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SOCIO-DEMOGRAPHIC FACTORS AFFECTING FAMILY PLANNING
IN NIGERIA: IMPLICATIONS FOR HEALTH POLICY
Department of Sociology/Psychology, Delta State University, Abraka
This study is aimed
at identifying socio-demographic factors impeding family planning in Nigeria. Three
thousand women selected through the multi-stage technique from the six geo-political
zones in Nigeria participated in the study. They were socio-demographically characterised
by different ages, varied educational status, to different ethnic groups. The measuring
instrument_structured Interview schedule tested for construct validity and content
reliability was employed to gather data nation-wide. The instrument had three sections
describing socio-demographics of interviewees. Research assistants drawn from the
localities helped in conducting the interviews in their local dialects. The data
collected was analysed using chi-square statistics. The results showed that the
interviewees generally have good knowledge of family planning through modern methods
(X2 = 48.66, df = 3996; p < .05). In practice the modern methods of
family planning was also significant (X2 = 48.77, df = 3996; P< .05).
Also, the results shows that age does significantly determine family planning (X2
= 47.46, df = 3996; p < .05; X2 = 59.57, df = 2996; p < .05) for
women 40 years and under 60 years of age respectively. Another significant result
is poverty or economic class, women from low economic class earning less than
Keywords: Family planning, Socio-demographics, Health policy, impeding
The family is the building block of society. It is a nursery, a school, a hospital, a leisure place, a place of refuge and a place of rest, it encompasses the whole of society. It fashions beliefs. It’s the preparation for the rest of our life and women run it.
Abbot and Wallace 1992: 131.
Certain functions are basic to all types of family, namely those of reproduction, socialization of the young, economic and emotional support to family members. This is invariably linked to the contemporary issue of family planning. Family planning is an organized effort essentially to ensure that couples who want to limit their family size or to space their children have access to contraceptive information and services needed (Isiugo- Abanihe,1996).
The impact of family planning programmes on fertility vis-à-vis socio-economic and political development of Nigeria has been contentious (Davis, 1967; Berelson, 1975; Planned Parenthood Federation of Nigeria (PPFN) 1988; Nagi, 1992; Isiugo-Abanihe, (1994a). This paper is aimed at
profiling sociodemographic factors affecting family planning in Nigeria, and its implications for health policy.
Statement of Problem
The Nigerian annual rate of population growth is as high as 3.5% with a total fertility rate of 6.0 lifetime births per woman (Federal office of statistics, 1990; Population Bureau, 1984). Several studies (Odimegwu, 1999; Isiugo-Abanehe, 1996) have reported positive changes in Nigerians knowledge of and attitude toward family planning. But there are still some blockade factors. The issue of family planning in Nigeria is the study of women, who as child bearers have been the target of organized family planning activities (Isiugo- Abanihe, 1996). Nagi (1992) argued that family planning is available to help individuals and couples to choose if and when they will have a child (family planning) or to choose the number of children they want to have (family limitation). The choice depends on a complicated mixture of social, cultural and psychological influences (Adewuyi, Omideyi and Raini, 1994; Caldwell and Caldwell 1990; Isiugo-Abanihe, 1994b). In recent times population policies have made it possible for men and women to have reliable methods to enable them make their choice freely and relatively easy.
In some developed, modernized, healthier, better fed and prosperous countries in Western Europe, the population growth rate has diminished with low fertility rates as men and woman have chosen to have fewer children and by using birth control methods. This has resulted to having smaller families. In contrast, in most developing countries like Nigeria, the birth rates remain high with poor health conditions, inadequate food, environment in peril, and economic hardships. Only a few couples limit the size of their families against the National population policy objective of No:- 4.3:4, that is to reduce the number of children a woman has in her life time from 6 to 4. Fumilayo (1985) identified family planning problems as ‘generic’ barriers to the acceptance of contraceptive methods in Nigeria and grouped them into political, cultural, doctrinal prejudice, educational and fear of side effect.
Another aspect of cultural factor is based on sex selection. In a partrilineal society like Nigeria, preference of male children is widely accepted (Ewhrudjakpor, 2008a) This implies that without a male child, continuous child bearing is accepted until onearrives; otherwise, the man is forced to accept another wife. Regarding doctrinal prejudice, some religions are in favour of family planning, others have their rules, guidelines and principles. Some religions encourage polygamy which implies that unrestrained reproduction is encouraged.
Many low income countries like Nigeria are caught in a vicious cycle. Efforts to improve living standards and alleviate poverty are overwhelmed by the need to provide basic services (Ewhrudjakpor, 2008a). With population doubling every 25 to 30 years Nigeria has found it difficult to reduce the number of people living in extreme poverty.
The Nigerian government put into effect a national population policy in 1988 that called for a reduction in the birthrate through voluntary fertility regulation methods compatible with the nation’s economic and social goals (Federal Ministry of health 1988).This study is aimed at assessing how far this policy has fared after 20 years.
The research method employed in this study is survey research.
The Federal Republic of Nigeria is the 10th largest country in the world with a population of 140,003542 (The Daily Champion January, 2007). There are more than 250 ethnic and linguistic nationalities that make up the 36 states and the Federal Capital Territory. The Yorubas, Igbos and the Hausa / Fulani of the West, Southeast and the North comprise the majority tribes. The minorities of the Ijaws, Itsekiris and other nationalities occupy the south-south region. The states are grouped on the basis of ethnic homogeneity and geographical proximity into six geopolitical zones. It is estimated that approximately 70 million Nigerians earn below United States one dollar per day. The Human Development Report 2000 ranked Nigeria among the 20 poorest countries in the world. Modern health facilities and services
particularly in the rural areas are grossly inadequate. The cost of health care economically and bureaucratically is huge, encouraging impoverished natives to find an easy alternative in tradomedicine. The total fertility rate is 5.66 children per woman as at 2000, with a growth rate of 2.38%. The birth rate is 40.16 births per 1000 population, against a death rare of 13.72 deaths per 1000 population. (http://en.wikipedia.org/wiki/Nigerian people).
Three thousand female adults (women) were used to conduct this study. Out of this number; the ratio of 1:2 was used to select participants from rural and urban settlements in the six geopolitical zones in Nigeria (see table 1)
Table 1: Interviewees selection from the six
Geopolitical Zones in Nigeria (N = 3000)
Source: Fieldwork 2006/2007
The sampling technique adopted in this study was the multi-stage or cluster random sampling. Each of the settlements selected represents a cluster. 500 from each zone was deliberately selected. This number was further distributed in the ratio of 1:2 amongst illiterate (rural) and literate (urban) dwellers in the Zones. Furthermore in each of the six zones, the selection was distributed among the
states in the Zone. In each state the interviewees were then drawn from selected urban settlements and adjoining rural settlements.
The 47 questions were written in English language and interpreted by the research assistants in the languages of the ethnic group where the research is administered.
This study was conducted using a structured interview schedule. This was used to facilitate data gathering amongst the participants. The interview schedule was divided into three sections. Section A: contains seven questions about social demographic characteristics of women in this study, (see table 2). Section B. contains 20 questions on knowledge factors about family planning and Section C: contains 20 questions on practices about family planning.
Instrument Validity and Reliability
This interview schedule, originally with a known group method of construct validation yielded a validity score t = 598 df =28, P < 005, known- group of married women. And a reliability score of: r = 0.89; d.f, 28, P<.05, known-group of married and unmarried women.
The interview schedule was administered on all 3000 participants. Interviews were conducted by research assistants debriefed on the distribution of the respondents and the modus operandi. The researcher made sure to recruit assistants who hail from regions and settlements of the selected clusters in order to communicate effectively in the settlements native dialect. However, in most cases, English Language was used, particularly in urban areas with literate respondents.
Each interviewee ranked the questions on a three point scale reflecting her knowledge and practice of family planning. In each case the interviewee was asked to select an option among the following: Yes; No; don’t know. The whole exercise of interview lasted for fourteen months, between February 2007 and March of 2008.
Geopolitically, the survey is nationally spread to include urban towns (66.67%) and rural settlements (33.33%) from the six constitutionally designated zones. Equal number of 500 participants was deliberately used in each Zone, but the multi-stage sampling technique distinguished sampling from various stages in the zones. And in each zone the participants from States differ due to the census figure of each State. The higher the census figure, the more a State, city or village was represented. The chi –square value of rural dwellers of (x2 = 73.32, df = 6, P < .05) reached significance, at the 0.05 alpha level (see table 2).
1578 representing 52.60% of the participants were under 40 years of age. 1091 or 36.37 were below 60 years of age and only 331 (11.03%) were above 60 years. This distribution justified the prime age targeted for family planning that is under 60 years, particularly, below 40 years of age. The chi-square value of 47.46 and 59.57 for under 40 years and below 60 years respectively, were significant at the 0.05 alpha level.
The distributions of marital status of interviewees show
that married women were 2013 (67.10%). This indicated that most interviewees in
this survey are still very current with predicaments
of family planning. Marital status as shown in table 1 does not significantly affect
family planning in Nigeria. Also, most of the interviewees tend to be poor with
67.33% of them earning less than
reflected in the chi-square result (x2 = 31.62 df; 2996, p < 0.05; and X2 = 23.14, df, 2996, p< 0.05 respective for Christians and Muslims respondents.
Table 2: Social – demographic scores of interviewees and chi-square values. (N=3000)
*Significant at .05 alpha level.
Source: Fieldwork 2006/2007
This study indicates that majority of women have good knowledge and use of contraceptive methods particularly with modern techniques. But practicing these methods freely and fully is the bane of progress in actualizing their family planning ‘dreams’. It is some of these intrinsic barriers that this study aimed at studying and profiling. Past national surveys (Adewuyi, Omideyi, and Raini 1994; Caldwell and Caldwell, 1990; Odimegwu, 1999; FOS, 1996; Isiugo-
Abanihe, 1996; 1994a, 1994b) shows that factors militating against practicing family planning are both psychological and sociocultural. But this present study attempts to profile the intrinsic factors referred to here as socio-demographics impeding the full practice of family planning, against the backdrop of good knowledge acquired.
The socio-demographics of significance here, are: people
aged below 60 years, poor people earning
47.46,59.57,63.21,56.36,54.14,63.33,54.16,73.32,).representing respective geo-
political zones of south–south and south west; knowledge, modern method; Ever used,
modern method; current use, modern method; chronological age, of under 40 years
and less than 60 years, annual income, of less than
The respondents’ perception of what family planning should be also differs from the dictates of family planning campaigned by the Federal and State governments of Nigeria. In the sense that family planning should be a way of life. But most of these interviewees see it as a policy to ‘westernize’ or acculturate their way of life as in the United States and Europe. To these respondents’, to plan and count the number of children born and unborn, is not the African way, indeed of course not the Nigeria way of life. They believe that children are gifts from God, and like birds, God knows how they will feed in order to enhance their health and standard of living.
Educationally, an information, education and communications campaign was launched to change Nigerians attitudes towards family planning and thereby increase their contraceptive use. The campaign was based on evidence that family planning messages relayed through the mass media (modern methods of knowledge acquisition) can influence contraceptive behaviour (x2 = 48.66; df = 2996. p < 0.05) These campaigns have been turned dysfunctionally into knowing how to circumvent and undermine contraceptive methods by ignoring family planning measures as strategy of the developed world to impoverish the developing nations. In fact some respondents particularly illiterates (x2 = 54.14; x2 = 63.33 x2 = 54.16) claim that contraceptive methods is to empower the developed world and reduce our population which invariably affects negatively the military strength and agriculture. This confirmed earlier studies (Egburedi, 2007; Isiugo- Abanihe, 1994a). In fact politicians anchor this argument of family planning on resource allocation. This is because revenue distribution formula in Nigeria is premised on population numbers resulting in regions or states with the highest population getting huge amount of the national revenue, and in fact controlling Political power (Udo, 1968, 1985).
Regarding prejudice, respondents tend to situate this around their religious beliefs. This is because most religions (Islam Christianity and atheists as in this study, table 2) are not in favour of family planning particularly those favouring polygamy, do encourage unrestrained reproduction. Religious beliefs and practices discouragement of family planning is anchored on the fact that God gives life, and so, abortion and contraceptive methods that are not natural are seen as sin ‘a breach of one’s contract with God’. This factor is also viewed from the socio-cultural perspective of factors hindering family planning in Nigeria. Ali (1975) puts this perspective, thus:
The obstacle to population control programmes is not religious sensitivity but ethnic insecurity in a situation of high political competitiveness between groups … p.39
In Nigeria, most interviewees in this study situate neglect of family planning, despite modernity and public enlightenment, not on only the traditional beliefs and culture of the people. But individual factors in the family, for instance, some individuals believe that many children are regarded as superior to another man with fewer children in most Nigerian ethnic groups. This is because they believe that large number of children ensures that some of these children will grow into useful adults even if others fail by the way side. Traditionally, in the olden days, It is also believed that many children constitute economic advantage as they contribute meaningfully and on the farms, this belief has been over taken by modernity, urbanization, education and the Nigerian current economic reality this corroborates past studies (Caldwell, and Caldwell, 1990; Odimegwu, 1999; Isiogo- Abanihe; 1994).
Also, amongst the over 250 ethnic nationalities spread over these six geo-political zones, sex selection is deeply rooted in families and communities. That is, as a patriarchal society, the patrilineal nature means strong preference for male children. This implies that without a male child, further child bearing is accepted until a male child is born by a woman, otherwise the man is forced to accept and marry another woman, who will reproduce a male child for him. This is largely true contemporarily, but again relatives from individual to individual against the background of the man’s level of education, the higher educated the man, the less susceptible he is to this traditional practice. Hence as the result shows education is very potent in prosecuting the family planning agenda in Nigeria.
Economically, since 1986, there has been severe financial strain on households and Nigerians generally, particularly, the young adults or adolescents. With urbanization, rapid growth of higher education figures, not commensurate with job creation meanwhile national revenue has increased astronomically from crude oil exports, paradoxically, revenue distribution has continue to narrow to very few Nigerians, producing large scale poverty among majority of Nigerians particularly rural dwellers (Ewhrudjakpor, 2008b. This can be situated in Marx (1906) postulation that over population is not the cause of poverty, poverty is the cause of over population. This axiom is a difficult jigsaw to comprehend but it fits Nigeria state perfectly. However Marx provided a solution that it is greed and exploitation of individuals by individuals as in the Nigeria situation that causes poverty corroborating the theory of demographision as posited by Malthus (1965). This author agrees. Over population disastrous effects are in a vicious cycle (see figure 1).
Figure 1: Vicious cycle of poverty in Nigeria.
Source: Fieldwork, 2008.
Now, due to low wages in Nigeria (see table 2). Families have huge household expenditure on education, health care, housing, food and social engagements which eventually lead to low or no savings from the meager income. Therefore, no investment, so, efforts at procuring contraceptive methods with little income is not considered,
instead reproducing more children shall assist in farming, hawking and other sources of income generation for the family. Moreover because couples are poor and live in one room, most times idle, the tendency to engage in sexual intercourse is very high, and their reproductive rate does correlate positively. Federal office of statistics survey showed this fact graphically (FOS, 1990).
Implications of Family Planning For National Health Policy
Health policy is refered to any set of action or plans stated or unstated, intended or unintended by the Federal or State government that affects the physical, social, psychological and economic well being of Nigerians. Family planning is usually taken to mean fertility control. This has health implications on the individuals involved particularly women, and by extension others in terms of their familial relationship with women, such as husbands, and offsprings of marriages. Therefore the implication family, affects the whole household, community and the larger nation state.
Physically, the fewer children a woman bore, and at ages 18-35 years, the more physiologically fit she is. Studies (Fumilayo, 1985; Nagi, 1992) have shown that the risk of maternal and infant illness and death is highest in four specific types of pregnancies: pregnancies less than two years apart and after the fourth birth, all of which are prevalent here (FOS, 1988).
In fact, the Nigerian National policy on population (FOS, 1988) recognizes the impact of uncontrolled fertility which characterizes the rural population to mean that approximately 50-70 percent of farm output is consumed at home by the farmers and their families. Despite this a large number of children in rural families and urban squalor inhabitants are malnourished and succumb easily to infections.
Furthermore, many families live in squalid environmental conditions. Due to fertility rate not keeping pace with economic development, majority of Nigerians due to large families are poor, unemployed, underemployed and have inadequate access to health care services.
The goal of providing adequate health for all by the year 2000, has come and gone. Eight years after, the primary health centers (PHC) situated in almost all rural areas are empty, without physicians, one or no nursing staff, barely only the presence of non medical staff like messengers and security men. Modern health is still out of reach from majority Nigerians. The (FOS, 1988) reports that not only will the total population increase tremendously, but also the number of high health risk persons (children under 5 years of age and women in their child bearing years) will grow even more rapidly. It will become more and more difficult to provide enough basic health services and facilities for the entire population.
Family planning decision among women in Nigeria is characterized by certain socio-demographic problems. These include low education, early marriages or prolong reproduction period, chronological
age and nature of settlement. Inferiority complex of women due to the patriarchal nature of families in Nigeria, reproductive or contraceptive decisions are finalized by men, the taboo on discussion of number of children to produce, and the perceived side effects of contraceptives are all underpinned by the socio-demographics of the woman herself.
The Federal government should implement fully, the policies legislated to enforce that no woman reproduces more than four children. Women faces a lot of psychological, social and cultural barriers which block their practice of family planning desires. Significantly is the patriarchal nature of the Nigerian family structure in which reproduction and socialization of children take place. But all these are effected by the woman, hence government new fertility policies should be focused on the demographics of women of reproductive age. In fact (Udo, 1985) puts it succinctly thus:
The main reason for focusing attention on developing countries in discussions of population policy is, therefore, to bring about a reduction in fertility so that they may become demographically and, hopefully, economically more like the developed countries.
Abbot, P. and Wallace , C. (1992) The Family and the New Right, London: Pluto Press.
Adewuyi, A.A, Omideyi, A K and Raini, M.O. ( 1994) Evaluation of Ppublic Service
Announcement on Family Planning Knowledge, Attitudes and Practice in Nigeria, main report submitted to FHS/IEC Division of the FHS Project Victoria Island,
Ali, M.(1975) Ethnicity, Power and Population in Eastern Africa in Udo, R.K. et.al (Ed). Population Education Source Book for sub-Saharan Africa, London: Heinemann.
Barelson, B (1975). The Great Debate on Population Policy: An Occasional Paper, New York: the Population Council.
Caldwell, C. and Caldwell, P. (1990). Cultural Forces Tending to Sustain High Fertility. In : Acsadi, G.T.F. Johnson –Acsadi, G. and Bulatao, R.A. (Eds) Population Growth and Reproduction in sub-Saharan Africa: Technical Analyses of Fertility and its Consequences. Washington D.C: The World Bank, 199 -214.
Davis ,K. (1967): Population Policy: Will Current Programs Succeed? Science, 158: 730-739.
Demographics of Nigeria (2008) hHp://en.wikipedia.org/wiki/Nigerian people.10/1/2008.8.31 AM.
Egburedi, O.E (2007) Cultural and Psychological Hindrances on Family Planning: A Case Study of Warri Town in Delta State. (An unpublished B.Sc Sociology Thesis in the Department of Sociology /Psychology Delta State University, Abraka- Nigeria)
Ewhrudjakpor .C (2008a). Cultural Factors Blocking the Utilization of Orthodox Medicine: A Case Study of Warri Area in Delta State of Nigeria. Review of Sociology. Vol.14, No. 1-15.
Ewhrudjakpor .C (2008b). Poverty and its Alleviation: The Nigeria Experience. International Social Works Vol. 51, No. 4:519-531.
Federal Government of Nigeria(1988): National Population Policy for Development, Unity and Self- Reliance, Ikoyi , Lagos, Nigeria; Federal Ministry of Health.
Federal Office of Statistics(1990): Nigeria Demographic And Health Survey.
Isiugo – Abanihe ,U.C. (1994a). Demographic Transition in the Context of Africa, Kinyanju and E. Mburrugu (eds) African Perspectives on Development, London: James Currey.
Isiugo –Abanihe, U.C. (1994b). The Socio-Cultural Context of High Fertility among the Igbo Women. International Sociology. 9(2): 237-258.
Malthus, T.R (1965) An Essay on Population, New York: Augustus Kelley
Marx, K (1906): Capital : A Critique of Political Economy, translated from the third German edition by Samuel Moore and Edward Aveling and edited by Freidrick Engels. Now York: The Modern Library.
Nagi, M (1992): Family Planning Success Stories, Policy Research working paper No. 1041.
National Population Bureau( 1984): The Nigeria Fertility Survey 1981-1982. Principal Report, VOI. I, WFS. International Statistical.
Odimegwu, C. O. (1999): Family Planning Attitues and Use in Nigeria: A Factor Analysis. International family planning Perspectives, 25 (2): 85-91.
Planned Parenthood Federation of Nigeria (1988:) Profile of Planned Parenthood Federation of Nigeria. Lagos: PPFN.
Raini, MO, (1992). The Impact of Public Service Announcement on Family Planning Knowledge and Practice in Nigeria, paper presented at the Ninth population Association of Nigeria conference, Benin city, Nigeria, May 3-5.
Udo, R.K (1968) Population and Politics in Nigeria, in Caldwell, J.C. and Okonjo, C. (eds): The Population of Tropical Africa (London: Longmans) Pp.67 – 105.
Udo, R.K (1985) :Population Policies and Politics (National and International) Population Education Monographic 12.