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HORN INTERNATIONAL UNIVERSITY AND COLLEGE

COLLEGE OF HEALTH SCIENCES

FACTOR AFFECTING FAMILY PLANNING UTILIZATION AMONG CHILD BEARING

AGE IN KEBRIBEYAH WOREDA OF FAFAN ZONE.

RESEARCH PROPOSAL

June, 2021

NAMES ID/NO

1. SAHRA HUSSEIN HASSAN

2. SIHAM JIBRIL YOUSEPH
3. RAHMO HUSSEIN MOHAMED
4. SABLE SALMONOUS ARGO
5. LAYLA DAYIB OMER
6. FAIZA ADISU
7. YORDANOZ TADAZE YOHANIS
8. ILHAN MOHAMOUD ABDI

ADVISOUR :- MOHAMED ABDI

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FACTOR AFFECTING FAMILY PLANNING UTILIZATION AMONG CHILD BEARING AGE IN

KEBRIBEYAH WOREDA OF FAFAN ZONE,

A Research Paper Submitted to Horn international university and college Facility of Health Sciences
Department BSC nursing.

June, 2021

HORN INTERNATIONAL UNIVERSITY COLLEGE JIGJIGA CAMPUS

ACKNOWLEDGEMENT

First and foremost I would like to acknowledge My university Horn international University College of
health science. My deep gratitude goes to my advisors Ms Fikru Wondu for patience and expertise
guidance offered me throughout the preparation of research proposal. Then I would like to acknowledge
Horn international university jigjiga campus librarians for their patience and respect throughout using
materials for developing this proposal.

ACRONYMS

ADIS Acquired Immune Deficiency Syndrome

ARH Adolescent Reproductive Health

CPR Contraceptive prevalence rate

DHS Demographic Health Survey

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EPHA Ethiopia public Health Association

ESOG Ethiopia society of Obstetrician and Gynaecologists

FP Family Planning

HIV Human Immune Deficiency Virus

HP Health professional

KAP Knowledge Attitude and Practice

MOH Ministry of Health

MC Modern Contraceptive

RHB Regional Health bureau

SRH Sexual and Reproductive Health

STI Sexually Transmitted Infection

STD Sexually Transmitted Disease

UAP Unwanted adolescent pregnancy

UNAIDS United nation program on HIV/AIDS

WHO World Health Organization

Table of Contents

ACRONYMS ………………………………………………………………………….iii

Abstract/Summary……………………………………………………………………….vii

Chapter 1 INTRODUCTION ……………………………………………………………….1

Background of the Study……………………………………………1

1.2 Statement of problem …………………………………………..3

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1.3 Significant of study …………………………………………………….4

Chapter 2. LITERATURE REVIEW ……………………………………………………5

2.1. Education………………………………………………………………………. 5

2.2. Cultures and Religion…………………………………………………….. 6

2.3. Quality of Care………………………………………………………………. 7

2.4. Inter spousal Communication………………………………………… 8

2.5. Knowledge and Information…………………………………………… 9

Chapter 3. OBJECTIVES………………………………………………………………………. 10

Chapter 4. METHODOLOGY………………………………………………………………… 11

4.1 Study Area………………………………………………………………………. 11

4.2 Study period……………………………………………………………………11

4.3 Study design……………………………………………………………………. 12

4.4 Study population…………………………………………………………….. 12

4.5 Sample size determination………………………………………………. 12

4.6 Sample technique…………………………………………………………… 13

4.7 Data collection……………………………………………………………..13

4.8 Quality control………………………………………………………………14

4.9 Variables………………………………………………………………………14

4.10 Data collection instrument…………………………………………14

4.11 Data Collection Technique………………………………………….15

4.12 Data processing and analysis……………………………………..15

4.13 Ethical consideration………………………………………………….15

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. Table of Contents

ACRONYMS ………………………………………………………………………….iii

Abstract/Summary……………………………………………………………………….vii

CHAPTER ONE INTRODUCTION

1.1 Background of the Study

Family planning was adopted in Ethiopia since 1966 by concerned volunteers who established family
guidance association of Ethiopia (FGAE). Ministry of health (MOH) integrated family planning with the
mother & child health (MCH) services during early 1980. In spite of long history & effort the population
increased from 42.6 million in 1984 to 53.5 million in 1994. In any community with low contraceptive
prevalence there is high level of unmet need, which is defined as not using contraceptives despite
expressed demand for limiting or spacing a child. Demographic and health survey Ethiopia revealed
unmet need for modern contraceptives to be 36 % for married women. Traditionally research activities &
services for family planning are focused on women. But unmet need is not the issue confined to married
women only; other subgroups of population such as unmarried women, men, couples, all have unmet
need with varying magnitude. A mix of factors that determine unmet need development are by and large
similar; but the weight each factor contributes for its development is different which entails studying its
magnitude and most important factors. Over the past two decades the goals of official family planning
policies of many countries have shifted from an emphasis on increasing contraceptive prevalence (&
reducing fertility) to satisfying unmet need (and reducing Unintended fertility (1, 2).

Despite surprising technological advancements the world is still challenged by numerous unresolved
problems. Rapid population growth is among the top ranking global problems. But all regions of the
world don’t equally share this fact. Because developed nations could stabilize their population growth at
the replacement level and now enjoying the benefits of the outcome. Recently, there is a debate that
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global fertility rates are falling and population growth rates are diminishing, therefore family planning
programs are no longer needed. Some recent commentators on public policy have sounded an alarm about
a coming population implosion, the so called “birth dearth” implying that population growth is no longer
an important policy concern and public priority. As far as developing countries are concerned, this alarm
is far from reality. The birth dearth discussion may focus selectively on Western and few other highly
developed nations such as Japan. While fertility rates have declined in many nations in the past few
decades, global population growth is projected to continue well in to 22nd century. For most of the
nations’, especially in the Middle East, Africa and South

Asia the major demographic challenge over the next several decades will continue to reducing mortality
and fertility through a combination of economic growth and social sector programs, including those in
education, health and family planning (1).

1.2 Statement of problem

Family planning services rendered are primarily restricted to maternal and child health centre where only
women are invited for service. In addition most researches about fertility and Family planning issue in
developing countries involved only women. The roles of female in making family life decision of
reproductive health life of the family are well emphasis (6).

According to the guidelines for Family Planning service in Ethiopia Family Planning means of promoting
the health of women and families. All individuals’ males and females who can convince or cause
conception regardless of age or marital status are illegible for Family Planning in the country. This
statement ratified that, couples are encouraged to use Family Planning service for mutual benefits (7).

According to the guidelines for Family Planning service in Ethiopia Family Planning means of promoting
the health of women and families. The success of some forms of contraception like coitus interrupts and
periodic abstinences depends on the cooperation of the husband. The role and the responsibility of men
in contraceptive and fertility regulations have been ignored. For many years, family planning program
planners have their attention focused on women’s attitude and behaviours in matter concerning
reproduction. But the effectiveness and continues use remain unsuccessful because of the lack of approval
from their husband (8)

Many studies have also suggested that family planning in many African societies were unsuccessful
because failed to take in account the power relations between couples, and patriarchal nature of the
societies. Many researches, studies and reports suggests male dominance in the culture, women would
be forced to bear large number of children. This reported to be the major obstacle in fertility regulation
decisions by women esp. in Southern community (12).

So this research is also used to study different factor which influences the family planning utilization of
the child bearing age women’s of kebribeyah woreda zone.

1.3 Significant of study

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The result obtained from this research will helpful to create awareness among the concerned bodies.
This study will provided base line information to assist in formulation and designing appropriate
intervention strategy that will be effective to achieve the desire change on utilization of contraceptive data
for further information to kebribeyah woreda. The result of this study will be given useful ground for
government agencies to intervene the practice of reproductive health prevention and the factors hinders it;
Generally, this study will be used as base line information for further studies and it also help any
organizations or individual who want to study on this issue.

CHAPTER TWO LITERATURE REVIEW

It is believed that information education and communication about the importance of modern
contraceptive use play an important role in raising contraceptive prevalence rate. However, different
empirical evidences revealed that having knowledge about modern contraception (MC) alone could not
guarantee utilization of the service. Previous studies have shown that there was a wide gap between
knowledge and use of modern contraception. However, utilization of contraception is evident in most
developing countries especially sub Saharan Africa countries recording the lowest level of contraceptive
prevalence rate (CPR) in the world. Surprisingly, Knowledge about modern contraception is relatively
high when compared with utilization rate (7).

For instance, knowledge about modern contraceptive was around 85 % in Tanzania, 96 % in Kenya and
81 % in Ethiopia, but their CPR was far below 20 %. From the above reality it can be summarized that
modern contraceptive use does not necessarily depend on the knowledge of methods but there are other
additional determinant factors that influence utilization of the service. Among the various determinant
factors indicated by different studies conducted so far, few important factors indicated once will be
reviewed below (8).

2.1. Education

In a study conducted among women of reproductive age group in Zimbabwe by World Bank, modern
contraceptive use and fertility regulation have significant association with increased educational
attainment, although at low level of education (less than 6 years) there was no clear association between
education and use of modern contraception. It was reported among women who have completed primary
school (seven years of education) that the powerful effect of education becomes apparent Similarly
women who have completed secondary school and above were about twice as likely to use modern
contraceptive methods as women who didn’t complete primary schooling (8).

In a study conducted recently in Uganda, modern contraceptive use was independently and positively
associated with formal education .In the study reported that urban areas

women with at least a secondary education had significantly higher odds of contraceptive use than non-
educated women. The effect of education on use was even more striking in rural areas: compared with
women with no education, those with at least some primary schooling had nearly five times the odds of
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contraceptive use and those with secondary schooling or higher had almost ten times the odds of
contraceptive use (9).

A study conducted in Loa (Asia) in 1993 identified significant variation in mean number of pregnancies,
6.2 among women of no schooling, 4.8 pregnancies among 1-7 years, and 3.2 pregnancies among 8 years
or above schooling. Other studies in different parts of the world have also shown a positive linear
relationship between education and modern contraceptive use (10).

In Ethiopia the situation is not exceptional from the above-mentioned facts. A study conducted in
Southern Ethiopia reported broad association of literacy with current and intended use of contraception. A
study conducted in Gondar town showed that there was a positive trend of association in contraceptive
use with increased educational status. The study showed that the relative percentage of contraceptive use
increases from 33.7% to 41%among primary and secondary schooling and 52.5% among higher educated
women. Another study conducted on urban youth in Ethiopia indicated that contraceptive use was 4.9 %
in those with no education, 13.1 % in low education and 82 % among higher education (11).

2.2. Cultures and Religion

The roles of religion and culture as a fertility determinant have been a subject of considerable discussion
in fertility literatures. Every social group has a characteristics culture, complex of belief, attitudes, values
and social controls. The cultural and religious background of a given community has powerful effect on
health seeking behaviour in general and contraceptive use in particular. Globally, the strongest opposing
was from the Catholic Church, which prohibits utilization of artificial contraception in the1930s and
followed by Islamic religion (12).

Throughout Sub Saharan Africa, traditional religious beliefs and practices are embedded in lineage and
descent systems that structure society and sustain high fertility. A study

According to the 2000 demographic and health survey (DHS) Ethiopia report, significantly high
proportion of females reported that in most cases religious leaders oppose the use of MC and ethnicity
and religion were the determinant factors to the use of contraception (12).

2.3. Quality of Care

Quality of care did not become a central concern until elaborated by Bruce and Jain in 1990(19). Since
then quality of care has rightfully emerged as a central concern for FP programs. Situation analysis
conducted in several African countries reported that a small proportion of sites in each of these countries
were serving the bulk of clients while the remaining sites underutilized. The major reason for under
utilization of service capacity was the lack of attention given to systems operating at institutional and
local service sites (9).

In one study conducted in Jimma zone (Ethiopia) in 2003, virtually all components of quality of care
could not be fully achieved by service delivery points. In this particular study the main identified
deficiencies were unavailability of method mix, lack of providers special training, failure to explain about
various methods available, lack of the
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national guideline of FP service and the like. The above facts showed that family planning programs
focused heavily on contraceptive supply and paying insufficient attention to client needs and quality of
care at large (Amha, 2003).

2.4. Inter spousal Communication

Although, inter spousal communication could be considered as a reflection of culture, it can be affected
by the level of knowledge and education status of the couples. Spousal communication is a result of
power asymmetry between men and women, which is usually ascribed by the culture in which they are
living in. However, spousal communication could be improved through planned information, education
and communication (IEC) programs. This was seen in population-based study, which was carried out in
three waves to assess the impact of radio drama serial project in Nepal. Results of the test indicated that
on the baseline study in 1994, use of MC was highest among couples in which the husband made FP
decisions (55%), followed by those FP decision made jointly (47 %), and lowest among women made
decision by themselves 45% (12).

In 1999 the third wave of assessment, showed that those who reported joint decision making had the
highest level of use (66 %), followed by couples in which the wife made FP decisions (60 %) and those in
which the husband made decisions (58%). A study in Bangladesh indicated that there was a significant
association of use with decisions made jointly by husbands and wives (35.6 %) than decision made only
by husbands (17.4 %). In this particular study husband wife communication about family planning
decision-making has net significant effect on current use. Couples who discussed family size matters were
about two times more likely to be current users of contraceptives, than those who didn't discuss family
planning methods among themselves. However

2.5. Knowledge and Information

Having information and knowledge about modern contraceptive methods is mandatory to utilize the
service. In one study conducted in Laos Democratic Republic in 1993 with regard to the fecund period,
only 14 % of the respondents seemed to know that the fecund period is in the middle of the intervals
between menstruations, while 23 % thought that their fecund period occurs immediately after
menstruation and the remaining 58 % had no opinion about when that period occurred (10).

A study conducted in Africa identified that high proportion of women (74.3%) who belonged to various
clubs and associations that discussed health related topics were knowledgeable and contraceptive users,
which indicated that information exchanges through discussion in such organizations increase the desire
to modern contraceptive use (12). 

CHAPTER THREE OBJECTIVES

3.1 General objective

This study is aimed at investigating the factors that contributing for family planning utilization practice of
child bearing age women’s from june to jully 2021

3.2 Specific Objectives

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This study has the following specific objective

• To assess the family planning utilization practice of child bearing age women’s,

• To assess factors that affecting family planning utilization and

• To identify the knowledge interims of availability or shortage of contraceptives utilization.

CHAPTER FOUR METHODOLOGY

4.1 Study Area

Kebribeyah woreda is one of the 12 woredas of the fafan zone of somali Regional State and located
between 7 51’ and 8 48’North latitude and 4035’and 4134’East longitude. It is bordered by
maqaaloqarankabale in the Northwest, ban in the North and Northeast, jigjiga woreda in the South,
borderd by tojwajaale in the West and Southwest. The woreda capital is called Harooris and it is located
30 kms from the zonal capital, The woreda is characterized mainly as flat land with an average altitude
ranges 200masl to 300masl. In other words, the agro-ecological zone of this woreda comprises of low
lands

The total population of the study woreda in the year 2012, as projected from the 2008 Population and
Housing census, is estimated to be 24,271. There are one health stations (clinics), and one health centre in
the woreda owned by government as well as there two pharmarcy. The main problems affecting the health
status of the people in the woreda are: lack of safe and adequate water supply, shortage of health
professionals, shortage of medical supplies and equipment and shortage of health facilities. The following
are the top nine diseases prevalent in the woreda: diarrhoea, pulmonary tuberculosis, respiratory infection,
sexually transmitted diseases, eye diseases, skin diseases and intestinal parasites.

The study were conducted in kebribeyah woreda of Fafan zone, which is found at distance 696 km from
Addis Abeba. Institutional based cross-sectional descriptive study designs were conducted. The data
expected to use in this research is primary and secondary data. Totally one health institution found in t.
The total family planning of the study area up to 2012 was around 68.5%(3).

4.3 Study design

A community based cross sectional descriptive quantitative study will be conduct at kebribeyah
association of fafan zone.

4.4 Study population

4.4.1. Source of population

All wife’s’ whose age is 15-49 year and living in kebribeyah worade who living at area for -----

4.4.2. Study unit

All wives, whose age is 15-49 year

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4.5 Sample size determination

The sample size uses the following formula to calculate.

z 2 p ( 1− p )
¿=
d2

ni= Sample size from finite population.

Z= the standard score (critical value) corresponding to 95% confidence level = 1.96.

d= the proportion of sampling error between the sample and the population = 5% (0.05).

P = we took p value 50% because no p-value available in any literature review

( 1.96 )( 1.96 ) ( 0.5) ( 0.5 )

n= =384
( 0.05 ) ( 0.05 )

As the target population was less than 10,000 (i.e. 4298 total population of the PA with 5 family sizes on
average the wives estimated to be about 460) we need to apply correction formula

n0
Where n =
 n0 
1 + 
 N 
nf = required sample size when target population is < 10,000

N = Population target

Therefore = 384

1+384

460

= 230

Contingency = Sample size + 10%

= 265 X 10%

= 230x10/100

= 23

Approximate to = 280….?

The minimum sample size of our study will be 280

4.6 Sample technique

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There are 19 Peasant associations and two cities in the kebribeyah woreda and as Fafan zone will go to
be included in the study purposively. Study participants will be selected by using simple random
sampling technique method on contraceptive utilization among child bearing age wives and until the
required sample size allocated 280 is fulfilled. Selected study subjects who refuse to participate in the
study will be considered as non-respondent.

4.7 Data collection

Data will be conducted through questionnaires by interview which consist closed and open ended
question in relation to contraceptive utilization and the problem of major adolescent reproductive health.

 4.8 Quality control

Quality of the data also will be controlled through continuous checking the completeness of the
questionnaires. The questionnaire will be transferred to soamli version pre test of the questionnaire will
be given to students who are included study population and supervising by the research member.

4.9 Variables

Dependent variables

 Contraceptive utilization

Independent variable

 Age

 Education

 Family size

 Family monthly income

 Occupations

 Unwanted pregnancy

 Abortion

 Sexual practice

 STI
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4.10 Data collection instrument

A structured questionnaire surveys will adapt to fit with the local situation and the objectives of study and
variables of interest. The questionnaire contains close-ended and open ended question including
information on daily use of contraceptive and practice and relating factors of reproductive health among
child bearing age of Hawa Galan woreda. This questionnaire will be prepared in English and translated to
local language Somali.

4.11 Data Collection Technique

Two enumerators who are nurses are (diploma) *( Five enumerators who are graduate classes (degree))
professional will be conduct the interviews and they will supervise by the researcher. Data will be
collected by interviewer administer technique using structured questionnaire that will be filled by
interviews.

4.12 Data processing and analysis

The responses will systematically tabulated and analyzed using percentages, tables and verbal
explanations separately or together depending on the nature of questions by using computer excel and
calculator for analyzing the data. Finally, the findings of the study will be summarized and discussed
based on the nature of questions.

4.13 Ethical consideration

Official letter from Horn international college of health science will be send to kebribeyah woreda office
before starting the study. The respondents will be informed about the objective of the study by making
clear explanation and discussion according to the issue raised. The respondents also told about their
response are confidential and no need of raising their name. Then respondents will be assessed for their
willing to fill the questionnaires.

 
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6. REFERENCES

1. FMOH, technical and procedural guideline for safe abortion services in Ethiopia, A. AMOH,
2006, page 5-7

2. EPHA, young people HIV/AIDS and reproductive health needs and utilization services, Ethiopia,
A.A US center for CDC, 2005, page 4-9, 17-48

3. Central bureme of statistics (CBS), ministry of health (MOH) and ORC marco (2005). Kenya
demographic and health survey 2005.

4. Eaton, L. Flisher, A.J. &, L.E (2003). Unsafe sexual behavior in south Africa youth social science
& medium. 56, 149-165.

5. Abdella A, Reproductive studies on abortion in Jimma Hospital AA, 1996 EC, 167-170

6. Kwlly, G.F. (2001). Sexuality today; the human perspective (7th ed) New York ny Mc Graw-Hill.

7. USAID, 2006. Report on the Global AIDS Epidemic, Executive Summary, UNAIDS 10th
anniversary special edition.

8. USAID, 2007. AIDS Epidemic Update: December 2007. Joint United Nations Programme on
HIV/AIDS (UNAIDS) and World Health Organization (WHO). Geneva: UNAIDS.

9. USAID, 2008. Report on the global AIDS epidemic. UNAIDS. (also available
http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_Global_report.asp.

10. Kaba m, fertility regulations among women in rural communities around Jimma, western
Ethiopia JOURNAL OF health development Aug2000 14 (2): 117 -125.

11. Akutu,A Health women ,health mother on information guide second edition USSA,” family care
international “, 1998 VOL-2PAGE 164-166 .

12. Gebereselassie T. Determinants of the contraceptive use among urban youth in Ethiopia..
Journal of health development 1996; (10) 97- 104

13. Amha H,Nebreed.F. Emergency contraception potential clients and perspectives Ethiopian
Journal of health science 2006; 16 (1)2-3.
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ANNEX A

Questionnaires

The aim of this questionnaire is assessment of utilization of contraceptive among child bearing age of
wives and reproductive control methods so we are kindly request you to give as appropriate information.

Part one

1.Respondent identification -------------

1.1 Age -----
1.2 Residence
A. Urban B. Rural

1.3 Ethnics group

A. Oromo B. Amharic D. Garaged E. Other specifies ________________

1.4 Religion A. Muslim B. Orthodox C. Catholic D. Protestant E. Other Specify

1.5 Educational status

A. Illiterate B. Read and Write C. 1-6 D. 7-12 E. Above 12

1.6 Occupational Status

A) Farmer B) Merchant C) Government employee E) Other Specify

1.7 monthly incomes.

a) Below 300 birr b) 301-500 birr c) 501-800 birr d) 801-1000 birr e) than1000
1.8 How many children do you have? -------

1.9 what is your desired number of children? ------

Part 2

2.1 Have you ever heard about contraceptive? Yes, -----------no---------

2.1.1 If the answer of Q .no 2.1 is yes. Where do you get the information?
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A) Radio B) Television C) Health profession E) Magazine (News)

D) Friends F) others (specify) ---------

2.2 which contraceptive method do you know?

A) Pills b) Injection C) IUCD D) Condom E) Rhythm /cycle

F) Abstinence G) Other (Specify)

2.3Which benefit of contraceptive do you know?

A) Birth spacing C) Health of child

B) Berth limiting E) Mother health D) other (specify)
2.4 Have you ever belief taking contraceptive methods only by female?
A) Yes ----------B) No-----------

2.5 If the answer of Q no 2.4 is, which type of male contraceptive method do you know?

A) Condom B) Vasectomy C) other (specify)

Part 3
3.1 Males have responsibility to encourage our wives to use contraception.
A) Agree b) disagree d) Neutral

3.2 Male have responsible to prevent unwanted pregnancy.

A) Agree b) disagree d) Neutral

3.3Male should use the common male condom as contraception.

A) Agree b) disagree d) Neutral

3.4 Husbands must support his wives to use modern contraceptives.

A) Agree b) disagree d) Neutral

3.5 If wives have side effect or unable to take any contraception; husbands must take male contraception
even including vasectomy.

A) Agree b) disagree d) Neutral

3.6 Are you currently using any of contraception (specify ) ________________________

PART 4

4.1 who made decision about family size?

A) Husband B) Wife C) both D) Other

4.2 Who made decision about method of contraceptives

A) Husband B) Wife C) both D) Other

4.3 Have you ever used contraceptives?

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A( Yes, b) No
4.3.1 I f the answer of Q No 4.3 is yes what types of contraceptives have used.

A) Condom B) Vasectomy C) with drawl D) Other specifies

4.4 what is your main reason of contraceptive use?

A) child spacing B) Child health C) Child limiting D) Other--------

4.5 Have your partner ever used contraceptive method?

a) YES, b) No,

4.6 if the answer of the Q No 4.5 is yes, which method used?

A) Pills B) Inject able C) Child limiting D) IUD E) Other.

4.7 Did you got unwanted pregnancy? A) Yes B) No

4.8 If yes to Q 4.7 what is your measurement taken_________________

4.9 What is you plan to practice family planning for the future ?_____________________

4.10 What the use of contraceptive in relation to your life style in general
___________________________________

Thank you.