As in other countries of West Africa, Benin has a low rate of MCM utilization. The factors which lead to this low rate of use vary from one country to another. Purpose: The purpose of this work was to determine the factors associated with the use of modern contraceptive method (MCM) by women of childbearing age (WCBA) in Parakou in 2017. Materials and Methods: It was a cross-sectional and descriptive study with an analytical purpose among WCBA selected in households of the municipality of Parakou after a 2-degree cluster survey. Results: The WCBA’s average age was 29 ± 5.6 years old with extremes of 15 and 46 years. The modern contraceptive prevalence was 14.74%. Among WCBA, 57.14% had an average level of knowledge. The media were the main source of information (75.84%). Among them 34.39% never discussed the matter with their spouse; the latter were not in favor of contraception. The educational level, the perception of woman, the spouse’s favorable opinion, the discussion with the spouse, the level of knowledge of MCM and the knowledge of the existence of FP service were significantly associated with the use of MCM with p = 0.0000 after multivariate analysis. Conclusion: The level of MCM use still remains low. Any effort to increase the modern contraceptive prevalence should take into account its associated factors in order to optimize the use of MCM in the municipality of Parakou in 2017.
Benin is characterized by a high maternal and infant/child mortality but also a high birth rate with a composite fertility index (CFI) of 4.9 children per woman [
It was a cross-sectional and descriptive study with an analytical purpose and prospective data collection which was carried out over a three-month (3) period from April 1st to June 30th 2017.
It consisted of all the WCBA of the municipality of Parakou in 2017.
Were involved in our study, WCBA (15 to 49 years old) who resided permanently in Parakou for at least 6 months and who gave their free and informed consent.
Were not involved in our study, people with mental illnesses, pregnant women, women in early menopause, women who could not have children (bilateral salpingectomy, uterine agenesis, uterine malformation, hemostasis hysterectomy).
The sample size is obtained using Schwartz formula: N = kZα2p (1-p)/ i2.
With a 14% contraceptive prevalence in Benin (BDHS-IV); a p-value (α) of 0.05 that is to say Zα=1.96; a desired accuracy (i) of 3% and a cluster effect (k) of 2.
N = (1.96)2 × 0.14 × 0.86 × 2/(0.03)2 = 1027.8414222 ≈ 1028 subjects.
This size was increased by 10% to take account of non-respondents and possible poorly completed forms.
The study was conducted according to a 2-degree cluster effect survey technique. The sampling frame was composed of the list of 106 neighborhoods and sub-neighborhoods in the municipality of Parakou with their respective target populations. We chose to take 30 clusters, as suggested by WHO. The size of each cluster was 37.7 ≈ 38 (1131/30) individuals.
The selection of the thirty clusters was made as follows:
1) The realization of the table of the cumulative target population (the cumulative total population is 49,743).
2) The determination of the cluster step. It was obtained by dividing the cumulative total population by 30 (the cluster step obtained is 1658).
3) Determination of the beginning (d): We drew a number between 1 and the cluster step thanks to the software epi table (the number pulled is d = 100).
4) This number allowed us to determine the first cluster.
5) The second cluster was obtained by adding to number (d) the step of cluster.
Draw of concessions:
In each cluster drawn, the interviewer placed himself in the center of the district and drew lots of direction (either by the method of bottle or turned pen). In this direction, the investigator had entered a concession on two starting with his right with each new result we added the step of cluster until we get the 30 clusters.
Selection of households by concession and subject to survey by household:
1) Within the selected concessions, the households were in turn numbered and half of the households were randomly drawn.
2) In each selected household, a subject was drawn from the list of eligible subjects present in the household when the collection team passed.
3) If the number required for the cluster was not obtained in this direction, the investigator returned to the center of the district to choose another direction with the same method.
The dependent variable was the use of MCM. It is a modality qualitative binary variable (Yes/No). By MCM, we referred to the following methods: femidon, condom, pill, injectable, implant, intrauterine device (IUD), spermicide, tubal sterilization, vasectomy because they were the only ones to be mentioned by the WCBA.
We considered the following factors predictive of the use of MCM: age, place of residence, ethnic group, religion, socio-professional group, educational level, socio-economic level, marital status, household type, parity, gestity, level of knowledge, perception of WCBA, spouse’s opinion, discussion with the spouse and the knowledge of the existence of FP services.
The assessment criteria of the WCBA’s level of knowledge was inspired from the model of Essi et al. [
1) <25% of right answers = Poor.
2) [25% - 50% [of right answers = Insufficient.
3) [50% - 70% [of right answers = Average.
4) ≥70% of right answers = Good.
Data were collected during a personal interview on the basis of a prepared questionnaire administered to all the women involved in the survey.
Data collection procedure:
1) Interviewer training: There were six (06) interviewers with good knowledge of the local language trained by ABPF to raise awareness about FP.
2) A pre-test was done in an unsuccessful neighborhood.
3) The investigation phase itself: it had been spread over a period of three months (01 April to 30 June 2017).
The data collected were stored with EPI Data 3.1 software. Bivariate analysis was carried out by means of Epi Info 7.1 software. Multivariate analysis was performed by means of SPSS version 2.0 software. Microsoft Excel 2016 helped to organize the data in tabular and graphic forms. Quantitative variables were expressed in the form of averages with their standard deviation. When intersecting two qualitative variables or comparing two percentages, Chi-square test (or Fisher exact test according to the case) and p-value had been used. We admit that there is a statistically significant association between two variables for any probability below 5%.Prevalence ratio (PR) and Odds ratio (OR) were presented with their Confidence Intervals (CI). Logistic regression was used to identify factors which were associated with the use of MCM. Outputs for logistic regression were presented as Odds Ratio (OR) and confidence intervals (CI). CI not crossing one was assumed to be significant.
In total, we surveyed 1140 WCBA. The WCBA’s average age was 29 ± 5.6 years. The major part of the women were Beninese (99.04%) and resided in an urban area (80%). Most of them belonged to the Bariba ethnic group (33.33%) and Fon related ethnic group (27.11%) practicing Islam (56%). The women surveyed were mostly traders/retailers (30%). They were not educated (25.35%) or had primary school level (32.81%) and an average socioeconomic level (52.02%). They were married in 58.68% of cases and lived in a monogamous household for most of them (47.54%). The number of pregnancies ranged from 0 to 11 with an average of 3 ± 1.9. The WCBA surveyed were mainly pauciparous (38.07%) and multiparous (24.3%).
They used modern contraceptive methods in 14.74% of cases and injectable contraceptives were mostly used (
More than half of the women surveyed had an average level of knowledge. The main sources of information were the media (75.84%) and parents/friends (74.63%) (
The educational level; OR 6.4; IC [3.52 -.11.63], P < 0.001, the perception of woman; OR 12.78; IC [8.36 - 19.54] P < 0,001. The spouse’s favorable opinion; OR 3.29; IC [2.23 - 4.96], P < 0.001, the discussion with the spouse; OR 6.54; IC [3.86 - 11.07], P < 0.001. the level of knowledge of MCM and the knowledge of the existence of FP services; OR 11,38; IC [5.56 - 23.30], P < 0.001 et 8.75 [4.41 - 17.35], P < 0.001.as regards modern contraceptive methods appeared as factors associated with the use of MCM after multivariate analysis (
The average age of the WCBA involved in our study was 29 ± 5.6 years old with extremes of 15 and 46 years old. This result is similar to those of Olamijulo et al.
Number | Proportion in % | |
---|---|---|
Use of MCM | ||
Yes | 168 | 14.74 |
No | 972 | 85.26 |
Type of MCM | ||
Oral Contraceptive | 17 | 10.12 |
Injectable Contraceptive | 72 | 42.86 |
IUD | 4 | 2.38 |
Spermicide | 1 | 0.6 |
Condom | 49 | 29.17 |
Implant | 28 | 16.67 |
Diaphragm and cervical cap | 0 | 0 |
Femidom | 1 | 0.6 |
Tubal Sterilization | 0 | 0 |
Vasectomy | 0 | 0 |
Number | Proportion in % | |
---|---|---|
Knowledge | ||
Poor | 72 | 6.31 |
Insufficient | 155 | 13.6 |
Average | 651 | 57.11 |
Good | 262 | 22.98 |
Heard of FP | ||
Yes | 1068 | 93.68 |
No | 72 | 6.32 |
Sources of information on FP | ||
Care giver | 191 | 17.88 |
Parents/Friends | 797 | 74.63 |
Media | 810 | 75.84 |
Association | 32 | 3 |
School/University | 120 | 11.24 |
Internet | 8 | 0.75 |
OR | CI95% | P-Value | |
---|---|---|---|
Age (≤15/≥40) | 1.09 | 0 - 1.12 | 0.96 |
Ethnic group (Fonand related/Dendi) | 0.7 | 0.66 - 0.83 | 0.99 |
Maritus status | 0.7 | 0.61 - 0.87 | 0.41 |
(Single/Married) | |||
Religion (Christianity/Endogenous) | 1.4 | 0.15 - 14.49 | 0.73 |
Socioprofessional group [Civil servant/ worker(blue collar)] | 0.9 | 0.89 - 1.08 | 0.72 |
Educational level (Higher/Non educated) | 6.4 | 3.52 - 11.63 | P < 0.001 |
Socioeconomic level (High/low) | 0,7 | 0 - 1,12 | 0.85 |
Type of household (No household /Monogamous) | 1,2 | 1.03 - 1.52 | 0.13 |
Parity (Pauciparous/Nulliparous) | 0.8 | 0.73 - 0.96 | 0.18 |
Heard of MCM (yes/no) | 1.04 | 0.01 - 1.12 | 0.96 |
Level of knowledge (Good/insufficient) | 11.38 | 5.56 - 23.30 | P < 0.001 |
Perception of woman (good/bad) | 12.78 | 8.36 - 19.54 | P < 0.001 |
Spouse’s favorable opinion (yes/bad) | 3.29 | 2.23 - 4.96 | P < 0.001 |
Discussion with the spouse(often/never) | 6.54 | 3.86 - 11.07 | P < 0.001 |
Knowledge of the existence of FP services (yes/no) | 8.75 | 4.41 - 17.35 | P < 0.001 |
in Nigeria in 2012 and Traoré in Mali in 2008 in their studies carried out on populations. They had respectively found average ages of 30.86 ± 7.54 years old, 29.9 years old and 28 ± 7.8 years old [
In our study, the modern contraceptive prevalence was 14.74% as against 19 % in Senegal and 11% in Nigeria [
So, the perception of MCM by the women surveyed was bad in 50% of cases ; similar results to those of MBACKE in Senegal [
The scope of the study was limited to the factors associated with the use of MCAs by women of childbearing age in the city of Parakou and not contraception in general; what we recommend for future research. This study could, however, include an information bias because of the method of questioning the women surveyed which is the one to one interview with the interviewers. Indeed, because of the sensitivity of the subject, there may be women who have not answered the question frankly. However, their number would be limited because of the explanations provided to the respondents before the start of the interview
The level of utilization still remains low. Any effort to increase modern contraceptive prevalence should take into account the educational level, the perception of woman, the spouse’s favorable opinion, the discussion with the spouse, the level of knowledge of FP services in order to optimize the use of MCM in the municipality of Parakou in Benin.In order to mitigate the effects of its disadvantages on the use of CMC by women of childbearing age in the city of Parakou, it is necessary to:
1) Strengthen sex education and reproductive health programs in schools (middle and high schools),
2) Encourage family planning programming through the media,
3) Intensify the promotion of family planning during pre-natal, post-natal and pre-school counseling.
4) Create and train community relays in family planning in women’s and men’s groups
5) Promote communication within the couple.
Salifou, K., Sidi Imorou, R., Vodouhe, M., Gounon, M.E., Hounkponou, F., Obossou, A., Koukoui, C., Perrin, R.X.E. and Alihonou, E. (2018) Factors Associated with the Use of Modern Contraceptive Methods by Women of Childbearing Age in Parakou in 2017. Open Journal of Obstetrics and Gynecology, 8, 521-530. https://doi.org/10.4236/ojog.2018.85059