Factors affecting contraceptive use in Eastern Uganda
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It is estimated that globally 222 million women in developing countries would like to delay or stop childbearing but do not use any method of contraception. The main reasons for this disparity include limited choice of methods, limited access to contraception, fear or experience of side effects, cultural or religious opposition, poor quality of available services, and gender based barriers. As a result, 21 million unsafe abortions are carried out every year, mostly in developing countries. This shocking figure causes 47,000 maternal deaths annually. Many of these deaths could be prevented if information on family planning and contraceptives was available and put into practice (Joshua, 2015). Promotion of contraception and ensuring access to contraceptive methods for women and couples is essential to securing the well-being and autonomy of women, while supporting the health and development of communities. Contraception has direct health benefits on maternal and child health such as prevention of unintended pregnancy and subsequent decreased maternal mortality and morbidity. Women with unintended pregnancies that are continued to term are more likely to receive inadequate or delayed prenatal care and have poorer health outcomes than women with planned pregnancies, such as low infant birth weight, and higher infant and maternal mortality and morbidity. In sub-Saharan Africa, 23% of married women are using family planning 18% with a modern method and 5% with a tradi¬tional method. 53% of women of reproductive age have an unmet need for modern contraception largely due to factors such as limited access to contraception, cultural and religious opposition, poor quality of available services, gender based barriers, and spousal disapproval in Africa. In Eastern Africa specifically, the increase in unmet need is associated with socioeconomic variables, the family planning program environment and reproductive behavior models (Shoran et al. 2009). The regional levels range from 10% in West and Central Africa, 24 percent in East Africa, 43 percent in North Africa, and 58 percent in Southern Africa. Uganda was recorded the highest level of unmet need for family planning (FP) of 41 percent in 2006. Uganda is one of the African countries where fertility levels have remained high with a total fertility rate (TFR) of 5.8 Uganda demographic and health survey 2015.National population and housing census provisional results 2014 also indicates that If Uganda’s population maintains the growth rate of 3.03, its population will increase to 46.7 million in the year 2025 with an increase of 11.8 million persons in 11 years. Such population growth can only be curtailed by extensive fertility regulation using contraception. Research so far conducted on fertility regulation shows that although knowledge on contraception is almost universal among Ugandan women, contraceptive use remains very low. Low usage of contraceptives results in short birth intervals and a generally high total fertility level, a situation that may lead to increased dependency ratio, child and maternal fatalities. Fertility control using modern methods such as the Pill, Intrauterine device (IUD), Implants, Injectable, sponge and cervical cap, diaphragm, Condom (male and female) and voluntary sterilization plays a major role in reducing unplanned and unwanted pregnancies. Contraceptive use is one of the proximate determinants of fertility. After postpartum amenorrhea, the risk of falling pregnant increases should the woman become sexually active and not use any form of contraception. The Uganda demographic and health survey (UBOS) and ORC Macro. 2011) indicated that only 32 % of Uganda’s married women aged between 15-49 use modern contraceptives and only 34 % use any method of contraceptives. However researchers have come up with many factors that determine choice of contraceptives method and these include education, number of methods known, source of contraceptives, religion, and place of residence, marital status availability and supply of family planning services in community, attitude towards family planning, and perceived problems associated with modern contraceptives (UBOS and ORC Macro. 2011) and also indicates that knowledge of family planning methods both traditional and modern sources to obtain them seem to be crucial elements in deciding whether to adopt a contraceptive method or not. (UBOS and ORC Macro. 2011) ideal family size is 5.6 and 4.8 respectively among the married women. It is assumed that individuals and couples would act in the same way that they achieve their necessary preferred family sizes if the necessary family planning services are available, accessible and affordable. Bongaarts (1988) calculated that 75% of married women in a society need to be contraceptives users in order to produce a level of fertility that just replaces each generation.