Perspectives among postpartum women, men, and healthcare providers on barriers to family planning services in rural Nigeria

Love B. Ayamolowo, Nadine N. Rall, Sindiwe S. James

Abstract

Low uptake of family planning (FP) particularly during the postpartum period contributes to unintended pregnancies, thus increasing the risk of maternal morbidity and mortality globally. This cross-sectional mixed-methods study explored barriers to FP in rural southwest Nigeria using surveys from 388 men and women and interviews with 14 midwives across three states (June–July 2022). Eligible participants included postpartum women, men, and midwives. Quantitative data were analyzed using SPSS, and qualitative data using Braun and Clarke’s thematic analysis in Atlas.ti. The results show that although 62.6% of respondents had good knowledge of FP, only 35.5% reported current use. However, positive attitude (OR=1.689, p<0.05), tertiary education (OR=2.331, p<0.05), and having multiple partners (OR=1.793, p<0.05) were significant predictors. Thematic analysis of provider interviews revealed user-related, provider-related, and health system barriers. The study highlights the need for targeted FP education and structural interventions to improve uptake and overcome both individual and systemic challenges in rural communities.

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References

World Health Organisation. High rates of unintended pregnancies linked to gaps in family planning services: new WHO study. Geneva: WHO; 2019. Available from: https://www.who.int/news/item/25-10-2019-high-rates-of-unintended-pregnancies-linked-to-gaps-in-family-planning-services-new-who-study. Accessed 27 May 2024.

Clinton Health Access Initiative. Global family planning report. 2018. Available from: https://www.clintonhealthaccess.org. Accessed 26 May 2024.

Bankole A, Adewole I F, Hussain R, Awolude O, Singh S , Akinyemi J O. The incidence of abortion in Nigeria. Int Perspect Sex Reprod Health. 2015;41(4):170–81.

World Health Organization. Trends in maternal mortality 2000 to 2023: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. Geneva: WHO; 2025. Licence: CC BY-NC-SA 3.0 IGO. Available from: https://iris.who.int/bitstream/handle/10665/381012/9789240108462-eng.pdf. Accessed 27 May 2024.

World Health Organization Regional Office for Africa. Maternal health. 2021. Available from: https://www.afro.who.int/health-topics/maternal-health. Accessed 26 May 2024.

World Health Organization. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: WHO; 2019. Available from: https://data.unicef.org/resources/trends-maternal-mortality-2000-2017. Accessed 26 May 2024.

World Health Organization. Postpartum family planning: essential for ensuring health of women and their babies. Geneva: WHO; 2018. Available from: https://www.who.int/reproductivehealth/topics/family_planning/world-. Accessed 26 May 2024.

National Population Commission (NPC) [Nigeria] and ICF. Nigeria Demographic and Health Survey 2018: Key indicators report. Abuja, Nigeria, and Rockville, MD, USA: NPC and ICF; 2018. Available from: https://dhsprogram.com/pubs/pdf/SR264/SR264.pdf. Accessed 26 May 2024.

World Bank. Rural population (% of total population) – Nigeria. 2018 revision. Washington, DC: World Bank; 2018. Available from: https://data.worldbank.org/indicator/SP.RUR.TOTL.ZS?locations=NG. Accessed 26 May 2024.

Okereke E, Ishaku S M, Unumeri G, Mohammed B , Ahonsi B. Reducing maternal and newborn mortality in Nigeria: a qualitative study of stakeholders’ perceptions about the performance of community health workers and the introduction of community midwifery at primary healthcare level. Hum Resour Health. 2019;17(1):102.

Abimbola S, Okoli U, Olubajo O, Abdullahi M J , Pate M A. The Midwives Service Scheme in Nigeria. PLoS Med. 2012;9(5):e1001211.

World Health Organization. Programming strategies for postpartum family planning. Geneva: WHO; 2013. Available from: https://www.who.int/reproductivehealth/publications/family_planning/ppfp_strategies/en. Accessed 26 May 2024.

Kaydor V K, Adeoye I A, Olowolafe T A , Adekunle A O. Barriers to acceptance of postpartum family planning among women in Montserrado County, Liberia. Niger Postgrad Med J. 2018;25(3):143–8.

Abraha T H, Teferra A S, Gelagay A A, Welesamuel T G, Fisseha G K, Aregawi B G , Belay D S. Knowledge and associated factors of lactational amenorrhea as a contraception method among postpartum women in Aksum town, Tigray Region, Ethiopia. BMC Res Notes. 2018;11:1–6.

Ujah O I , Kirby R S. Long-acting reversible contraceptive use by rural–urban residence among women in Nigeria, 2016–2018. Int J Environ Res Public Health. 2022;19(20):13027.

Jalang’o R, Thuita F, Barasa S O , Njoroge P. Determinants of contraceptive use among postpartum women in a county hospital in rural Kenya. BMC Public Health. 2017;17:1–8.

Owuor H O, Chege P M , Laktabai J. Predictors of postpartum family planning uptake in Webuye Hospital, Western Kenya. Afr J Prim Health Care Fam Med. 2018;10(1):1–6. https://doi.org/10.4102/phcfm.v10i1.1567

Anate B C, Balogun M R, Olubodun T , Adejimi A A. Knowledge and utilization of family planning among rural postpartum women in Southwest Nigeria. J Family Med Prim Care. 2021;10(2):730–7.

Hazel E, Mohan D, Chirwa E, Phiri M, Kachale F, Msukwa P, Katz J , Marx M A. Disrespectful care in family planning services among youth and adult simulated clients in public sector facilities in Malawi. BMC Health Serv Res. 2021;21:336.

Yamane T. Statistics: an introductory analysis. 2nd ed. New York: Harper & Row; 1973.

Tesch R. Qualitative research: analysis types and software tools. London: Falmer Press; 1990.

Creswell, J. W., Creswell, J. D. (2018). Research design: Qualitative, quantitative and mixed methods approach (5th ed.). Los Angeles: SAGE.

Bhatt N, Bhatt B, Neupane B, Karki A, Bhatta T, Thapa J, Basnet L B , Budhathoki S S. Perceptions of family planning services and its key barriers among adolescents and young people in Eastern Nepal: a qualitative study. PLoS One. 2021;16(5):e0252184. https://doi.org/10.1371/journal.pone.0252184

Jonas K, Duby Z, Maruping K, Harries J , Mathews C. Rumours, myths, and misperceptions as barriers to contraceptive use among adolescent girls and young women in South Africa. Frontiers in Reproductive Health. 2022;4:960089. doi:10.3389/frph.2022.960089.

Kriel Y, Milford C, Cordero J, Suleman F, Beksinska M, Steyn P, Nkole T, Cupp P, Nkosi B, Smit J , Steyn P S. Male partner influence on family planning and contraceptive use: perspectives from community members and healthcare providers in KwaZulu-Natal, South Africa. Reprod Health. 2019;16:89:1–5.

Imtishal M , Mohammadnezhad M. Male partners and medical staff’s perception on contributing factors of family planning in Fiji. Heliyon. 2021;7(1):e05956.

Dral A A, Tolani M R, Smet E , Van Luijn A. Factors influencing male involvement in family planning in Ntchisi District, Malawi: a qualitative study. Afr J Reprod Health. 2018;22(4):35–43.

Akamike I C, Okedo-Alex I N, Eze I I, Ezeanosike O B , Uneke C J. Why does uptake of family planning services remain sub-optimal among Nigerian women? A systematic review of challenges and implications for policy. Contracept Reprod Med. 2020;5:1–11. https://doi.org/10.1186/s40834-020-00133-6

Hlongwa M, Kalinda C, Peltzer K , Hlongwana K. Factors associated with modern contraceptive use: a comparative analysis between younger and older women in Umlazi Township, KwaZulu-Natal, South Africa. Womens Health (Lond). 2021;17:17455065211060641.

Herbert S. Social norms, contraception and family planning. Birmingham: Governance and Social Development Resource Centre; 2015.

Sieverding M, Schatzkin E, Shen J , Liu J. Bias in contraceptive provision to young women among private health care providers in Southwest Nigeria. Int Perspect Sex Reprod Health. 2018;44(1):19–29.

Schwandt H, Boulware A, Corey J, Herrera A, Hudler E, Imbabazi C, King I, Linus J, Manzi I, Merritt M, Mezier L, Miller A, Morris H, Musemakweli D, Musekura U, Mutuyimana D, Ntakarutimana C, Patel N, Scanteianu A, Shemeza B-E, Sterling-Donaldson G, Umutoni C, Uwera L, Zeiler M , Feinberg S. Family planning providers and contraceptive users in Rwanda employ strategies to prevent discontinuation. BMC Womens Health. 2021;21:361.

Speizer I S, Guilkey D K, Winston J , Calhoun L M. Does provider bias affect choice of a facility for family planning services by women in urban Senegal? Stud Fam Plann. 2022;53(1):133–51. https://doi.org/10.1111/sifp.12181

Solo J , Festin M. Provider bias in family planning services: a review of its meaning and manifestations. Glob Health Sci Pract. 2019;7(3):371–85.

El Weshahi H M, Galal A F , Sultan E A. Providers’ perspectives of socio-cultural and health service challenges related to postpartum family planning in Alexandria, Egypt. J Egypt Public Health Assoc. 2021;96:1–9. https://doi.org/10.1186/s42506-020-00066-7

Hasselback L, Dicko M, Viadro C, Ndour S, Ndao O , Wesson J. Understanding and addressing contraceptive stockouts to increase family planning access and uptake in Senegal. BMC Health Serv Res. 2017;17:1–8. https://doi.org/10.1186/s12913-017-2316-y

Silumbwe A, Nkole T, Munakampe M N, Milford C, Cordero J P, Kriel Y, Zulu J M , Steyn P S. Community and health systems barriers and enablers to family planning and contraceptive services provision and use in Kabwe District, Zambia. BMC Health Serv Res. 2018;18:390.

Zuniga C, Wollum A, Grindlay K, Douglas-Durham E, Higgins S, Barr-Walker J , Blanchard K. The impacts of contraceptive stock-outs on users, providers, and facilities: a systematic literature review. Glob Public Health. 2022;17(1):83–99. https://doi.org/10.1080/17441692.2020.1850829

Sampson S, Oni F, Ayodeji O, Oluwatola T, Gab-Deedam S, Adenipekun O, Adenipekun A , Atobatele S. Addressing barriers to accessing family planning services using mobile technology intervention among internally displaced persons in Abuja, Nigeria. AJOG Glob Rep. 2023;3(3):100250.

Dotse-Gborgbortsi W, Nilsen K, Ofosu A, Matthews Z, Tejedor-Garavito N, Wright J , Tatem A J. Distance is “a big problem”: a geographic analysis of reported and modelled proximity to maternal health services in Ghana. BMC Pregnancy Childbirth. 2022;22(1):672.

Nwankwo O N O, Ugwu C I, Nwankwo G I, Akpoke M A, Anyigor C, Obi-Nwankwo U, Andrew S Jr, Nwogu K , Spicer N. A qualitative inquiry of rural-urban inequalities in the distribution and retention of healthcare workers in Southern Nigeria. PLoS One. 2022;17(3):e0266159.

Afriyie D O, Nyoni J , Ahmat A. The state of strategic plans for the health workforce in Africa. BMJ Glob Health. 2019;4(Suppl 9):e001115.

Miseda M H, Were S O, Murianki C A, Mutuku M P , Mutwiwa S N. The implication of the shortage of health workforce specialist on universal health coverage in Kenya. Hum Resour Health. 2017;15:1–7.

Williams C R, Britton L E, Bullington B W, Wambua D M, Onyango D O , Tumlinson K. Frequency and impact of long wait times for family planning in public-sector healthcare facilities in Western Kenya. Glob Health Action. 2022;15(1):2128077.

Bang K S, Chae S M, Lee I, Yu J , Kim J. Effects of a community outreach program for maternal health and family planning in Tigray, Ethiopia. Asian Nurs Res (Korean Soc Nurs Sci). 2018;12(3):223–30.

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