FACTORS AFFECTING FAMILY PLANNING SERVICES IN RURAL AREAS AMONG WOMEN (A CASE STUDY OF NSIT IBOM)
Abstract
The empowerment and autonomy of women to enable them to take active part in their child-bearing decisions, decide as to when to marry and give birth and either to space or limit their births have been given much prominence at major international and national seminars and conferences on population, women and Development over the years. This study this assess the child bearing decisions made by women in Nsit Ibom Local Government Area of Akwa Ibom State.  The study revealed that women of the study communities do not independently make decisions in their Family planning issues and most women are not educated hence education is a pre- requisite for effective reasoning and informed decision making.Therefore midwives have a role to play by health educating women on the need for their involvement in decision making with regards to their fertility and also the need for family planning as an effective way to reduce their family size, unsafe abortion, maternal mortal and achieve their MDG 4 $ 5 target.
 TABLE OF CONTENTS
CHAPTER ONE
1.0             Introduction
1.1       Background of the study
1.2       Statement of the problem
1.3       Objectives of the study
1.4       Significance of the study
1.5       Scope and Limitations of the study
1.6       Assumptions of the study
1.7       Formulation of Hypothesis
1.8       Definition of Terms
 CHAPTER TWO
2.0  Review of Related Literature
2.1  Conceptual review
2.2 Theretical review
2.3 Empirical review
CHAPTER THREE
3.0             Design and Methodology
3.1       Primary Sources of Data
3.1.1   Personal/Oral Interview
3.1.2   Questionnaire Method
3.2       Secondary Sources of Data
3.3       Population and Sample Size Determination
3.4       Methods of Data Collection
3.5       Method of Validating the instrument
3.6       Method of Data Analysis
3.7       Problems of data collection
CHAPTER FOUR
4.0             Presentation of Analysis of Data
4.1       Presentation of related data
4.2       Analysis of Data
4.3       Test of Hypothesis
4.4       Interpretation of Result
CHAPTER FIVE
5.0             Summary of findings
5.1       Conclusions
5.2       Recommendations
            Bibliography
CHAPTER ONE
INTRODUCTION
 Background to the study
 The ability of women to take decisions in family planning issues such as family size, when to have a baby, choice of spacing period and the use of family planning services may not only enhance their bargaining power in family matters but will also reduce their vulnerability to sexually transmitted infections (STIs) (Tavory & Swidler, 2009) Fertility and its decisions in the family is influenced by ideas and changes that occur in the life of the individual associated with such characteristics as education and income levels. Thus as women climb the educational ladder and men are faced with economic challenges of life, coupled with the pressure from the family to provide and satisfy their physiological needs, women are faced with the need to make choices with respect to the number of children they should give birth to and the size of their families (Weeks, 2010) and many others. In developed and industrialized societies, the trend towards smaller family sizes has emerged due to the spread of formal education, medical and health advancements and the enhanced status of women (Miller, 2010).
 Education, for example, is a very powerful indicator of involvement in fertility decision making among women globally (United Nation, 2005). It has been widely recognized as a key concept in understanding fertility behaviour (Miller, 2010). This is in line with Weeks (2010), who asserted that women who delay marriage are more likely to stay in school and then upon attaining higher education, are also more likely to find suitable employments ,they are able to compete effectively with their male counterparts in family building and lower parities than their less educated female counterparts that give birth to larger number of children.
In as much as women have been empowered through education and economic employment to be assertive in family life decisions gender inequality, is a universal phenomenon which largely confronts women. The UN World Conference held in Mexico City, Copenhagen and Nairobi in 1975, 1980 and 1985 respectively for the advancement of women underscored the peculiar problems facing women (Pietila, 2007).Globally, women do not enjoy equality with men in terms of political, legal, social and economic rights. It has been observed that in every country, jobs that were predominantly done by women were the least well-paid and had the lowest status (Marger, 2008).The 1995 World Bank report acknowledged the same fact that gender inequality also manifests itself in family planning decision-making hence gender inequality in decision-making constitutes the major concern in this study. Family planning decision of women is a global concern because of the social and environmental impacts of population growth and maternal mortality (Ronsmans & Graham, 2006) .Furthermore, Marger, (2008) admitted the gender differences in family planning decision making and attributed to power relation and traditional gender roles. This view was surported by Vaessen, (2004) who argued that women lack control over decision-making in reproductive health especially with regards to their family planning. They commented that women are often pressured by husbands and relatives to have large families and maintained that society had not recognized and made use of women’s knowledge and capabilities. In most developing societies, most women have no option than to succumb to the dictates of their spouses, friends and kinsmen with no control allowed over their family planning decisions (May, 2014). Of great concern is the high value traditionally placed on children, which has sustained the high fertility rate in Nsit Ibom Local Government Area and made it resistant to the forces that brought about decline in fertility in the developed countries. The cultural and national traits of women of some geo- political regions of the world do influence their family planning decisions to the extent that the family planning preferences of these women even in the developed nations reflect what obtains in their home regions as revealed by Woollett, Matwala and Hadlow ( UN, 2009). Human reproductive behaviour which is the result of a complex interplay of economic, social, cultural, religious and biological factors influence the family planning decisions of women in the developing world (Caldwell, 2009). Family planning decisions within the traditional family system are based on factors such as children as old age security for parents, prestige attached to large family size, labour force for agricultural practices, as security against high infant mortality and the social benefits of having children and grandchildren. Children are, therefore, cherished as sources of labour in the agrarian and traditional societies. This has led many women into having many children as a result of many child births which have effects on the mother, children in such families and the nation at large. The effects include: maternal, neonatal and child mortality and morbidity; over population, social ills, poverty and lack of community development hence the family is the building block of the community. The low status accorded to women made them desire for larger family sizes. They felt secure in the number of children they had, as a woman’s value and status were linked to her reproductive efficiency and this also give them support in the event of unexpected vicissitudes of life such as widowhood, divorce and physical incapacitation. How applicable are these global gender inequalities with respect to child bearing decision-making of women in the 21st century Nigeria especially in Nsit Ibom-North Local Government, Akwa Ibom state. This is what the researcher seeks to investigate.
STATEMENT OF PROBLEM
 More than half a million women, nearly all of them in developing world die each year in pregnancy or childbirth, amounting to one death every minute (Ronsmans & Graham, 2006). Another million suffer serious, and sometimes permanent pregnancy – related injuries such as – vesico vaginal fistula etc. Much of this suffering and death could be prevented through appropriate maternal and child health services including ANC, labour and delivery services as well as family planning services. 4 In Nigeria traditional attitudes towards gender relations have affected the power of decision- making both within and outside the house hold. Buor, (2004) observed that women, especially in traditional families were subservient to the man in marital relationship, so the man assumes a key position in decision making which is evidenced in the area of Family planning. Some of the result of such subservient role in decision making include; a situation where a pregnant woman’s life is in danger on presenting to the hospital required immediate surgical intervention but will refuse to give her consent until the husband comes. This was observed severally by the researcher and most times when the husband comes, he might decide to take the woman out of the hospital putting the woman’s life in great danger and many others scenario that the researcher personally observed in Nsit Ibom – North LGA hence the women cannot solely make decision on their own even on issues that affect their health during Family planning which sometimes result to maternal death due to delay in decision making. It was suggested that traditional attitudes towards gender relations might reduce effective communication between couples and restrain a wife’s freedom to make chilbearing decisions (May, 2014). The effect of the inferior role of women in decision- making is that they have traditionally been suppressed in taking decision even on matters that affect them such as childbirth. The National Population commission (2014) reported that Akwa Ibom State in Nigeria demographic and health demographic and survey (NHDS, 2013) recorded a total fertility rate of 5.7 and there existed fertility differentials between the rural and urban communities of the state of 7.0 and 4.7 respectively. The researcher also observed a similar trend in the Family planning pattern of women in Nsit Ibom  LGA which was recorded to be 5 based on the findings from the research study. Women’s non involvement in their Family planning decisions affects their health and could lead to high frequency of childbirth among women which could result in serious health risk like; maternal, neonatal and child mortality and morbidity; over population, social ills, poverty, lack of community development hence the family is the building block of the community, economic stagnation, marital  burden and inability of families to educate most of their children resulting in high illiteracy rate in the rural communities of the State . Consequently the question that comes to mind are: Is the large family size the choice of the woman or women have no role in decision making with regards to controlling their fertility ? If family planning is women’s rights do these rights apply in family decisions? To what extent do women exercise reproductive right by participating in issues that directly affect their well beings ? Do women have any control over decision - making issues that relate their child bearing ? To answer these questions and many others the study seeks to assess the child bearing decision of women in Nsit Ibom  Local Government Area, Akwa Ibom State. Hence the need for this study cannot be overemphasized, especially in an environment with high fertility and low contraceptive use.
PURPOSE OF THE STUDY
The purpose of this study was to assess the child bearing decisions made by women in Nsit Ibom Local Government Area of Akwa Ibom State.
The specific objectives of the study include;
The objectives of the study were to:
 1. Identify the pattern of family planning  among women in Nsit Ibom  Local Government Area, Akwa Ibom State.
2. Identify the extent of women’s participation in family planning decisions in Nsit Ibom  Local Government Area, Akwa Ibom  State
 3. Determine the factors that influence women’s family planning  decisions in Nist Ibom  Local Government Area, Akwa Ibom State.
  RESEARCH QUESTIONS
 The research was guided by the following questions as:
1. What is the pattern of child-bearing among women in Nsit Ibom  Local Government Area, Akwa Ibom State?
 2. To what extent do women in Nsit  Local Government Area, Akwa Ibom State participate in child-bearing decision making?
 3. What are the factors that influenced decisions made by women during Family planning in Nsit Ibom  Local Government Area, Akwa Ibom State?
SIGNIFICANCE OF THE STUDY
 The study is to help in finding the reasons for women’s participation or not in family planning  decisions of their families that, to some extent, inform the pattern of childbirth which results in fertility differentials in Nsit Ibom Local Government Area, Akwa Ibom  State. This will help address the issues related to women’s empowerment and their reproductive autonomy in Nsit Ibom Local Government Area, Akwa Ibom  State. Findings from this study will add to the existing literature on pattern of Family planning and how decisions about Family planning are taken in Nsit Ibom local government, Akwa Ibom state  Nigeria. The result of the study will also assist planners and administrators of the town to adopt strategic plans that will help raise the level of consciousness of the women in the town with regard to their child bearing. The study will also serve as the source of information to students and the basis of further research into women’s reproductive decisions.
 SCOPE OF THE STUDY
The study was delimited to the birth patterns and Family planning decisions of women in Nsit Ibom Local Government Area, Akwa Ibom  State, the factors that influence women’s Family planning  decisions and the extent to which they have the autonomy to participate in the Family planning decisions of their families. This study is delimited to all women within the age of 15 and 49 years who will be present in the area during the period of the study and will be willing to participate in the study.
DEFINITION OF TERMS
FAMILY PLANNING; the practice of controlling the number of children one has and the intervals between their births, particularly by means of contraception or voluntary sterilization