KAMPALA INTERNATIONAL UNIVERSITY WESTERN CAMPUS ISHAKA BUSHENYI

ASSESSMENT OF KNOWLEDGE, ATTITUDES AND PRACTICE OF CONTRACEPTIVE USE AMONG PREGNANT WOMEN

ATTENDING ANTENATAL CLINIC AT COMBONI HOSPITAL KYAMUHUNGA SUBCOUNTY BUSHENYI

DISTRICT.

BY

TUYISENGYE IMMACULATE

BPH /0059/143/DU

SUPERVISOR. PHARMASIST KABANZA ROBERT

A RESEARCH REPORT SUBMITTED TO THE SCHOOL OF PHARMACY IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD

OF BACHELOR DEGREE IN PHARMACY OF KAMPALA

INTERNATIONAL UNIVERSITY

DECEMBER 2018.

1 DECLARATION This Research dissertation is my original work and has not been presented for a Degree or any other academic award in any University or Institution of Learning.

Signature ..~ ...... Date ..... f~! .1.~.1.:?.'?.1.

TUYISENGYE IMMACULATE

BPH/0059/143/DU APPROVAL I confirm that this research dissertation (assessment of knowledge, attitude and practices of pregnant mothers on use of contraceptives) was written by the candidate under my supervision.

Signature.. ~ •...... ~ ... Date ....lr:{ ..l.?:-: . \ . ~ . ~·· ·· · ··· ·

:MR.KABANZA ROBERT

(SUPERVISOR).

ii . LIST OF ABRREVIATIONS

TFR Total Fertility Rate

MDGs Millennium Development Goals

WHO World Health Organization

MMR Maternal Mortality Ratio

CPR Contraceptive Prevalence Rate

FP Family Planning

ANC Antenatal care

IUD Intra Uterine Device

UNEST Uganda Newborn study

PNFP Private Not for Profit

SSA Sub Salwran Africa

lMR Infant Mortality Rate

PNC Post Natal Care TABLE OF CONTENT DECLARATION ...... i APPROVAL ...... ii LIST OF ABRREVIATIONS ...... iii LIST OF TABLES ...... vii LIST OF FIGURES ...... viii ABSTRACT ...... ix

CHAPTER ONE ...... 1 INTRODUCTION...... 1 1.0 Introduction ...... 1 1.2 Problem Statement...... 4 1.3 Purpose of the study ...... 5 1.4 Objectives of the study ...... 5 1.5 Research questions ...... 5

1.6 Scope of the stt~dy ...... 5 1.6.1 Geographical scope ...... : ...... 5

1.6.2 Content scope ...... 5 1.6.3 Time Scope: ...... 6 1. 7 Si!,'llificance of the Study ...... 6 1.8 Conceptual frame work ...... 7 CHAPTER T\VO: ...... 8

REVIEW OF REU.~D LlTERA"'."1.lRE .... , ...... 8 2.0 Introduction ...... 8 2.1 Knowledge on.the use of contraceptives ...... 8 2.2 Attitudes ou the use of contraceptives ...... 9 2.3 Practices on the use of contraceptives ...... 11 CHAPTER THREE ...... 12 METHODOLOGY ...... 12 3.0 Introduction ...... : ...... 12 3.1 Studycesign ...... 12 3.2 Study setting...... 12 3.4 Sample size determination...... 13 : ·' . ' iv 3.5 Sampling procedure ...... 13 3.6 Selection criteria ...... 14 3.6.1 Inclusion criteria ...... 14 3.6.2 Exclusion criteria ...... 14 3.7 Research Instruments ...... 14 3.8 Data collection procedure ...... 14 3.9 Data analysis ...... 15 3.10 Data presentation ...... 15 3.11 Quality control techniques ...... 15 3.11.1 Reliability ...... 15 3.11.2 Validity...... 15 3.12Ethical consideration ...... 16 3.13 Anticipated study limitations/delimitations ...... 16 CHAPTER FOUR: DATA PRESENTATION ...... 17 4.1 Introduction ...... 17 4.2 Socio-demographic findings ...... 17 4.3 Knowledge of pregnant mothers on use of contraceptives ...... 18 4.3.1 Awareness on birth control or coutraceptive ...... 18 4.3.2 Method of family planning or contraception ...... : ...... 18 4.3.3 The method of family planning /contraception that can be used after delivery because it does not interfere with the process of breast feeding ...... 19 4.3.4 Places/information of accessing family planning services/contraception ...... 19 4.3.5 Knowledge on birth control/contraceptives b3sed on socio demographic factors ...... 20 4.4 Women's attitude towards contraceptives use ...... 21 4.4.1 Birth control/contraception delay the pregnancy ...... 21 4.4.1 Attitude toward birth control ...... 22 4.4.2 Using birth control/contraception after birth ...... 22 4.4.3 Opinion on ben":fi!s of birth control/contraception ...... 23

4.4.4 Supporting family and friends t~ ure bi:th contrc!lcontraception ...... 24

4.4.5 Attitude based on ~ociD dem0graphic factors ...... 24

4.5 Practices on the usc of cont,r.~eptives ...... ,; ...... ; •...... 26 4.5.1 Using birth control methods ...... •...... 26

v 4.5.2 Reasons to use birth control/contraceptives ...... 26 4.5.3 Factors supporting the choice ofbirth control/contraception ...... 27 4.5.4 Practices on use birth controls based on socio demographic factors ...... 27 CHAPTER FIVE...... 29 DISCUSSION OF RESULTS, CONCLUSION AND RECO:MMENDATIONS ...... 29 5.0 Introduction ...... 29 5.1 Discussion of results ...... 29 The use of family planning was largely associated with the socioeconomic reasons leaving out the health concern to the mother exposed to too many and very closes pregnancies ...... 31 The attitude towards family planning uptake is greatly associated with religion, education level, number of children one has, marital status and type of work of the respondents ...... 31 Despite the fact that the responded knew that family planning use is beneficial 91.4%, the use of contraceptives was still low at 52.9% ...... 31 Although the respondents had knowledge about family planning, there was information deficit about some family planning methods ...... 31 5.3 Recommendations ...... 31 APPENDIX II: RESEARCH QUESTIONAIRE SHEET ...... 37 APPENDIX V: PROPOSED BUDGET ...... 44 APPENDIX VI: TIME FRAME ...... 45

vi LIST OF TABLES Table I: table illustrating places/information of accessing family planning services ...... 20 Table 2: Bivariate analysis showing knowledge of birth control based socio demographic factors ...... 20 Table 3: Table showing attitude toward birth control ...... 22 Table 4: Table showing attitude based on socio demographic factors ...... 25 Table 5: table reasons to use birth control/contraceptives ...... 26 Table 6: Table showing Practices on use birth controls based on socio demographic factors ...... 28

vii LIST OF FIGURES Figure 1: Table illustrating Socia demographic factors ...... 17 Figure 2: Table illustrating method of family or contraception ...... 18 Figure 3: A graph Methods of family planning that can be used after delivery because it does not interfere with the process of breast feeding ...... 19 Figure 4: A graph illustrating Birth control/contraception delay the pregnancy...... 21 Figure 5: Table showing respondents who wanted to use birth control/contraception ...... 23 Figure 6: A graph showing how birth control/contraception ...... 23 Figure 7: A graph illustrating respondents who Support family and friends to use birth control/contraception ...... 24 Figure 8: A graph showing usage birth control methods ...... 26 Figure 9: tables illustrating factors supporting the choice of birth control/contraception ...... 27

viii ABSTRACT

Background: too many people (250 million) don't have the mea..'1S to control their fertility and it was argued that doubling that modest investment in FP and maternal child health progrmes would result in a 70% reduction in maternal deaths and a 44% reduction in the deaths of newborns with additional health, societal and economic benefits. In Uganda there was a high unmet need for FP services of 41%. This study was ain1ed at assessing lmowledge, attitude and practices on use of contraceptives among pregnant mothers attending antenatal care services.

Methodology: This study design used was a cross-sectional study from April to July 2018 was carried out at Comboni Hospital in the antenatal clinic. The study population consisted of pregnant women attending antenatal care services and a sample size of 70 participates was purposely considered. A structured questionnaire was used to collect data and entered in SPSS version 25.0. Analyzed and presented in form tables and graphs.

Results: Majority 26(37.1 %) didn't complete primary level, majority 28(40.0%) were protestant, a greater number 38(54.3%) were farmers, and 63(90.0%) were married. Majority 69(98.6%) had ever heard of birth controls or contraceptives and only 1(1.4%) had never heard ofbirth control or contraceptive. majority 46 (65.7%) perceived birth controls as necessary when delaying or tern1inating pregnancy and LlJ.e least 3(4.3%) were tmdecided. majority 37(52.9%) had ever used birth control methods and 33(47.1 %) had never used birth control methods

Conclusion, a high percentage of 98.6% had ever heard of birt.lj_ controls or contraceptives and lmowledge of contraceptives was seen as an essential factor associated with effective use of these methods. The co!lh-nonest methods of family planning used were injections and pills. 67.1% had ever accessed family planning services from Health Centre and 65.7% got the information from radios. Finding information about birth controls a.'1d get family planning services were not found difficult. Birth controls were found to be necessary when delaying or tem1inating pregnancy and 71.4% of the respondents suggested talking health workers about selection methods of birth control. It was found that use bicth control/contraception are beneficial as supported by 91.4% of women. Edw::at!ou level, marital s~2~s, Catholics,.Protestants and Private employees were seen to mfect attitl•de t-:w?rds l:Se C f blr:~ c:n~tmlicontrc.ception that is .women with higher levels of education were mere !ik~1 y to use birth cc1:trob, the divorced were more likely use birth controls.

ix CHAPTER ONE

INTRODUCTION

1.0 Introduction Access to family planning services and contraception is critical with the world population currently at seven billion inhabitants. Unfortunately, too many people (250 million) don't have the means to control their fertility (UNFP A, 2011 ). The health of women is closely related to their reproductive

role. Pregnanci~s which are either too early, too close, too many or too late, expose mothers to high morbidity and mortality during pregnancy and childbirth (Gebremedhin, 2002). Child survival is also influenced by mother's parity, birth interval, and birth order in addition to duration of breastfeeding (Sebastian. M.P, 2010; World Health Organization (WHO), 2011). Among adolescents and young adults, the major health problems relating to pregnancy include, complications related to abortions and childbirth and among others. Delivery of effective family planning (FP) services is therefore fund!!r.J.ental and cost effective in ensuring a healthy and productive population.

Fan1ily planning services are defined as educational, comprehensive medical or social activities which enable individuals, including minors to determine freely the munber and spacing and tlil'ing of their children, and to select the means by which this may be achieved (WHO, 2011 ). Such means include use of contraceptives and the treatment of involuntary infertility. Modern contraceptive methods include all hormonal methods (i.e., the pill, injectables and implants), btrauterine devices (IUD), male and female sterilization, condoms and modern vaginal methods (e.g., the diaphragm and spermicides) (Asma & Balala, 2009)

Worldwide-225 million women in developing countries have an unmetneed for FP (WH0-2016) resulting in 80 miHioa unintended pregnanCies due to low use ofFP (Bwazi et al., 2014).

SSA-30% ofWW-unintended pregnancies due to unmet need ofFP at 40% (Bwazi et al., 2014) leading to ncreased risk o.funsate ahorti~ns ancl maternal death (Hounton et al., 2015).

In Uganda, 62/1000 t!llSafe a!Jortbns due to low use ofFP (25%) (USAID & MCHIP, 2015).

1 A woman's ability to space and limit her pregnancies has a direct impact on her health and well­ being as well as on the outcome of each pregnancy (WHO, 2011). Adding It Up, a joint Guttmacher/UNFP A report (2009), they argued that doubling that modest investment in FP and maternal child health programmes would result in a 70% reduction in maternal deaths and a 44% reduction in the deaths ·of newborns with additional health, societal and economic benefits (Susheela $ Singh 2009). They further posit that providing women with family planning information and services frees up scarce resources that could be used to provide universal access to maternal and newborn ca:e. In addition, 50% of all maternal mortality in the developing world could be addressed through FP services (Winikoff. B, 1987).

Sub-Saharan Africa has an average Total Fertility Rate (TFR) of 5.1, the highest average in the world; which is twice that of South Asia (2.8) (World Bank, 2009). The average contraceptive prevalence rate (CPR) of22% is half of South Asia (53%) due to low acceptance and high cultural resistance to FP. Consequently, the maternal mortality ratio of 500/100,000 live births is high and most SSA countries are not on track to achieve Millennium Development Goals (MDGs) (WHO, 2012).

In Uganda, the maternal mortality ratio (MMR) has barely reduced in the past decade; currently at 438/100,000 live births. The total fertility rate (TFR) of 6.2 has resulted in a population growth rate of3.2%, the fastest in Africa and the third highest in the world. The contraceptive prevalence rate (CPR) among married women, which has recently improved from 24% to 30% (UDHS, 2011), is still unfortunately low. Uganda also has a high umnet need for FP services of 41% (UDHS, 2011, 2006; Shane$ Khan, 2008).

Antenatal care service is an important goal concerning the health status of the pregnant women during their reproductive pericd and its health benefits accounting for nearly one quarter of all pregnancies worldwide. (Lincetto, Mothebesoa.t1e-anoh, Gomez and l\1unjanja, 2013). Through the antenatal C!Jie service attempts have been made to identify pregnant women not at risk and those at risk group based on their previous pregna.'lt or currently historical or clinical factors and steps are planned to prevent it in this allegedly high- risk group of women to reduce adverse pregnancy outcomes (Lincetto eta!., 2013) Unfortunately, adverse pregnancy outcomes can occur even in women without identifiable risk factors. Numerically, more pregnant women without risk factors

2 have seen to end up with serious adverse outcome compared to those with risk factors during the attendance of antenatal care service (Dowswell et al., 2013) In order to·prevent pregnancy adverse outcomes worldwide, interventions should therefore be targeted for all pregnant women attending antenatal care. The need of implementing knowledge, attitude and practice of ANC intervention in pregnant women has showed that as a package comprising the following interlocking system i.e. interventions, early screening, administration of a preventive prophylactic therapy and cure of the various detected risk conditions are effective on the basis of reduced maternal complications (Hajela, S. 2014)

Additionally, antenatal care service is not a single intervention; instead, it represents a series of

assessments and interventions over ti.'Uo;) thP.t is not uniformly applied effectively by different health care provider3 found in developing countries (Kavanagh et al., 2012) Not only is the "quantity" of antenatal care service relatively difficult to measure through the required timing and number of visits adjusted for gestational age at delivery but also the quality and the effectiveness of individual components on outcome. (Tekelab $ Berhanu, 2014). However, the major gpal of antenatal care service is to ensure the birth of a healthy baby with minimal risks for the mother.

Despite high ANC attendance in Tanzania, only 14% of pregnant women start ANC during the first trimester as per the national guidelines. The median number of months that women are pregnant at their first visit is 5.4 months. One LlJ.ird of women do not seek ANC until their sixth month or later (Te~{elab $ Ber!Jmu, 201~) However, early booking has an advantage for proper pregila.."lcy inform:>,tron sharing and pregnancy monitoring. Everyday approximated 800 women worldwide die due to pregnancy r.r.d pregnancy delivery complications and most of these deaths occur in poor resource countries (Mwaikambo, 201 0).

Tanzania is one of the ten cmmtries contributing to 61% and 66% of the global total of maternal and newborn deaths, respectively ("CCBRT Strategy-Changing Lives, Changing Co=unities., 2013). In Tenzania, tl:le estimated annual number of maternal deat.lJ.s is 13,000, the estimate for under-fives is 157,000, and newborn deaths are estimated at 45,000 (Mwaikambo, 2010).

'' Contraception, defined as methods or devices used to prevent pregnancy, is categorized into two types: modem and traditional methods. Modem methods include clinic and supply methods such as the pill, intrauterine device (IUD), condom, and sterilization whereas traditional methods include periodic abstinence (rhythm), withdrawal, and folk methods Women in the Uganda were asked if they were using anything to delay or stop child bearing altogether and those who were currently u5ing modem or traditional methods were regarded as current contraceptive users.

1.2 Problem Statement Family planning is fundamental in the effort to reduce the Total Fertility Rate and the consequential maternal mortality aud morbidit'J as well as contributing to improvement i11 infant welfare.

The Health Directorate has opened more health units to improve on access ofhealth services; more than 70% of the population is within 5 km distance from health unit. All levels of health facility should be able to provide family plauning services. Sensitization of the community on use and importance of family planning has been ongoing for the last two years by community health workers under the Uganda Newborn Study (UNEST). However, the extent ofFP service provision or missed opportunities is not clear.

Contraceptive use in Uganda still remains low despite the increase from 15.4% in 1995 to 18.6% in 2000/01 and 24.4% in 2006. The increase ill contraceptive use accelerated in the five years prior to the 2006 DHS than in th-e 1990s due to improvements in economic growth, literacy, and education. The increase in contraceptive use may have been influenced by complex interactions between micro !evd factors such as age aud education as well as macro level factors such as urbanization and improvements in health service delivery.

In Uganda, the risk of unintended pregnancies and unsafe abortions remains high due to relatively low contraceptive use. There is paucity of data on knowledge, attitudes and practices towards modem contraceptives and sexual aud reproductive health especially among pregnant women.

Uptake of contraceptive services conti...'lu:::s to remain low, with only 26% of married women curren~ly using fau1ily plaP.ning methods. Although, there have been met.l:tod specific increases in the use of short term m~thocl.s, uptake of lon~~ te1m 2nd permanent methods remains low over the

4 years for instance, while the uptake of contraceptive pills increased from 2.6% in 2006 to 2.9% in 2011 and injectable from 7.7% in 2006 to 14.1% in 2011; the uptake of intra uterine devices increased slightly from 1.7% in 2006 to 2.9% in 2011. Awareness of specific family planning methods also follows a similar trend, with high knowledge reported for short but not long term methods.

This study will therefore assess the knowledge, attitudes and practice of contraceptive use among woman attending antenatal clinic at Comboni Hospital, Bushenyi District.

1.3 Purpose of the study To assess knowledge, attitude and practices on use of contraceptives among pregnant mothers attending antenatal care services

1.4 Objectives of the study

1. To assess knowledge of pregnant mothers on use of contraceptives.

11. To examine women's' attitude towards. contraceptives use. iii. To assess practices on the use of contraceptives by women attending antenatal care at Itojo district hospital.

1.5 Research questions i. Are pregnant mothers knowledgeable about use of contraceptives?

11. What are the attitudes and perception of pregnant mothers towards use of contraceptives? m. What are the contraceptive methods used by of pregnant mothers?

1.6 Scope of the study

1.6.1 Geographical SCOJ:le

The study \7as Ci:fr;ed o;.•t at Co:nb:J:ll hospit~ in Bushenyi district in westem Uganda.

1.6.2 Content scope Factors to be considered are knowledge, attitude and practices on use of contraceptives

5 1.6.3 Time Scope: The research was done from September to October 2018.

1.7 Significance o( the Study ' . At national level;

To tailor programs such as mass media messages to help accelerate the use of contraceptives in the country in general.

District level;

To improve supervision of health service delivery especially Antenatal care and to organize refresher courses for district health workers on how to advise mothers on use of contraceptives.

Hospital level;

To recognize limitations of mothers a11d gaps in use of contraceptives in hospital which will enable them to directly appropriate health information to mothers right from .Antenatal clinics (ANC), support mothers and supervise thermal provision to ensure continuity of care .

Community level;

The knowledge base of mothers and community will improve a.'ld this will empower them to change unhealthy attitudes and embrace practices recommended for use of contraceptives thus contributing to reduction of neonatal mmiality rate.

Medical research

Knowledge. enrichment and referred paper for comparison of data obtai.ned elsewhere in Uganda.

6 1.8 Conceptual frame work Independent variable (IV) Dependent variable (DV)

Knowledge of women on contraceptive use.

Women's attitudes towards Effective contraceptive use. contraceptive use.

Practices of contraception done by the women.

Intervening variable • Social economic status of pregnant mothers • Spouse options . - CHAPTER TWO:

REVIEW OF RELATED LITERATURE

2.0 Introduction. This chapter reviewed literature in accordance to the study objectives

2.1 Knowledge on the use of contraceptives Individual knowledge about contraceptive methods is closely linked to the use of the methods (Mbonye, 2003; Agyeli, 1995). Knowledge of family planning methods was found to be universal in Uganda, with over 90% of women in the reproductive age group having heard of at least 1 method of contraceptives (UDHS 2006) (Nattabi, 2011). The attitudes towards contraceptive use were favorable. However, the level of contraceptive use was found low in comparison with knowledge and attitudes. There is thus a need to assess the barriers to higher contraceptive uptake in Uganda, since knowledge of family planning methods is very high

According to studies conducted in Uganda, post-primary education and urban residence were strong predictors of knowledge and favorable attitudes towards FP services. The presence of the spouse in the househ9ld ~d discussion offa1ui!y planning with spouse were also found to strongly influe1:ce contraceptiYc us;:. How·~ver child mortality did not have :my impact on uptake of FP services (Nattabi, 2011; (Agyei, 1Y95).

The wealthy were found to have more knowledge about FP methods and with a higher Contraceptive Prevalence Rate (CPR) compared to the poorest; consequently the richest had a Total Fertility Rate (TFR) of4.3 far less compared to the poorest of8.0 (Agyei 1995; UDHS 2006).

Knowledge, acceptance and use of contraceptives; The actual use. of contraceptives at the household level depends besides on the availability of accessible FP services in the local environment, on the knowledge people have on FP measures, and their attitudes towards (accepta11ce of) these services (Emens, 2008; Pebley & Brackett 1982; Malnnood & Ringheim 1996). A lack of knowledge of fP sou!·ces and methods is often cited as a key variable in deterrn'ini.ng contrrice;:tive· use (Bo~gr.<>its & Bruce, 1995; Caster!ir.e & Sindlng, 2000; Korra, -·.

8 2002). It is expected that the more people know about and accept modem contraceptives, the more they will use them

Knowledge of contraceptives is considered one of the essential factors associated with effective use of these methods. (Biney, 2011) observed that lack of knowledge about contraceptives among Ghanaian women led to failure of contraceptive use which in turn led to unintended pregnancies and induceq abortions. Similarly, Lindstrom & Hemandez (2006) found that limited knowledge of contraceptive methods among recent rural-urban migrants in Guatemala was associated with unmet need and limited choice of contraceptives. Knowledge about contraceptives and their side effects may affect their actual use also indirectly, through its effect on the attitudes people have regarding contraceptive use (Easterlin & Crimmins 1985; Chipeta eta!., 2010; Fikree eta!. 2001; Smith, 2002).

2.2 Attitudes on the use of contraceptives Nigerian women with positive attitudes towards contraception (i.e. those who approved FP and those who discouraged early marriages) were found to use contraceptives more than other women (Odimegwu, 1999). Zabin et.al,. (1993) fu..rther showed in their study on the relationship between attitude and behavior among adolescents in Baltimore that positive attitudes towards contraception had a significant effect on contraceptive use.

Davidson and Jaccard (1979} also provide evidence that married women's attitudes towards birth control are positively correlated to tl1eir actual use and author's reference found dishict-level use of contraceptives to be positively affected by knowledge and acceptance of contJ·aceptives in Afiican countries. Information campaigns There is evidence that FP messages through media may play an important role in increasing the knowledge ofFP methods and through this increased knowledge also their acceptance and use, especially in those areas where the literacy level is low (Easterlin & Crimmins, 1985; Saluja eta!., 2011; Fikree eta!., 2001).

Several empirical studies have shown that mass media campaigns may lead to behavioural changes and in this way reduce fertility (Olaleye & Bankole, 1994; Jato eta!., 1999; Agha & Van Rossem,

2002; De.s Gup~a ~(a!., 2.003, Jnbn & Kabir, 2000; Cheng 2011, Rabbi, 2012). For example, in Bangladesh, mass media exposure was found to b.e a significant differential offertility, even after controlling foc- the effects of contraception and socio-economic status (Rabbi, 2012). Cheng (2011)

9 established that in Taiwan mass media and social networks played important roles in disseminating contraceptive knowledge and that women transformed this knowledge into behaviour - that is, contraceptive knowledge reduced fertility. Another study in Pakistan showed that people who had exposure to condom advertisements on radio or TV experienced increases in the following areas: perceived availability of contraceptives, discussion of FP, approval of FP, and procurement of contraceptives (Agha & Meekers, 201 0).

Control factors; besides the variables of interest, our model contain two control factors that are known or expected to influence wealth accumulation, fertility changes and use and knowledge of FP services. The first control factor is education. Education provides people with the knowledge and skills they need to live better lives. One extra year of schooling may increase an individual's earnings by up to 10%. Education of women is one of the key factors driving fertility reduction. Women wit.'t higher levels of education are more likely to delay and space their pregnancies and to seek health care and support (UNESCO, 2011 ). Education influences women's reproduction by increasing their knowledge of fertility, by ir..creasing their socio-economic status, and by changing their attitudes towards fertilityccntrol (Castro & Juarez, 1994). Educo:tion is also closely linked to the use of contraceptives: more educated women are more likely to use FP (Kasarda et al., 1986, Robey et al., 1992, Saleem & Bobak, 2005; Ainsworth et al., 1996; Rutenburg et a!., 1991). A major pathway by which education influences women's contraceptive use is through increasing their level of knowledge (Hemmings et al., 2008). Besides individual education, also the educational level of the context in which one lives is important (Kravdal, 2002).

There is evidence for African cow1tries that access to education is an important determinant of wealth acctimulation, with wealthy households being concentrated in areas where over half of heads received formal educPtion (Burke eta/., 2007; Burger eta/., 2006). The education level of other people in the connunity .may play a.role through social learning and other indirect effects (Bongaarts & Watkins, 1996; Kobler et al., 2001; ,Montgomery & Casterline, 1996). Another, closely related, characteristic of the context that may play a role is its h;:vel ofurbanization. Women living in rural areas tend to use fewer contraceptives and have more children than their urban coW1terparts .(Rutstein, 2005; Conde-Agudelo & Balizan, 2006). In the 1990s, urban fertility in

Sub-Sall:rran Af~<'fl._''!as on av~:;:age

10 fertility rates in rural areas, whereas fertility in the cities has decreased considerably (Tadesse & Headey, 2012). A major reason might be that the costs of children are higher in more developed and urban areas than in rural areas (Smith & Gozj olko, 201 0).

2.3 Practices on the use of contraceptives Contraceptive prevalence rate among married women by any method has barely improved from 19% in 1995, 24.4% in 2006, to 30% in 2011. The use of modern methods has slowed somewhat, while use of traditional methods declined between 1995 and 2000. Injectable contraceptives are the commonly used method among married women because they are long lasting, convenient to them, and can be used without the knowledge of the male partners who may not agree to family planning use (ministry of health, 2000). The contraceptive mix changes with the sexually active unmarried women; with condom use being the highest at 27% followed with injectables at 13% (Shane, 2008).

11 CHAPTER THREE

METHODOLOGY

3.0 Introduction This chapter presents the research methodology which as the detailed procedure of the study. The chapter comprises of the following sections: study design, study setting, study population, selection criteria, sample size determination, sampling technique, study valiables, data collection techniques and instruments, data management, and data analysis. Quality control techniques and ethical considerations of the study are discussed in this chapter as well.

3.1 Study design This study was conducted through a cross-sectional study design from April to July 2018. In medical research and social science, a cross sectional study is a type of study that analyses data collected from a population, or a representative subject, at a specific time that is cross-sectional data (Schmidt, et al2008). The study design was used to examine pregnant mothers' knowledge, attitude and practices towards contraceptive use.

3.2 Study setting The study was carried out at Comboni Hospital in the antenatal clinic .. It is a Private Not For Profit hospital located in Ryabagoma village Kyamuhunga Catholic Parish in Kyanmhunga Sub county, Igara West Constituency Bushenyi District. It is a Roman Catholic Church based institution in Mbarara Archdiocese.

The hospital was gazette in May 1996 with a capacity of 100 beds. With a maternity department, surgical ward, general medical ward, temporary operation theater and some stuff houses.

The hospital is owned by the Registered Trustees ofMbarara Archdiocese. The Archdiocese is the entity that holds the legal titles of ownership.

The hcspitd provides s~rvi<::e3 ill f.:lfilhner::~ of t.'te IT'ission of the Reman Catholic Health services in Uganda, as approved by t.l:te Episcopal Conference on 24/06/1999.

12 3.3 Study Population

The study population consisted of pregnant women attending antenatal care services which are 450 and according to records department in Comboni hospital

3.4 Sampll" size determination. But given a limited period and funds, a sample size of 80 participates will be purposely considered.

This was determined using solves fonnulae of sample size determination

n= N

1+ N (e) 2 n = 120

1 +120(0.05)2 n = 120/1 + 120*0.0025 n = 120/ 1.3 n = 90

3.5 Sampling procedure Simple random sampling method was used for quantitative data collection. To reduce bias the number of mothers present in the clinic was elicited, equal numbers of papers assigned "yes" and "no" will be folded, then mixed in the box and each mother will be given a chance to pick one. Those who will randomly pick "yes" was given questionnaires to fill. A patient who picks "no" was not be an eligible participant .md when t'le sample size is not realized, this was replaced by another round of picking assi ~ned "yen" or "!10" by those who were not selected in the first round.

13 3.6 Selection criteria

3.6.1 Inclusion criteria The study included all mothers Attending antenatal care services at Comboni hospital and willing to consent to the study.

3.6.2 Exclusion criteria Mothers who were very sick, mentally ill or challenged and the deaf will be excluded from the study.

3.7 Research Instruments A structured questionnaire was used as a tool for gathering information. The structured questionnaire is preferred in t.'lls study because a lot of information can be collected over a short period oftime. The structured questionnaire will be divided into four sections:

The first section was used to collect data about socio-demographic profile, that is to say, age, religion, occupation, and others. The second section explored knowledge of mothers on Contraceptive use and third section explored attitude towards Contraceptive use. The fourth section assessed practices of mothers towards contraceptive use.

3.8 Data collection procedure After the sampling process was completed, the researcher interviewed mothers at Antenatal clinic. The researcher introduced herself to the prospective participant and read to the individual participant the consent form that has details about the title and pwpose of the study as well as the rights of the participant. Whenever a participant agreed to be interviewed he/she was asked to provide written consent by signing or thumb printing. If they refused to pmiicipate the interview would not proceed.

After obt:linin::l ,t,.~e wri~en consent,. the investigator entered the questionnaire serial number and date of interview ~nd rroceeded frGf..l t.hc t!rst up to the last question using a language understood by the participant. The inve~tigator entered responses given by t.~e participant by ticking the appropriate response and entering the same number in to the coding box. This was done to ensure data quality a:: the response number ticked is supposed to be the same as the one entered in the

14 coding box. The researcher reviewed the questionnaires to ensure they are being completed correctly and any errors corrected to avoid being repeated. The process of data collection continueed m1til every effort to contact every study participant in the sample has been exhausted.

3.9 Data analysis Quantitative data was collected using a structured questionnaire. Completed questionnaires were checked for accuracy, for any missing data and completeness after data collection at the end of the day. This was followed by coding and entry of the data using Epi info 3.4.1 software for Windows and double entry into SPSS version 20.0 software for analysis.

3.10 Data presentation

Data was analyzed by descriptive ~tatistics using Statistical Package for Social Scientists (SPSS) version 20.0 software and presented in frequency tables, pie charts and bar graphs.

3.11Quality control techniques

3.11.1 Reliability The questionnaires was administered by two trained research assistants with minimum qualification of certificate in nw·sing, who worked Wlder close supervision of the principle researcher. The research assistants were trained on skills of patient engagement and interviewing techniques, obtaining cooperation to avoid i.TJfluencing outcomes of t.lJ.e study. Both closed and open ended questions were used. Thus, if the same questions are administered to the same study participant at different times, the chances are very high that one would get the same or a similar response. Therefore, introduction of bias was reduced.

3.11.2 Validity Questionnaire pretesting was done in Krunpala international university Teaching Hospital, since it has the same characteristics with the area of study. The questionnaires were then revised and content adjustments made accordingly. After data collection, questionnaires were checked, for completeness, clarity, consistency and uniformity by the principle investigator.

15 3.12Ethical consideration A letter of introduction was obtained from Kampala International University Western Campus School of Pharmacy to permit the researcher to carry out the research. Pennission was obtained from Comboni Hospital In charge. All participating mothers were selected on the basis of informed consent. The study was on voluntary basis and information was kept private and confidential. Participants' anonymity was kept. The study was conducted while upholding the professional code of conduct in a manner that was not compromise the scientific inclinations of the research.

3.13 Anticipated study limitations/delimitations It may be hard to obtain audience from the mothers, this was however be overcome by creating rapport and administering a questimmaire before they obtain treatment. There is anticipated problem of language barrier. A research assistant however will help to interpret whenever necessary.. CHAPTER FOUR: DATA PRESENTATION

4.1 Introduction

This chapter presents the study findings in line with the objectives.

4.2 Socio-demographic findings From the table below, majority 26(37.1 %) didn't complete primruy level, majority 28(40.0%) were protestru1t, a greater number 38(54.3%) were farmers, 3lld 63(90.0%) were married.

Figure I: Table illustrating Socia demographic factors Variable Frequency Percent Educational level of the respondent Did not complete primary level 26 37.1 Completed Primary Level 21 30.0 Completed secondary Level 19 27.1 Completed a Tertiary institution level 4 5.7 Religion .of the respondent Moslem 3 4.3 Protestru1t 28 40.0 Seventh Day Adventist 1 1.4 Others 8 11.4 Work type Housewife 19 27.1 Farmer 38 54.3 Private employee 10 14.3 Others 3 4.3 marital status of rc&porrdent Not Married 4 5.7 Married . 63 90.0 Divorced 3 4.3

17 4.3 Knowledge of pregnant mothers on use of contraceptives

4.3.1 Awareness on birth control or contraceptive

From table below, majority 69(98.6%) had ever heard of birth controls or contraceptives and only 1(1.4%) had never heard of birth control or contraceptive.

• YES • NO

FREQUENCY PERCENT

4.3.2 Method of family planning or contraception

From the table below, the commonest methods of family planning used were injections 41 (58.6%) and pills 19(27.1 %).

Figure 2: Table illustrating method offamily or contraception

Methods of family planning or contraceptives you know Frequency Percent

Condoms 7 10 Pills 19 27.1 Injections 41 58.6 Diaphragm lnplant 1 1.4 IUD 2 2.9 Total 70 100

18 4.3.3 The method of family planning /contraception that can be used after delivery because it does not interfere with the process of breast feeding

From the table below, majority 32(45.7%) said injections can be used after delivery because it does not interfere with the process of breast feeding, 26(3 7.1%) said they can be used after delivery because it does not interfere with the process ofbreast feeding, and the least 2(2.9%) said lactation amenorrhea can be used after delivery because it does not interfere with the process of breast feeding.

Figure 3: A graph Methods offamily planning that can be used after delivery because it does not inteJfere with the process ofbreast feeding

0 Percent 0 Frequency

Do not know ~

~ ~ ~,--~ ~= ~=~- 3 Implant 26 I -

10 Pill 7 1

~ ___:-.:::::...._ - - ~~-- --~;:.,;;;; ,=--~~: 45.7 _I injection J ------

--- -~ Lactation amenorrhea EP 0 10 20 30 40 50

4.3.4 Places/information of accessing family planning services/contraception

From the table below, majority 47(67.1%) said they access family planning services from Health Centre and the least 1(1.4%) accessed family planning services from phannacies. Majority 46 (65.7%) got the information from radios and 15(21.4%) got the information from friends.

19 li!h!e !: table il!ustratmg places mjormatton ofaccessmgfi:amlv plamzmg sen•1ces

places can access family planning services/contraception Frequency Percent I Hospitals i 18 25.7 I I i Health Centre 147 167 1 I ·..,..----; I Pharmacies 114 1~7 I~ ,

J whe•·e do you get infm·mation about bh·th control/contraceptives 1·-::T::-:\c:/--·-----·------T. -:,:------,·7=-::1--- 1 ' • I ~ '.' / Radio /65.7 I Newspapers

I Health Worker t I I !.4 ' I Friends 121.4

4.3.5 Knowledge on birth contJ·oi/contraceptives based on socio demographic factors

From the table below, educational level, religion, work type and marital status were not sigl1!ficantly contributing to knowledge of birth control/contraceptives since their p-values >0.05.

7iih!e ]: Hn·anate ana!J'.\'1.\' s/zowmg knowlecZ<:

have you ever had of biiih control or contraceptives

YES NO p-Yalue Odd ratio

of the respondent Completed Primary Level 20 0.970 1.039 Co:npleted secondary Level !9 0 Completed a Tertiary institution 4 0 level Religion of the Catholic 30 0 respondent Moslem 3 0

20 Protec;;tl'lnt ?7 0 ()0() 1 4)() Seventh Day Adventist 0 Others 8 0 Work type House wife 19 0 Farmer 37 0.830 0.801 Private employee 10 0 .., Others .) 0 Marital status of Not Married 4 0 respondent Married 62 0.971 0.887 Divorced 3 0

4.4 Women's attitude towards contraceptives use

4.4.1 Birth control/contraception delay the pregnancy

From the graph below, majority 46 (65.7%) perceived birth controls as necessary when delaying or tcm1inating pregnancy and the least 3( 4.3%) were undecided.

;·,g;;rc; -1: A graph ;//ustralfng Birth control contraccptwn delay the pregnancy

D Percent D Frequency

DO NOT KNOW :::::::J 4 5.

UNDECIDED ~ 34.3 3:1 Rl > 24. NO 117 65 7 YES 4E

0 10 20 30 40 so 60 70 Valid YES NO UNDECIDED DO NOT KNOW D Percent 65.7 24.3 4.3 5.7 D Frequency 46 17 3 4

21 4.4.1 Attitude toward birth control

From table below, majority 54(77.1 %) couldn't find it ditTicult to find information about birth control and the least 2 were undecided. 50(71.4%) were not finding it difficult to get family planning services and the least 2(2.9%) didn't know. 50(7!.4%) said they would talk health workers about selection methods of birth control. l(Jh!e 3: l(dJ/e slzmving artitude mwunf hirth con fro/

do you find it difficult to find information about birth control Frequency Percent YES 11 15.7

77 1 .~",, r 1, t UNDECIDED 2 2.9

3 "7<_1·' 0 do you find it difficult to get family planning sct·vices/contraception YES 8 11.4 NO 50 71.4 UNDECIDED 10 14.3 DO NOT KNOW 2 2.9 whom a1·e you going to talk about the selection methods of birth control THF HFA TTH WORKFR(DO('TORIMTDWTFF/Nl JRSF) 'iO 71 4 HUSBAND 18 25.7 FAMILY 2 2.9

4.4.2 Vsing birth control/contraception after bil·th

From the table below, majority 42(60%) said they wanted to use birth control/contraceptive and the least 5(7%) didn't know.

22 Figure 5: Table showing re.~pondents who wanted to use birth control contraception

• Valid YES

• valid NO

Valid UNDECIDED

• Valid DO NOT KNOW

4.4.3 Opinion on benefits of birth control/contraception

From the table below, 64(91.4%) said birth contro!/contraception are beneficial.

1 C'Tf'arp A <•hQl-'lna h()W hiJ•ft• /''()f•l•·of ...J;f·rtZII'~' h .. "" 6·. . 4 b tt. •J•.. • ....{"') • .. • ...... ~ - ... • • -/''()"'fJ'OI"Opit,., .. -...... II. ''~)PI ...

DO NOT KNOW

UNDECIDED 0 :::; <( > NO

YES

0 20 40 60 80 100

• Percent • Frequency

23 4.4A Supporting f~mHy ~ntf friend~ to n~e hirth controll('ontnweption

From the table below, majority 66(94.3%) said they can support family and friends to use birth control/contraception and the least I (1.4%) could not support family and friends to use birth controL'contmception. Private employees had good attitude tmvards birth control since 70.0% said they would use birth control/contraceptives.

F1gure 7: A graph illustrating respondents who Support Jan11ly and _fi-1ends to use htrth control contraception

4.4.5 Attitude based on socio demographic factors

From the table below, good attitude was seen among participants who had completed secondary compared to other levels that is 73.7% said they would usc birth control/contraceptives. Catholics and Protestants had good attitude towards birth control compared to other religions accounting to 60.0% and 60.7% respectively who said they would use birth control/contraceptives. The divorced had better attitude toward compared to the married and unmarried since 66.7% 7 said they would use birth control/contraceptives.

24 Tahie -1: litbfe sizmrmg altt!ude based on socw demograplucfactors

After birth, do you want to use birth control/contraception YES NO Undecided Do not know Educational level of Did not complete 14(538%) 5( 19,2%) 6(23, 1%) 1(3,8%) the respondent primary level

r , ...... I,.+a.rl p,.;,...... ,..,,...., 1 'l/t:::.7 1 0;:, \ A I 1 0 ()Or:,\ ':l:l1t1~0r:,\ '110 ,;;:oi~\ '-- 0 u•pn.. ,\.VU- J ~IIJH.Uj' '\ 1 ,,v .•vJ -\ -"•-' !Vj ·--\~···· '"' -'\' '·--''"! Level

')11{\.<;:"0/\ 11< '10/\ /11().::'0/\ Cmnpl..::tcd secondary 14(73.7%,) ..:..\IV,-''0) 1\->.J •UJ -\lV.-'-'\.1/ Level Completed a Tertiary 2(50%) 1(25%) 1(25%) 0 institution level

-- --- ~~ ~- RELIGION OF THE Catholic 18(60.0%) 5(16.7%) 5(16 7°io) 2(6.6%)

RFSPONDFNT Moslem 1(11 i%) 0 0 7( (i(i 7%) Protestant 17(60.7%) 5( 17 9%) 5( 17.9%J) 1(3.8%)

1{ 100%\ Seventh Day 0 .,-~-·~j 0 0 Adventist Others 6(85.7%) 1(143%) 1(14.3%) 0 WORK TYPE House 10(52.6%) 3(15.8%) 5(15.8%) 1(5.3°o) Farmer 12 (57.9%) 8(2ll%) 5( 13.2%) 3(7.9%) Private employee 7170%) 1110%,) 1(10%) 1110%) Others 3( I 00%) 0 0 0

!(:?)~;0) _,_71 ')0%) .. , 117'i%\ !\f!AR!TAL STATUS Not Married 0 -\-. -' OF RESPONDNT Married 39(61.9%) 9( 14.3%) 11(17.5%) 4(6.3%) Divorced 2(66.7%) I (33.3%) 0 0

25 4." Pr~wtke~: on the tt~E' of contr~ceptivP~

4.5.1 Using biith conh ol Illetho(h

From the table below, majority 3 7( 52.9%) had ever used birth control methods and 33(4 7.1%) had never used birth control methods.

Figure 8: A graph showing usage birth control methods

4.5.2 Reasons to use birth control/contraceptives

From the table below, majority 16(22.9%) gave socioeconomic reasons for using birth control/ contraceptives and 13( 18.6%) said they wanted to space childcen.

?'Lib/~ 5: table re~.iSuiiS fv use birth tAiiilral~.-tmlr<-l~.-eptives

reasons to use birth control/contraceptives frequency percent

want to improve their O\vn health and child 2 2.9

,~ ." ,. wanllu space children 1..) 1~.0 preventing unwanted pregnancies 5 7.1 . . socro economic reasons 16 22.9

26 it is recommended by health workers( doctor/midwife/nurse/pharmacist 1.4

4.5.3 Factors supporting the choice of birth controVcontraception

From the table below, the commonest factor suggested by many 20(28.6%) was fewer side effects

/IOf..) \.4J..l-'lnrf 8(11 , t V SUrtfTestodbb '"""' J.,lWhnsbanrl - ontiAntJ\..lVl,

•f ,'t'bnzn•e "' ""0.· fal-.ln(•..., ...... "iffZI"IrQh"'rt ... .,... • ...-,o./- f'ociO''<'" · "' ,','ZtrppO!' { l·nrrb ffzn...... r t..l• Ot.Ce o.1f'bi • rfh• C'-',_,;,"'fr o •l ...... r'Q~'~{f'rlrnnl ·.. -'"' ...... 1 "' "' itH1''' •

·H.l clrdn't l~l'lf' ,1 factor 33

7.1 other'> - :...... s

11.4 fllJSBANfh OPTION 8

;- 2.9 1\UVU\':J 11SING ON SOCfAL MEDIA ; .... 2

!8.fJ llWfl\ ')IDI EFFCIS .'0

FREE ·- 2.9 ,.. 2

0 5 10 15 20 25 ~0 35 .!() ·l'i ~ ,()

ADVEHSTISIN Ff\:VU\ '>IDE HUSBANDS drdn't grn: a FIU: L G ON SOCIAL others EFFCTS OPTION factor MFDII\ . - Percent 2.9 28.G 2.9 11.4 7.1 ·il'.l • Frequencv ·' 20 2 8 5 .33

4.5.4 Practices on use birth controls based on socio demographic factors

From the table below, education level, religion, work type and marital status were not significant related to using birth control/contraceptives since their p-values>0.05.

27 Table 6: Table showing Practices on use birth controls based on socio demographic factors

have you ever used birth control/contraception before YES No p-value Odd ratio educational level of Did not complete 12 14 the respondent primary level Completed Primary 10 11 0.712 0.909 Level Completed secondary 13 6 Level Completed a Tertiary 2 2 institution level religion of the Catholic 15 15 respondent Moslem 2 1 Protestant 15 13 0.825 0.959 Seventh Day 0 1 Adventist Others 5 3 work type Housewife 9 10 Farmer 18 20 0.189 0.709 Private employee 8 2 Others 2 I marital status of Not Married 3 I respondent Married 32 31 0.725 1.3222 Divorced 2 I

28 CHAPTER FIVE

DISCUSSION OF RESULTS, CONCLUSION AND RECOMMENDATIONS

5.0 Introduction

This chapter presents discussion of results in line with the study objectives, conclusion and recommendations.

5.1 Discussion of results

The study revealed that 98.6% had ever heard of birth controls or contraceptives which were higher than 90% women who had ever heard of birth control/contraceptive as revealed by UDHS (2006) and Nattabi (20 11 ). In addition Biney, (20 11) supports this study by suggesting that lmowledge of contraceptives is considered one of the essential factors associated with effective use of these methods.

The commonest methods of family planning used were injections 41(58.6%) and pills 19(27.1 %) and according to Mbonye, (2003) suggests that individuallmowledge about contraceptive methods is closely linked to the use of the methods.

45.7% had !mowledge that injections can be used after delivery. In regard to Nattabi, (2011) post­ primary education and urban residence were strong predictors of lmowledge towards FP services in this study they were not.

This study also reveals that 67.1% had ever access family planning services from Health Centre and 65.7% got the information from radios. Which concurs with Saluja et al., 2011 who revealed that information campaigns through media played an important role in increasing the lmowledge of FP methods? Another study in Taiwan showed that Cheng (20 11) established mass media and social networks played important roles in disseminating contraceptive lmowledge and a study in Pakistan showed that people who had exposure to condom advertisements on radio or TV.

In addition77.1% couldn't find it difficult to find intormation about birth control and 71.4% were not finding it difficult to get family planning services.

29 This study showed 65.7% perceived birth controls as necessary when delaying pregnancy and 71.4% suggested talking to health workers about selection methods of birth control.

It was also revealed that 60% wanted to use birth control/contraceptive and 91.4% said birth control/contraception is beneficial. 94.3% said they can support family and friends to use birth control/contraception.

In addition it was seen that good attitude toward use birth controls/contraceptives was seen among participants who had completed secondary compared to other levels that is 73.7% said they would use birth control/contraceptives. Which disagrees with UNESCO (2011) where women with higher levels of education were more likely to delay and space their pregnancies and to seek health care and support. Also Saleem & Bobak, (2005) also does concur with this study since more educated women are more likely to use FP.

The divorced had better attitude toward compared to the married and unmarried since 66.7% 7 said they would use birth control/contraceptives. Davidson and Jaccard (1979) also provide evidence that married women's attitudes towards birth control are positively correlated to their actual use and author's reference found district-level use of contraceptives to be positively affected by knowledge and acceptance of contraceptives in African countries. More to this study reveals that Catholics, Protestants and Private employees had good attitude towards use birth control.

It was shown that 52.9% had ever used birth control methods 22.9% gave socio economic reasons for using birth control/ contraceptives and 18.6% said they wanted to space children. The commonest factor suggested by many 20(28.6%) was fewer side effects and 8(11.4%) suggested husband option.

Contraceptive prevalence rate among married women by any method.has barely improved from 19% in 1995, 24.4% in 2006, to 30% in 2011. The use of modem methods has slowed somewhat, while use of traditional methods declined between 1995 and 2000. Injectable contraceptives are the commonly used method among married women because they are long lasting, convenient to them, and can be used without the knowledge of the male partners who may not agree to family planning use (ministry of health, 2000). The contraceptive mix changes with the sexually active unmarried women; with. condom use being the highest at 27% followed with injectables at 13% (Shane, 2008).

30 CONCLUSION

In conclusion, a high percentage of98.6% had ever heard of birth controls or contraceptives and knowledge of contraceptives was seen as an essential factor associated with effective use of these methods. The commonest methods of family planning used were injections and pills. 67.1% had ever accessed family planning services from Health Centre and 65.7% got the information from radios. Finding information about birth controls and get family planning services were not found difficult. Bilih controls were found to be necessary when delaying pregnancy and 71.4% of the respondents suggested talking health workers about selection methods of birth control.

It was found that use birth control/contraception is beneficial as supported by 91.4% of women. Education level, marital status, Catholics, Protestants and Private employees were seen to affect attitude towards· use of birth control/contraception that is women with higher levels of education were more likely to use birth controls, the divorced were more likely use birth controls. Finally 52.9% had ever used birth control methods 22.9% gave socio economic reasons for using birth control/ contraceptives and 18.6% said they wanted to space children.

The study revealed that 98.6% of respondents had knowledge offamilyp!anning or contraceptive~. The use of family planning was largely associated with the socioeconomic reasons leaving out the health concern to the mother exposed to too many and very closes pregnancies. The attitude towards family planning uptake is greatly associated with religion, education level, number of children one has, marital status and type of work of the respondents.

Despite the fact that the responded knew that fanlily planning use is beneficial 91.4%, the use of contraceptives was still low at 52.9%.

Although the responder,:ts hd knowledge about family planning, there was information deficit about some t~'lmily planning methods.

5.3 Recommendations

There the researcher recommends the following;

31

.I'· • Health workers and ministry of health to organize educational programs and seminars to increase uptake of birth control methods. • Though respondents were knowledgeable about the benefits of family planning, there should be continuous education of women about reproductive health issues and integration of men's participation in the family planning programs to increase utilization of family planning services.

32 REFERENCES

Namazzi, G. (2013). Missed Opportunities for modem family planning services among women attending child health clinics in Iganga/Mayuge, Uganda., (January).

Adofo, E. (2014). Postpartum Contraceptive use among young mothers in Kwaebibirem district, Ghana.

Archer, K., and S. Lemeshow. 2006. Goodness-of-Fit Test for a Logistic Regression Model Fitted Using Survey Sample Data. Stata JoUinal6(1): 97-105.

Blanc, A., A. Tsui, T. Croft, and J. Trevitt. 2009. Pattems and Trends m Adolescents' Contraceptive Use and Discontinuation in Developing CoU11tries and Compruisons with Adult Women. Intemational Perspectives on Sexual and Reproductive Health 35(2).

Chowdhury, A., and J. Phillips. 1989. Predicting Contraceptive Use in Bangladesh: A Logistic Regression Analysis. Joumal ofBiosocial Science 21(2): 161-168.

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Gorgen, R., M. Yansane, M. Marx, and D. Millimounou. 1998. Sexual Behavior and Attitudes among Umnanied Urban· Youths in Guinea. Intemational Family Planning Perspectives 24(2): 65-71.

Haberland, N., E. Chong, H. Bracken, and C. Parker: 2005. Early Marriage and Adolescent Girls. Available at http://www.popcouncil.org/pdfs/Early_Marriage.pdf, accessed 14 January 2013. Healthy Action. 2011.

Health Budgeting in Uganda: A Reality Check. Available at http://www.dsw­ online.org/fileadrnin/user_upload_ en/PDF /Budget_ Studies/Healt.l-ty Action_ Bud getStudy_ Uganda_201l.pdf, accessed 14 January 2013.

Henshaw, S. 1998. Unintended Pregnancy in the United States.Family Planning Perspectives

30(1): 24-29 & 46. Hosmer, D., llild S. Lemeshow. 1980. Goodness~of-Fit Tests for the Multiple Logistic Regression Model.

33 J. Schoemaker, "Contraceptive use among the poor in Indonesia," International Family Planning Perspectives, vol. 31, no. 3, pp. 106-114, 2005. View at Publisher · View at Google Scholar · View at Scopus

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D. Ojal

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35 APPENDIX 1: CONSENT FORM

The research under study is aimed at assessing !mowledge Attitude and Practices about the use of contraceptive use. Any information provided for this study shall be regarded confidential to the researcher.

!...... , have accepted to participate in this research being conducted by Tuyisengye irrunaculate, a pharmacy student .She has explained to me the objectives and benefits of the research and I have submitted willing! y to participate in the research.

Signature ...... Date ......

36 APPENDIX II: RESEARCH QUESTIONAIRE SHEET RESEARCH TOPIC: ASSEMENT OF KNOWLEDGE ATTITUDE AND PRACTICES ABOUT THE USE OF CONTRACEPTIVE USE AMONG PREGNANT MOTHERS ATTENDING ANTENATAL CARE SERVICES AT ITOJO DISTRICT HOSPITAL

Reference number DO 0

Date: ...... /...... !......

Introduction

Name of Researcher: Tuyisegye Immaculate

Purpose of the questionnaire: This questionnaire is developed as a data collection tool to be filed in by selected respondents. The data obtained from here shall be used only for research purposes in partial fulfillment of the award of Bachelor of Phannacy of Kampala International University. The investigator requests your participation in the capacity of a resource person basing on your qualification, job description and experience with the subject of study.

This data will be treated with the utmost confidentiality it deserves and will not be released to anyone/organization except for an academic purpose.

Personal and socio demographic details:

1. Name

2. Date of birth

3. Address

4. Education level

• Did not complete primary level • Completed primary level

37 • Completed secondary level • Completed university level • Completed a tertiary institution level

5. Religion

• Catholic • Islam • Protestant .. Seventh day Adventist • Others

6. Work type

• Housewife • Fam1erlworker • Health worker • Employees of private

7. Status

• Notman1ed • M=ied • Divorced • others

8. Age at marriage

9. The number of pregnancies

10. The number of children living

11. Number of miscarriages

38 KNOWLEDGE

12. Have you ever had of birth control or contraceptive?

YES NO

13. Method of family planning or contraception you know?

• Condoms • Lactation amenorrhea method 0 Calendar • Pills • Injections • Implant • Diaphragm .. IUD .. Sterilization of wo:nen

0 Male sterilization/vasectorr.y

14. Where you can access family planning services/contraception above

• Hospitals " Health ce:1.tre • Phannacies • Clinical personal doctor • Others

15. Where' do you get infonnation about birth control/contraceptives?

• TV • Radio • Newspapers • The health worker (doctor/midwife/nurse/phannacist) • Family

39 • Friends • Others

16. The method of family planning/contraception that can be used after delivery because it does not interfere with the process ofbreast feeding is

• Lactation amenorrhea method • IUD • Implant • Condoms • Injection • Pill • Do not know

ATTITUDE

17. To delay or terminate the pregnancy, I need birth control/contraception

• Yes • No • Undecided • Donotknow

18. I find it d~fficult to fmd information about birth control/contraceptives from health personnel (doctor/midwife/nurse/pharmacist)

• Yes • No • Undecided • Donotknow

19. I fwd it diffic11lt to get f:nn.ily planring servi~es/contraception

" Yes ., No • Undecided • Donotknow

20. After birth, I want to use birth control/contraception

• Yes • No • Undecided • Donotknow

21. Whom am I going to talk about the selection methods of birth control/contraceptive?

• The health worker (doctor/midwife/nurse) • Husband • Friends • Family • Others

22. In my opinion, using birth control/contraception is beneficial

• Yes • No .. Undecided · " Do not know

23. I will S'l!>pcr·t tho:: family and friends to use bi1ih control/contraception

• Yes • No • Undecided • Donotknow

41 .. PRACTICES/BEllAVIOR

24. Have you ever used birth control/contraception before?

YES NO

IF YES

25. Method of birth control used/contraception used

26. How long the birth control/contraception used

IFNO

Is there a desire. to use them at a later date?

YES NO

27. What are the reasons to use birth control/contraceptives?

• Want to improve their own health and that of the child

o Want to space chidren • Preventing unwanted pregnancies • Prevent sexually transmitted diseases • Socioeconomic reasons • It is recommended l;>y health workers (doctor/midwife/nurse/pharmacist)

e Others

28. What factors support th·~ d:,oic.:: of birth control/contraception?

~ Offers/free • Fewer side effects • Advertising on social media • Husband's option • I hear from friends/family • Others

42 29. Which birth control method will you use after delivery?

• Calendar • Lactation amenorrhea method • Condom • Pills • Injection • IUD • Implant • Sterilization women .. Diaphragm • Do not know

30. What is the reason you do not want to use birth control/contraceptives?

• Still want to have children • Lack of information on family planning/contraception • Fear of side effects of birth control/contraception • Breaking belief/religion • Prohibition of parents/family • Prohibition husband " Husband has been doing family planning/contraception use condoms or sterile sample • Husband works out of town that felt no need • Already using natural methods, such as coitus interrupts or dates

. '• 43 APPENDIX V: PROPOSED BUDGET Item Quantity required Unit coast Total cost (shs) (shs) Stationary Pens, Papers, Rulers, Folder files Stapler, - 35,000/- staples, etc. Communication - - 5,000/= Flash disc 1 30,000/= 30,000/=

Secretarial services Typing, Binding, Printing etc. - 50,0001~ Internet bundles 2GB 35,000/= 70,000/= Data treatment - - 35,000/= ·- Data analysis - - 50,000/= Production of research - - 100,000= report Allowance for research Two research assistants each 5,000shs 100, 000/= 200,000/= assistants per day for 20 days Subtotal - - 575,000/= Overhead (15% of - - 86,250/= total direct expense) GRAND TOTAL - - 661,205/= APPFNnlX VJ~ TTMF. FRAMF:

Task May/June 20181July-august2018

Pwposal wt iiing

Proposal presentation

Proposal approval

Proposal corrections

Data collection

Data entry

Draft repon

Submission of final report

45