According to Ministry of Health, (Dr. Stephen O. Malinga), in the second National Health Policy of promoting people’s health to enhance socio-economic development Speech (July, 2010), he said health resources such infrastructure has grown from 1979 in 2004 to 2301 in 2010. However, inequity exists in the distribution of health facilities and most facilities are in a state of despair, inadequate transport is a major limitation especially newly created districts. He further said that rehabilitation of buildings and maintenance of medical equipment is not regularly done. Other challenges are shortage of basic medical equipment accommodation of staff, and transportation remains major challenges. He further stated that inadequate financial and human resources, only 30% of the essential medicines and health supplies required for the basic packages are provided for in the framework for medium expenditure.

CHAPTER THREE

METHODOLOGY

3.0 INTRODUCTION

This chapter presents the methodology used in the study and these include: research design, area of the study, study population, sample size, sample techniques, the data collection methods and instruments, validity and reliability the procedures of data collection, data processing, presentation and analysis and ethical considerations.

3.1 RESEARCH DESIGN

In this study, a cross sectional design was used with the help of qualitative method of data collection. This approach was used because it would bring the researcher closure to the respondents and provide an interface for interaction. This thus helped the study to get out the social reality. Qualitative approach involves an unstructured approach to inquiry and allows flexibility in all aspects of the research process. It was more appropriate to explore and interpret the nature of a problem, issue or phenomenon without quantifying it. Its main objective was to describe the variation in a phenomenon, situation or attitude like description of an observed situation, or opinions.

3.2 AREA OF STUDY

The study was carried out in Tororo municipality in Tororo district in the eastern region.

3.3 POPULATION OF THE STUDY

This population of the study included men and women, local leaders and health workers.

3.4 THE SAMPLE SIZE

The sample size of the study used was 20 respondents.

Table 1: Sample Size Distribution

Category	Number of respondents	Percentage
Men and women	15	75
Local leaders	1	5
Health workers	4	20
Total	20	100

Source: primary data

3.5 SAMPLING PROCEDURES

Purposive Sampling: According to Baron (2011), this involves deliberate selection of respondents. In this study, men and women was selected purposively because the researcher will choose the sample based on who she thinks was appropriate for the study. The local leaders and health workers were selected using convenient sampling because it involved selecting them by virtue of their positions.

3.6 DATA COLLECTION METHODS AND INSTRUMENTS

3.6.1 Interviews

The main method in data collection was interview.

According to Christopher (2014), interview involves a one-on-one conversation with one person acting in the role of the interviewer and the other in the role of the interviewee. The researcher endeavoured to get first-hand information by making appointments with individual respondents to answer questions related to the study topic. Semi-structured interviews were used to generate additional information from the respondents. This method was chosen because it helps in the collection of more data as it allows the interaction of both the researcher and the respondents. It was cheap and does not waste much time.

The interview guide was used as an instrument of data collection because it helped the researcher to acquire information which would not have if using other methods and it saved time for the researcher and the respondents since only key questions were asked.

3.6.2 Focus group discussions

Focus group discussions were used on men and women. Focus group discussions were used due to the capacity of the short period of time. This enabled the respondents to debate and discuss on the study directed by the few questions set and followed. The instrument used was the focus group discussion guide where questions were set and followed. The study involved 2 focus group discussions (one for men and the other for women) and took about 30 minutes each.

3.7 VALIDITY AND RELIABILITY OF RESEARCH INSTRUMENTS

There are no scientific principles which would guarantee a valid and reliable questionnaire, but there are ways in which this can be pursued. First, the items in the research instruments should be based on prior research whenever possible. Due to this, in this study most of the questions were to be based on prior research. Secondly, the questionnaires were pre-tested (Malhotra & Birks 2007).

3.7.1 Validity

To test the construct validity, citations of all sources where materials and evidence of material collected from was provided. The supervisor reviewed the research instruments and approved them.

3.7.2 Reliability

When conducting research, the researcher tried to act as neutral as possible in order to avoid being bias. The researcher was also conscious about the type of questions to ask.

3.8 PROCEDURES OF DATA COLLECTION

Before data collection, the researcher ensured the approval of the research instruments especially the interview guide; obtained the introductory letter from the university; introduced herself to the authorities, sought participants’ consent and made appointments when to meet them for interviews and data collection, and the data collected was analysed.

3.9 DATA PROCESSING, PRESENTATION AND ANALYSIS

3.9.1 Data Processing

Data was collected by sorting, editing and coding so as to obtain an objective and a reasonable judgment. Data was edited to check the completeness of the respondents’ responses with the purpose of detecting and eliminating errors and identifying vital information that was essential in coding and tabulation and finally data was entered to draw conclusions and recommendations.

3.9.2 Data Presentation

The data was presented using percentages and tables according to objectives of the study to come up with the conclusions and recommendations basing on the findings.

3.9.3 Data Analysis

The respondents’ scores were summarized from the sheet and made ready for analysis. Data was analyzed using relevant computer packages such as micro soft Excel and word where descriptive statistics such as frequencies and their corresponding percentages was generated.

3.10 ETHICAL CONSIDERATIONS

After the research proposal was approved by the supervisor, the researcher sought for approval from relevant regulatory bodies. Permission was sought from the department of community and disability studies.

The researcher collected data upon seeking respondents’ consent after revealing the type of information needed and the purpose to avoid potential concealment of vital information.

The researcher also maintained confidentiality of respondents’ information; and reported the true findings of the study without any bias.

CHAPTER FOUR

PRESENTATION AND DATA ANALYSIS

4.0 Introduction

The purpose of the study was to establish the effectiveness of oral contraceptive pill as a method of family planning. A case study of Tororo municipality, Tororo district. This chapter therefore presents the findings of the study which are organized and analyzed according to the objectives of the study. The information in each table is described at the end of the table.

4.1 Background Information of the Respondents

This section presents the background on the studied characteristics of respondents used for the study. A total of 20 respondents participated in the study.

Table 1: Background information of the respondents

Variable

Response.

Frequency

Age

Total

18-25
25-30
30-35
35+

Education level

Total

Primary
O level
A level
Diploma
Certificate
Degree

Religious affiliation

Total

Catholic
Anglican
Muslim
Others

Occupation

Total

Employed
Unemployed

Respondents were asked information relating to their age and the majority revealed that they were between the age of 18-25 years, others claimed that they were between 25-30 and 30-35 years of age and a few claimed that they were above 30 years of age.

Relating to the education background, the majority of the respondents were “O” leavers, very few had made it to degree level, A” level certificate level and primary level, regarding the religious affiliation, most of the respondents were Catholics, some of them were Anglican and a few were Muslims, regarding sex, most of the respondents were females and only few were men. Finally, respondents were asked to give information about their occupation and the majority were not working while a few were working.

4.2 Advantages of using oral contraceptive pill as a method of family planning.

Objective one of the study was intended to identify the advantages of using oral contraceptive pill as a method of family planning. Respondents were required to answer a couple of questions and responses were obtained and are presented in below;

Respondents were required to indicate whether they had knowledge about contraceptive pill as a method of family planning and from the response; all the respondents (100%) knew about contraceptive pill as a method of family planning.

However, the respondents had different ways of contraceptive pill as a method of family planning; 50% respondents understood it as one way that can be undertaken to space children, others (15%) respondents looked at it as a way used not to have unwanted pregnancies while (35%) respondents understand it as the agreement between spouses on the number of children they want to have and stick by that through the use of contraceptive pill as a method of family planning.

When the respondents were asked whether they have ever used contraceptive pill as a method of family planning; 75% respondents said yes, while 25% said that the know of it but have never used it. In fact one lady said that, “Tuwulira era twayagala nnyo okozesa pilu naye tetugitegera ate olumu tebakunyonyola abasawo bulungi,” meaning that they know about it and they would like to use it only that they lack proper explanation from the health workers.

When the student asked the respondents about how they acquired the knowledge about contraceptive pill as a method of family planning services they had this to say; Majority of respondents (30%) agreed that they acquired knowledge on contraceptive pill as a method of family planning services through workshops, 20% of respondents got information from friends or peer groups, 15% of said that they got the knowledge through mass media that is radios, televisions, news papers among others. 15% of respondents said that Straight talk programmes and 20% agreed that skits and drama was their source of information.

One respondent was quoted saying; “Mukwano gwange ye yambulira ku bya ka pilu ka famile, anti ng’alaba nzaalira kumukumu era yeyatwala ne mu ddwaliro omulundi ogw’asooka” meaning that; she was not spacing her children and her friend got concerned and told her about contraceptive pill and in fact she escorted me to my first visit the health center.

One respondent said that; using contraceptive pill has helped her to space children. Before she got to know on the use of contraceptive pill, her and the husband were using withdraw method as a method of spacing children however, the method was not effective. Then one of her friends, told her that the pill was a good method of spacing children and since then she has been using it for one and half years now and she has found it easier, convenient and effective that other methods.

Another respondent was quoted saying;

“My wife told me about her using contraceptive pill so that we can space children. Then I asked her where she got the information, she responded from a friend. I told her to go to a health worker in a nearby clinic and inquire. She did so, and the nurse told to start using it. But since 2015 we are using the pill and we have not found any problem with it”.

From the above, as the researcher I agreed that using contraceptive pill as a method of family planning is effective as majority of the respondents recommended it and term it as being simple and convenient.

4.3 The side effects of using oral contraceptive pill as a method of family planning

The second objective of the study aimed at investigating the side effects of oral contraceptive pill as a method of family planning. Results were obtained and are presented below;

Breakthrough bleeding

Majority of the respondents (85%) indicated that use of contraceptive pill as a method of family planning is bad as it may lead to breakthrough bleeding in women who may use it.

Respondents indicated that use of the pill may lead to virginal bleeding between periods.

One respondent was quoted saying:

‘when I had just started using this pill, I used to over bleed during my periods especially during the first few months of using it. However, doctors advised me that if I continue using the pill, the bleeding will stop after sometime. But I could not wait for that time since the bleeding used to disorganize me even during my work time. Therefore, I gave up on it. Now me and my husband are using different methods. My husband prefers to use withdraw though given him an option of injections but he refused’.

Depression

Majority of the study respondents indicated that using contraceptive pill increases the rate of depression in women. Respondents lamented that for women who are already depressed, the use of the pill worsens their condition.

However, one midwife was quoted saying:

“Yeah its true depressed women can further be depressed in case they use the pill however, low dose of the pill is unlikely to increase the risk of depression of women that are currently depressed”.

Risk of stock

Also most respondents indicated that use of the pill can lead to the risk of one getting a stroke. Respondents indicated that long continued use of the pill for women over 35years of age may increase the risk of stroke.

Change in weight

Study findings also revealed that majority of the study respondents indicated that over use of the pill or long term usage can lead to changes in ones weight.

One respondent was quoted saying:

“Before I started using this pill, I was small in size but after 2 years now, look at my size. I have increase like by 35 kilograms. Sometimes I feel I should stop using it but then I need to space children”

Swelling of ankle/feet

Findings also indicate that, use of the pill can cause one’s feet or ankle to swell. This can be caused as a result of long term use of the pill. One respondent was quoted saying;

“After sometime of using the pill, my feet started to swell yet I wasn’t pregnancy. Therefore I looked for medical attention and the nurse asked whether I use any artificial method of family planning and I told her, yes, I use the pill. Then she concluded that is the cause of the swelling. She advised me to use other methods of family planning. Right now I use injecta plan”.

Study findings also reveal that, 9 respondents revealed that use of the pill can cause frequent headache and vomiting. One health worker indicated that different women react differently to the use of the pill. Vomiting and headache happen mostly in the first few months but women are sensitized on how to minimize those two.

4.4 Factors that influences the use of using oral contraceptive pill as a method of family planning

The study also intended to identify the factors that influence the use of using oral contraceptive pill as a method of family planning. Results were obtained and are presented below;

Majority of respondents said sensitization and long term effects (40%), followed by attitude about western methods (15%), illiteracy (15%), availability of facilities (methods) (15%) and skilled personnel (15%). Respondents stated that some women tend to forget the returning date back for another dose because they do not know how to read and write, Factors like fear of long term effects like condoms they think it will rupture into a woman’s vargina, and end up being taken to theatre for operation.

Key informant interviews with health care providers yielded the same sentiments, suggesting that negative health workers’ attitude is a major barrier to access to family planning services.

Others indicated that there is a fear of deformed children after birth, intra-uterine device (coil) will tear the cervix which will result into removal of uterus and among others. After its use one lady said that he was told by her husband that

“he didn’t want to know anything about Family Planning Services”

Reaction of spouses was the least supported factor as it was supported by 1 respondent, the researcher found out that most of the people had knowledge about Family Planning Services and they cannot use them because of the reaction of spouses (husbands) towards it, husbands do not appreciate very much the family planning services by the government, but they have different perception.

One respondent (5%) made a comment stating what a husband said when she raised an issue of Family Planning Services said that, “If you know that you’re wife make sure never to go for Family Planning Services and not to take my children for immunization.”

Accordingly participants were asked on what they thought would be the likely remedies to improve accessibility to family planning services.

Majority of respondents (65%) agreed that the contraceptives should be given out freely because most women don’t have financial power to buy thus hindering their use.

One respondent said that; family planning is good but expensive yet we don’t have money.

Other respondents suggested that health education talks and public sensitization should be improved to help women to get informed and get rid of the myths they have about family planning services.

As one respondent said that; “I was told that if you use family planning you give birth the lame children; that are why I don’t use them”.

CHAPTER FIVE

DISCUSSION, CONCLUSION AND RECOMMENDATIONS

5.0 Introduction

This chapter presents a discussion on the major findings of the study, conclusions and gives recommendations. This was done according to objectives as earlier.

5.1 Discussion of results

5.1.1 Advantages of using oral contraceptive pill as a method of family planning.

In this study, most of the respondents indicated that using contraceptive pill as a method of family planning as helped them to space children. Others indicated that it is a simple and convenient method of family planning. Findings indicate that the pill also reduces the level of blood pressure in women. These findings are in line with WHO (2010) that argues that the use of oral contraceptives (birth control pills) for five years or more decreases the risk of ovarian cancer in later life by 50%. Oral contraceptive use reduces the risk of ovarian cancer by 40% and the risk of endometrial cancer by 50% compared with never users. The risk reduction increases with duration of use, with an 80% reduction in risk for both ovarian and endometrial cancer with use for more than 10 years. The risk reduction for both ovarian and endometrial cancer persists for at least 20 years.

5.1.2 The side effects of using oral contraceptive pill as a method of family planning

Study findings indicate that, use of contraceptive pill can lead to breakthrough bleeding, increase depression in already depressed women, risk of stock, change in weight and swelling of ankle/feet. These findings are in line with a French review article in 1992 which argued that different sources note different incidences of side effects. The most common side effect is breakthrough bleeding. A 1992 French review article said that as many as 50% of new first-time users discontinue the birth control pill before the end of the first year because of the annoyance of side effects such as breakthrough bleeding and amenorrhea. One study found that women using birth control pills blinked 32% more often than those not using the contraception.

Also WHO (2010) stated that progestin-only contraceptives are known to worsen the condition of women who are already depressed. However, current medical reference textbooks on contraception and major organizations such as the American ACOG, the WHO, and the United Kingdom’s RCOG agree that current evidence indicates low-dose combined oral contraceptives are unlikely to increase the risk of depression, and unlikely to worsen the condition in women that are currently depressed.

5.1.3 Factors that influences the use of using oral contraceptive pill as a method of family planning

In this study, respondents indicated lack access to the pill, lack of sensitization and long term effects, followed by attitude about western methods, illiteracy, availability of facilities (methods) and skilled personnel. Some women tend to forget the returning date back for another dose because they do not know how to read and write, Factors like fear of long term effects like condoms they think it will rupture into a woman’s vargina, and end up being taken to theatre for operation. These findings line with World Health Organization (WHO, 2009) stated that, reasons for unmet need are many and they are attributed to limited services and supplies, fear for social disapproval of partner’s opposition pose formidable barriers, worries of side effects and health concerns hold some people back, others lack knowledge about contraceptive options and their use.

Also the International Conference on Family Planning (2009) argued that an estimated 41% of Ugandan Women who would like to stop having children have no access to Contraceptives. However, this has resulted into unintended pregnancies and bigger families. It further stated that in Uganda a woman will give birth to an average of 6 – 7 children in her life time. Such large families in developing countries are linked to poverty, poor nutrition, low education levels and even health dangers, for example a woman is at risk of maternal mortality increase with each birth.

5.2 Conclusion

Using contraceptive pill as a method of family planning as helped women to space children. Contraceptive pill is a simple and convenient method of family planning as it also reduces the level of blood pressure in women. However, long term use of the pill may lead to breakthrough bleeding, increase depression in already depressed women, risk of stock, change in weight and swelling of ankle/feet. The factors that influence the use of contraceptive pill include no access to the pill, lack of sensitization and long term effects, followed by attitude about western methods, illiteracy, availability of facilities (methods) and skilled personnel. Therefore the contraceptives should be given out freely because most women don’t have financial power to buy and health education talks and public sensitization should be improved to help women to get informed and get rid of the myths they have about family planning services.

5.3 Recommendations

Basing study findings, the researcher recommends that;

Local leaders: some local people at the grassroots should be trained to volunteer as promoters to enhance the services and regularly issue public statements supportive of Family Planning to mobilize both political and people’s support. Hold meetings to harmonize and rationalize implementation of policies with stakeholders involved in Public Health services.

The government should ensure that Family Planning is a key component of all National strategies, including the National Development Plan. Thus by increasing allocations for contraceptive in National and district health budgets.

The government: increase involvement of the private sector in the provision of Public Health Services. They should be invited to Ministry of Health/District training and workshops benefits from supportive supervision and have feed on their activities the existence of illegal/non immersed private sector service providers must also be addressed. It is difficult at this time to control the price charged by private sector by Public Health service providers.

Improve use of existing policies and guidelines by increasing number of copies, improving on distribution methods and implementing a system of resupply that ensures availability support supervision should be used to check compliance to guide lines as well as drawing attention to use existing guidelines.

The government through the Ministry of Health should increase funding and investment in the population control through family planning provision. Between 2011 – 20015, if the government increases investment in Family Planning Services to US$ 10 million meeting the need for Family Planning substantial savings could be realized.

Mothers: guidance and counseling services should be conducted regularly to both mothers and community. And intensify advocacy and awareness raising at all levels for Public Health services.

5.4 Areas of Further Research

The research recommends the following areas for further research;

The role of sensitization and awareness in changing people’s attitudes towards the use of Family Planning services.

REFERENCES

“Contraceptive Use in the United States”. Guttmacher Institute. 2004-08-04. Retrieved 2016-12-11.

Aiko Hayashi (2004-08-20). “Japanese Women Shun The Pill”. CBS News. Retrieved 2006-06-12.

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Collaborative Group on Hormonal Factors in Breast Cancer (1996). “Breast cancer and hormonal contraceptives: Collaborative reanalysis of individual data on 53 297 women with breast cancer and 100 239 women without breast cancer from 54 epidemiological studies”. The Lancet.

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Harris, Gardiner (2010-05-03). “The Pill Started More Than One Revolution”. New York Times. New York Times. Retrieved 2015-09-21.

IARC working group (2007). “Combined Estrogen-Progestogen Contraceptives” (PDF). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. International Agency for Research on Cancer. 91.

Kemmeren JM, Tanis BC, van den Bosch MA, Bollen EL, Helmerhorst FM, van der Graaf Y, Rosendaal FR, Algra A (2002). “Risk of Arterial Thrombosis in Relation to Oral Contraceptives (RATIO) Study: Oral Contraceptives and the Risk of Ischemic Stroke”.

Mosher WD, Martinez GM, Chandra A, Abma JC, Willson SJ (2004). “Use of contraception and use of family planning services in the United States: 1982–2002” (PDF). Adv Data (350): 1–36. PMID 15633582. all US women aged 15–44

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Taylor, Tamara; Keyse, Laura; Bryant, Aimee (2006). Contraception and Sexual Health, 2005/06 (PDF). London: Office for National Statistics. ISBN 1-85774-638-4. British women aged 16–49: 24% currently use the Pill (17% use Combined pill, 5% use Minipill, 2% don’t know type)

Trussell, James (2011). “Contraceptive efficacy”. In Hatcher, Robert A.; Trussell, James; Nelson, Anita L.; Cates, Willard Jr.; Kowal, Deborah; Policar, Michael S. (eds.). Contraceptive technology (20th revised ed.). New York: Ardent Media. pp. 779–863. I.

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APPENDICES

APPENDIX I: INTERVIEW GUIDE FOR LC I

Education level
Source of income
Marital status
What do you know about oral contraceptive pill as a method of family planning?
Do people in this area use oral contraceptive pill as a method of family planning?
How effective is it?
What do you think are some of the side effects of oral contraceptive pill as a method of family planning?
What factors hinder women from accessing oral contraceptive pill as a method of family planning in Tororo Municipality?
What do you think can be done to improve the accessibility to family planning services in this area?
Any other information that you wish to add concerning oral contraceptive pill as a method of family planning?