American Journal of Health Research
2015; 3(4): 239-247
Published online July 3, 2015 (http://www.sciencepublishinggroup.com/j/ajhr)
doi: 10.11648/j.ajhr.20150304.16
ISSN: 2330-8788 (Print); ISSN: 2330-8796 (Online)
Assessment of Factors Affecting Long acting of Family
Planning Utilization in Adigrat Town, Tigray, North-East
Ethiopia
Addis Adera Gebru1, Atsede Fantahun Areas2, Kahsu Gebrekirstos Gebrekidan2,
Woldegebriel Gebregziabher Kahsay3,Weldegebral Gebru Tekle2, Yefter Woldemicheal Hailu2
1
Department of Nursing, Faculty of Health Sciences, Woldia University, Woldia, Ethiopia
Department of Nursing, College of Health Science, Mekelle University, Mekelle, Ethiopia
3
Department of Nursing, College of health science, Adigrat, Tigray, Ethiopia
2
Email address:
addisaderagebru@gmail.com (G. A. Addis)
To cite this article:
Addis Adera Gebru, Atsede Fantahun Areas, Kahsu Gebrekirstos Gebrekidan, Woldegebriel Gebregziabher Kahsay,Weldegebral Gebru Tekle,
Yefter Woldemicheal Hailu. Assessment of Factors Affecting Long acting of Family Planning Utilization in Adigrat Town, Tigray, North-East
Ethiopia. American Journal of Health Research. Vol. 3, No. 4, 2015, pp. 239-247. doi: 10.11648/j.ajhr.20150304.16
Abstract: Back Ground: Family planning is a key to slowing unsustainable population growth and the resulting negative
impacts on the economy, environment, and national and regional development efforts. Furthermore, the methods considered
“long-acting” in this context are –Intera Uterine Devices and implants, vasectomy and female sterilization are considered
“permanent family planning methods.” Pills, injectable, such as Depo-Provera are considered “short-acting family planning
methods “because their lengths of action are only from 1 to 3 months. Objectives: To assess factors affecting of long acting
family planning utilization in Adigrat town, Tigray, Ethiopia. Methods: A Community based cross-sectional study design was
conducted, from August 27, 2014 -September, 15, 2014 at six kebele of Adigrat town. . A total of 130 women at age group
between 15-49 years old who have used short acting and long acting family planning methods were involved in the study. The
data’s were collected through structured pre-tested self-administered questionnaires. Data was edited, clearance an analyzed
using SPSS version 16.0 statistical package. The findings of the study were summarized and presented using tables, descriptive
measures and statistical diagrams. The P-value of <0.05 was used for significance of the study. Result: Out of the total
respondent, 130(100%) were female. Majority of them 50(38.5%) were between 25-29 years old. shows that more than half of
subjects 92(70.8%) had known their own HIV status. The result also indicated that the highest percentage of participants28
(21.56%), who are using inject able contraceptive, were at age between 25-29 years old. Followed by 12(9.2%) were used
implant, 5(3.85%) were used IUCD. 5(3.85%) were used pills at age between 30-34 years old. Conclusion and
recommendation: To motivate the using contraceptive and to clear the misconception about family planning the recruitment
programs, and Health information communication training and motivation about purpose of Long acting family planning
should be strengthen. It is recommended that can intensive family planning methods training and motivation program should
be maintained this will allow people to be well informed turning the positive attitude of saving life through family planning to
a regular practice and finally we would like to recommend the need to carry out more detailed study regarding long acting
family planning.
Keywords: Family Planning, Long Acting, Contraceptive
1. Introduction
Family planning has the power to save lives, yet today,
more than 200 million women in the developing world don't
want to be pregnant but aren't using modern contraception
especially Long acting Family Planning(LAFP)methods such
as Implants, despite of meet their needs, can dramatically
improve the health and well-being of women, families, and
communities (1,2).Long acting contraceptive is a human
right and is essential to women’s empowerment as well as it
is central to efforts to reduce poverty, promote economic
growth, raise female productivity, lower fertility and improve
child survival and maternal health which prevents 20-35 % of
American Journal of Health Research 2015; 3(4): 239-247
all maternal deaths by enabling smaller family size and
balance natural resource use with the needs of the population
(3).In the least developed countries, use of LARCs/PMs
accounts for less than one-fifth (19 %) of the contraceptive
method mix. It is estimated that if 5,000 oral contraceptive
users were to switch to an intrauterine device (IUD) or
implant, approximately 1,250 unintended pregnancies could
be averted over a 5-year period(4,5,6,7,8,9).Women who are
not satisfied with short-acting methods but still wish to avoid
pregnancy need alternative family planning choices. In
developing countries, 20 percent to 30 percent of women
who use oral contraceptives or injectable stop within two
years of starting because of side effects or other health
concerns. Many of these women could benefit from
switching to an LAPM (10). The methods considered “longacting” in this context are IUDs and implants; vasectomy and
female sterilization are considered “permanent.” Pills,
injectable, such as Depo-Provera are considered “short-acting
“because their lengths of action are only from 1 to 3 months
(11). Fifty Five percent of reproductive age women in Africa
have an unmet need for modern contraception, in Asia, and
Latin America and the Caribbean regions have relatively high
contraceptive prevalence, with unmet need of 21% and 22%,
respectively. Furthermore 13% of the world's married women
use the Intrauterine Contraceptive device as their method of
contraception, Implants still remains at low rate, despite the
fact that, complications during pregnancy and childbirth are
the leading cause of death for women in Africa and voluntary
family planning empowers women and men to decide when
to have a child and to avoid unintended pregnancies and
abortions which results in healthier families, communities,
and nations, complications of un intended pregnancy rests on
African region (12,13).
An estimation of 358 000 maternal deaths occurred
worldwide in 2008, a 34% decline from the levels of 1990,
despite this decline, developing countries continued to
account for 99% (355 000) of the deaths. Sub Saharan Africa
(SSA) and South Asia accounted for 87% (313,000) of global
maternal deaths and more than 350 million couples
worldwide have limited or no access to effective and
affordable especially to LAFP methods(14).
Over 200 million women worldwide who want to use
contraceptives don’t have access to them and the world’s
poorest women and men are not empowered to decide the
number of children and timing of their births
(15). Experience in countries of Ghana, Kenya, Malawi,
Tanzania, and Zambia confirms this, for example, Ghana
removed policy barriers to allow trained nurses to insert
implants and they trained 600 nurses, and as a result more
than 88,000 Ghanaian women chose Norplant® up from
1998 to 2006, for example the CPR for implants rose over
10-fold, from 0.1% to 1.2 % in Ghana (16, 17, 18, 19, 20).
Ethiopia, the most populated country in Africa making the
second nation in Africa, has increased its population nearly
seven times from 11.8 million at the beginning of the 20th
century to about 80 million today. The total fertility rate of
Ethiopia is 4.8 children per women and population growth
240
rate are estimated at 2.7% per year(17), in addition,
contraception use among married women ages 15 to 49 was
at 15%, with 14 percent use of modern methods (up from five
percent in 1990) and most of the women were married as
young as 15 years of age or younger, had an average of 7 or 8
children, and believed that pregnancy needed to occur every
year in order to prove their fertility to their husbands and the
community (21). Long acting family planning methods
provide uninterrupted protection to women for 3 to12 years
and by far the most effective (99% or greater) and very safe
and convenient but still the utilization is so low (22). the
study area which is Adigrat town populated with 63,549
people, there are two government health centers, one private
clinic and one district hospital but the service utilization of
LAFP is significantly very low performance with coverage of
5.8%, in which 5.3% Implants and 0.5% Intrauterine
device(IUD), while currently utilization of short acting
family planning coverage is very high as compared to Long
acting family planning(LAFP) users with 94.2% coverage
that indicates2011/12 town health office report, this is
questionable that needs investigation, and the reasons why
the result of LAFP users becoming very low coverage if
majority of mothers used modern contraceptives, this
problem is not studied previously. From this point of view,
this study helps to dig out the current problems; prevalence
rate of long acting contraceptives by type, why clients
preferred short acting family planning methods rather than
long acting methods is highly significant for program
manager’s intervention, implementation, monitoring and
evaluation to improve utilization of long acting family
planning methods. The purpose of this study was to assess
factors affecting long acting family planning utilization in
Adigrat town, Tigray, Ethiopia.
2. Methods and Materials
2.1. Study Area and Period
This study was conducted in Adigrat town, Adigrat town is
located in Eastern Tigray. The total population of the town is
estimated to be 63,549 people, out of which 50.8% are
females. Age wise, 23.5% of the population are females in
reproductive age group and 14.6% are under five children.
The town is administratively divided in 6 kebels where the
kebels are further divided into 24 ketenas. The study area has
one district hospital; two governmental health centers, two
higher private clinics as well as one medium private clinic. In
addition, there are 351 Women’s Developmental Army
(WDA) teams, and 10,530 organized women with1755 team
leaders which facilitate community based health promotion
especially to prevent pregnancy related complications
(maternal mortality). Among those reproductive age group
mothers approximately 83.8% (n=12,520) are eligible for any
modern type of contraceptives. The coverage of modern
contraceptive is 89% (n=11142), which are 94.2% of them
are currently on short acting contraceptives and 5.8% of them
are on LAFP methods, accounted 5.3%, and 0.5% used
241
Addis Adera Gebru et al.: Assessment of Factors Affecting Long acting of Family Planning Utilization in
Adigrat Town, Tigray, North-East Ethiopia
Implant and IUCDs, respectively in 2012 (report). The study
was conducted in Adigrat town in 130 randomly selected
women at age group between 15-49 years old who have used
short acting and long acting family planning methods from
August 27, 2014 -September, 15, 2014 in the city.
A Community based cross-sectional descriptive study was
employed.
questions and keep the original meaning of the instruments.
Questionnaires for each item are adapted from previously
done similar studies (13). The instrument contains Five parts:
Sociodemographic data, of the respondents(11 items,
Reproductive history(08 items),Concerning Knowledge(4
items), Concerning attitude(03 items) , and concerning
practice(15 items) with combination of responses “Yes” ,”No”
and “ don’t know” assuming score of “Yes”=1 ,either of
“don’t know” or “No” =0,
2.3. Study Population
2.7. Data Collection Procedure
The study population consisted of women of reproductive
age group who have gotten long acting family planning and
hormonal contraceptives (oral contraceptive pills (OCPs) and
injectable) services during the study. Population of all
women age 15-49 years old who have used short acting and
long acting family planning (pills and inject able) methods
was included in the study. Women who used emergency
contraception, condoms, foam jelly and tubal ligation were
excluded from this study
The data were collected for five days in each study Ketena.
First the town was divided in to 24 clusters based on the
number of households (14,443) as well as their residents,
among these, six clusters will be taken randomly(one cluster
from each kebele and sampling interval calculation is
mandatory for selection of households, if a cluster is found
physically inaccessible, it was replaced by another randomly
selected cluster. After complete selection of clusters taken
over, households were leveled depending on the number of
clusters allocated. The first household was selected using
table of random numbers, while subsequent households was
picked-up by adding the sampling interval using systematic
random selection (every 7th) households based on the
structured developed questionnaire,130 respondents was
interviewing home to home in the community for all selected
households that exists based on the sampling frame. Data
collectors are 12 female nurses, two professionals per cluster
and 30 HH per data collector. Moreover, data collectors was
given training and orientation prior to data collection period
and strict supervision and follow up is the daily bases.
2.2. Study Design
2.4. Sample Size Determination
To determine sample size there are 5000 clients eligible for
modern contraceptives, as though documented study about
Prevalence of LAFP and short acting contraceptive methods
in the study area is not found, for sample size determination
the prevalence of long acting family planning users in
Mekelle town is 12%, was considered. The formula used to
determine the sample size with 95% confident interval, 5%
margin of error and cluster form of design effect will take in
to account. So the required sample size is
n = DE × Z p 1 − p /w2.
Design Effect (DE)-2, that is 2x1.962*0.04(1-0.04)/
(0.05)2=118 and 10% contingency of 33clients was made
total sample size of 130 respondents.
2.5. Sampling Procedure
Probability sampling technique was employed. In Adigrat
town, there are six Kebeles and these Kebeles encompass 24
Ketenas. Of those Kebeles with Woreda Health office
recommendation and with scarcity resource, and feasibility
one Ketena from each Kebele were selected and making 6
clusters were identified again by simple random
sampling .Then the study units were allocated proportionally
from each Ketena .Finally, simple random sampling
technique was used select the study participants.
2.6. Instruments and Measurements
Pretested and structured questionnaire was used
Translation of instrument is made from English language to
local Tigragna language and back to English language by
different experts who are familiar on the field of area and
blind on the original version of the questionnaire (English
version) in order to facilitate reliable response to underline
2.8. Data Processing and Analysis
The questionnaire checked for completeness and
consistency and entered and edited in the computer for
statistical analysis. Data was entered in to Epi Info version
3.5.1 database. Furthermore, the data editing and clearance
was done on the same software. Finally, the data was taken to
SPSS version 16.0 for the final analysis. Extreme
observations and missing values was assessed and managed.
The findings of the study was summarized and presented
using tables, descriptive measures and statistical diagrams.
Binary logistic regression was used to assess the independent
effect of the predictors on the utilization of Implants.
Statistical inferences were made by using chi-square test and
the measure of association was the odds ratio. All covariates
with nearly p≤0.05 in the bi-variable analysis or potential
confounders was included in to the final model to obtain
adjusted odds ratio and their 95% confidence intervals. All
statistical tests was two sided and was considered significant
at α= 0.05 or less. This study on completion could serve as a
baseline data as well as a reference material to researchers,
experts or policy makers for intervention. To reach these
bodies original copy of the study finding will be
disseminated to Mekelle University Ayder Campus,
department of Nursing In-service, Tigray Regional Health
American Journal of Health Research 2015; 3(4): 239-247
Bureau and Adigrat town health office. In addition, the
findings were presented on appropriate seminars, conferences
and workshops. Furthermore, the investigator was prepared
the manuscript and send for publication on reputable and
peer reviewed journals.
2.9. Operational Definitions
242
Mekelle University, college of Health Sciences, Department
of Nursing. Verbal consent was obtained from each study
participants. The ethical committee approved the consent
procedure since the study had no any harm to the study
participants
3. Results
Knowledge of long acting family planning: if the women
has mentioned implants o IUCD as one of the family
planning methods, she would be considered as having
knowledge of long acting family planning methods as
method of contraceptive
Non Implanon/IUCD users: Are women of reproductive
age group who used/got hormonal contraceptive (OCPS and
injectable).
Choice-means clients have a range of family planning
methods to choose them among alternatives.
2.10. Data Quality Control
To ensure the quality of data, first the questionnaire was
pretested. The pretested was conducted in 5% of the
participants at randomly selected Ketenas away from the
study Ketenas. Training was given for the data collectors and
supervisors before the actual data collection. Every day after
data collection, questionnaires were reviewed and checked
for completeness, accuracy and clarity by the supervisors and
principal investigators.
2.11. Ethical Considerations.
Socio-demographic Characteristics
Out of the total respondent, 130(100%) were female.
Majority of them 50(38.5%) were between 25-29 years old.
One hundred and eight (83.1%) of the respondent were
Orthodox in religion and followed by catholic17913.1%).
The majority of participants 115(88.5%) were Tigray by
ethinicity.The result shows that the majority of participants
45 (34.6%) were at level of education. The finding also
indicates that the majority of participant 53(42.3%) were
farmer by occupation. More than half of participants
105(80.8%) have good relation to the family as spouse. The
majority of participants 110(84.6%) were married, most of
the participants husband’s level of education 56(43.1%) were
above grade 12. More than half of subjects 92(70.8%) had
known their own HIV status. It indicates that they had good
experiences and information about HIV and its effect. The
majority of the response about their husband’s HIV status. In
addition, Most of subjects 44(33.8%) have range between
501-1000 Birr by monthly income (Table.1).Shows that
participants in this study had mainly used injectable family
planning method.
The study was approved by the Ethical Review Board of
Table 1. Socio demographic characteristics of women at age group between 15-49 years old who have used short acting and long acting family planning
methods at Adigrat town, Tigray ,Ethiopia 2014.
Roll
No
Variables
1
Age
2
Religion
3
Ethnicity
4
Level of education
Characteristics (classification)
15-19
20-24
25-29
30-34
35-39
40-44
45-49
Total
Orthodox
Catholic
Muslim
Total
Tigray
Amhara
Gurage
Others
Total
Unable to read and write
Able to read and write
Grade1-4
Grade5-8
Grade9-12
Above12 Grade
Frequency
Frequency(n)
8
32
50
22
7
5
6
130
108
17
5
130
115
8
5
2
130
14
9
13
15
45
34
Percentage
(%)
6.2
24.6
38.5
16.9
5.4
3.8
4.6
100
83.1
13.1
3.8
100
85.5
6.2
3.8
1.6
100
10.8
6.9
10.0
11.5
34.6
26.2
Mean and standard
deviation Mean M±SD
3.21±1.390
1.21±0.493
1.19±0.682
4.48±1.848
243
Roll
No
Addis Adera Gebru et al.: Assessment of Factors Affecting Long acting of Family Planning Utilization in
Adigrat Town, Tigray, North-East Ethiopia
Variables
5
Occupation
6
Relation to the
family
7
Do you know your
HIV Status
8
Do you know your
husband’s HIV status
9
Monthly income
10
Current marital
status
11
Husband level of
education
Frequency
Frequency(n)
130
55
4
33
16
7
12
3
130
18
105
1
6
130
92
38
130
81
49
130
26
44
24
15
21
130
8
110
3
6
3
130
4
4
3
24
39
56
130
Characteristics (classification)
Total
Farmer
Merchant
Government employee
Private
House wife
Daily laborer
Student
Total
Head
Spouse
Daughter
Others
Total
Yes
No
Total
Yes
No
Total
200-500 Birr
501-1000Birr
1001-2000Birr
2001-3000 Birr
Above 3000 Birr
Total
Single
Married
Living together
Divorce
Widowed
Total
Unable to read and write
Able to read and write
Grade1-4
Grade5-8
Grade9-12
Above 12 grade
Total
There was no significant relationship between Long acting
Family planning(LAFP) and age of participants.(Chisquare=0.901, Df=1).The result also indicates that the highest
percentage of participants 28(21.55), who are using
injectable contraceptive were at age between 25-29 years old.
Followed by 12(9.2%) were used Implant, 5(3.855) were
Percentage
(%)
100
42.3
3.1
25.3
12.3
5.4
9.2
2.3
100
13.8
80.8
0.8
4.7
100
70.8
29.2
100
62.3
37.6
100
20
33.8
18.5
11.5
16.2
100
6.2
84.6
2.3
4.6
2.3
100
3.1
3.1
2.3
18.5
30.0
43.1
100
Mean and standard
deviation Mean M±SD
2.71±1.792
2.00±0.787
1.29±0.457
1.45±0.727
2.70±1.351
2.12±0.682
5.31±1.539
used IUCD. 5 (3.85%) were used pills at age between 30-34
years old. The result also showed that, the majority of
participant 41(31.54%) were not used long acting family
planning methods at age between 25-29 years old. However,
only 24(20%) were used long acting family planning
methods at reproductive age (Show table.2).
Table 2. Respondents Choice, Educational back Ground and Age of women at age group between 15-49 years old who have used short acting and long acting
family planning methods at Adigrat town, Tigray ,Ethiopia 2014.
Educational back ground
Norplant
Inject able
Pills
15-19
20-24
25-29
30-34
35-39
40-44
45-49
Unable to read and write
Able to read and write
Grade1-4
Grade5-8
Grade9-12
Above12 Grade
Total
6
2
7
11
17
15
58
8
5
6
8
25
17
69
2
1
4
7
3
17
1
3
4
8
1
3
7
16
5
32
8
5
6
4
14
13
50
1
1
3
2
8
7
22
2
1
2
2
7
3
2
5
12
1
1
2
1
6
American Journal of Health Research 2015; 3(4): 239-247
The result in table3 shows more than half of subject
66(50.8%) had married between 18-20.It indicates that they
had good experience. The result also shows that majority of
participants 58(44.6%) had got pregnancy between 3-5,
106(81.8%) have not breast feeding expression at study
time,69(53.1%) have not decided the number of children
want to have .However, among the participants who have
decided the number of children want to have, the majority of
them 51(39.2%) have wanted to get four children. Shows that
most of subjects 105(88.8%) were not used long acting
family planning method. However, the majority 58(44.5%)
were used LAFP before. The result also reveals that the
majority 69(53.1%) have using inject able contraceptive
method currently. Regarding the method of LAFP preference,
more than half of the subjects 64(49.2%) had need for future
244
to control unwanted pregnancy. Most of the subject 70(53.8%)
have divorce as a main reason to prefer implant contraceptive
and generally LAFP method. The result shows that majority
of the participants 106(81.8%) were got LAFP from Health
center and Hospitals. The study result reveals that the
majority of the participants 84(64.6%) had discussion and
supportive by role of husband on utilization of Implant /
IUCD, 80(61.5%) have planned to use implants/IUCD for the
future, 82(63.1%) had preferred to get two times, 105(80.8%)
have not been faced unwanted pregnancy. However, among
these participants, the majority of the participant 66(50.8%)
were abortion have main solution if unwanted pregnancy
once occurred. Almost the entire participant 130(100%) were
suggested that distributions means of contraceptive method
are free service at health center and hospitals.
Table 3. Reasons for Preferences of the Method based on Marital Status. of women at age group between 15-49 years old who have used short acting and long
acting family planning methods at Adigrat town, Tigray ,Ethiopia 2014.
Marital status
Single
Married
Divorced
Separated
Others
Total
To limit family size
7
52
1
4
4
67
To space birth
45
2
2
49
To prevent pregnancy
1
7
8
The study result indicates that the majority of subjects
23(17.7%) who are living at Keble 03, were used inject able
types of contraceptive methods. The participants who are
living at Keble 03 were highly used all methods of
contraceptives than all other Kebels. However, the majority
of the subjects who are living at Keble 03, were used
implants. The result also shows that the majority of
participants 40(31%) had not used long acting family
planning methods. However, 46(49%), 37(28.5%) and
For my health
4
4
Others
1
1
Total
8
109
3
6
4
130
28(21.5%) were preferred implant, Intera Utrine
contraceptive device and other long acting family planning
method respectively. The association between types of LAFP
participant used before this study time is not significantly
associated with their educational back ground. The study
result also shows that the majority of subjects 21(16%) were
used IUCD before, followed by 17(13%) were used Implants
between grade 9-12 by their educational back ground. The
remain finding have putted on the table below (Table.4).
Table 4. Respondents Attitude to Change from Short Acting to Long Acting Methods of women at age group between 15-49 years old who have used short
acting and long acting family planning methods at Adigrat town, Tigray ,Ethiopia 2014.
Age
Unable to read and write
Able to read and write
Grade1-4
Grade5-8
Grade9-12
Above12 Grade
Total
Injectable
Pills
No
8
5
6
8
25
17
69
No
2
1
4
7
3
17
%
6.16
3.85
4.62
6.16
19.25
13
53.9
%
1.54
0.77
3.08
5.39
2.31
13
Plan to change to
Implants
No
%
2
1.54
3
2.31
4
3.08
3
2.31
11
8.47
9
6.93
32
24.64
The result shows that participants in this study had mainly
used injectable family planning method. The result of
Pearson chi-square indicates (table.3) that there was no
significant relationship between LAFP and age of the
participants (Chi-Square=0.901, Df=1).The result also
indicated that the highest percentage of participants 28
(21.56%), who are using injectable contraceptive, were at age
between 25-29 years old. Followed by 12(9.2%) were used
IUCD
No
2
1
2
2
5
12
%
1.54
0.77
1.54
1.54
3.85
9.2
Total
No
14
9
13
15
45
34
130
%
10.78
6.93
10.01
11.55
34.65
26.18
100
implant, 5(3.85%) were used IUCD. 5(3.85%) were used
pills at age between 30-34 years old. The result also shows
that the majority of participant 41(31.54%) were not used
long acting FP methods at age between 25-29 years old.
However, only 24(20%) were used long acting FP method at
reproductive age.Table4. reveals that there was not a
statistically significant correlation between educational back
ground and reproductive history. The result also shows that
245
Addis Adera Gebru et al.: Assessment of Factors Affecting Long acting of Family Planning Utilization in
Adigrat Town, Tigray, North-East Ethiopia
the mean score of participants who are above 12th grade
(3.52±0.511) were higher than unable to read and write
(2.21±0.893) who had decided the number of children want
to have. However, there was a relationship between
educational back ground and number of the first pregnancy at
reproductive age (P=0.009,F=3.002,Df=1) (table .5).
Table 5. Respondents Attitude to Change from Short Acting to Long Acting Methods of women at age group between 15-49 years old who have used short
acting and long acting family planning methods at Adigrat town, Tigray ,Ethiopia 2014.
Age
15-19
20-24
25-29
30-34
35-39
40-44
45-49
Total
Injectable
No
2
9
12
5
1
2
31
Pills
%
1.54
6.93
9.2
3.85
0.77
1.54
23.9
No
1
5
3
1
1
1
12
%
0.77
3.85
2.31
0.77
0.77
0.77
9.2
Plan to change to
Implants
No
%
2
1.54
4
3.08
4
3.08
5
3.85
1
0.77
1
0.77
17
13.09
The result shows that the majority of participants (45%;
n=58) were used Implant by types of LAFP you used before
Figure 1. distribution of participant types of LAFP used before by women at
age group between 15-49 years old who have used short acting and long
acting family planning methods at Adigrat town, Tigray, Ethiopia 2014.
4. Discussion
This study has attempted to assess factors affecting long
acting family planning utilization in Adigrat town, Tigray,
Norther, Ethiopia. Maintaining an adequate and safe family
planning service is an issue of concern to local health
planners especially with increase in demand as a result of the
decreases in population size and an increase in the numbers
of medical facilities and their safety in Adigrat town and as
country. Therefore, understanding the various factors
contributing to long acting family panning utilization is
curcial. Similarly; the result of this study on factors affecting
long acting family planning utilization shows that in a
diverse group of women of reproductive age groups who
have gotten LAFP and hormonal contraceptive services. The
proportion of women who reported current contraceptive use
was highest in age groups 25-29; where injectable
contraceptive users. The least proportion of current use of
family planning method Pill 5 (3.85%);Implant 12(9.2%)
were reported by age group 30-34.The possible explanation
is that most women strive to have small number of children
during their younger age, and at around 30 they might want
to have their desired number of children. A study was
conducted by EDHS, 2011, were shown that overall ,29% of
currently married women are currently using a method of
family planning ,and nearly all use is a modern method; only
one percent of currently married women are using a
traditional method and the most popular methods are
IUCD
No
4
18
28
9
4
3
4
70
%
3.08
13.86
21.5
6.93
3.08
2.31
3.08
53.9
Total
No
8
32
49
22
7
5
7
130
%
6.16
24.64
37.7
16.94
5.39
3.85
5.39
100
injectable 21% married women, only implants 3% and 2% of
married women reported using an Intera Utrine contraceptive
devices(IUCD). The result in this study were higher in
Implant contraceptive method than the previous study by
EDHS,2011.however,the injectable contraceptive types were
slightly higher than the participant in this study have good
knowledge on family planning .Study by Tefera,A.atKoteba
were a result has shown that women with young partners
were at relatively conductive environment to use family
planning methods compared to those with partners older
age.Similarly,this study has shown that women with
husbands who were younger than 30 years to use
contraception. In this study the majority of the respondents
had knowledge on their own HIV status. It indicates that they
had good experience and information about HIV and its
effect. The present study shows that the participant had
mainly used injectable family planning method. The current
study revealed that the least frequency used long acting FP
methods at reproductive age group. The present study shows
that more than half of subjects had need of implant
contraceptive method for future to control unwanted
pregnancy. In addition; they have divorce as main reason to
prefer implant contraceptive and overall Long acting family
planning. There were no any significant relationship between
LAFP and age of participants. The association between role
of husbands on utilization of implants/Intrauterine
contraceptive devices and is not statically significantly
associated with their marital status. This indicates that in this
study the result of inject able family planning method was
higher in FP than other methods compared with previous
studies. The probable reason for this differences may be due
to the service given on inject able family planning method
becomes increased from time to time in this study area,
women of reproductive age group need of practical uses for
this types of contraceptives and this may suggest that those
who need to use injectable family planning method replay
more on seeking the best motivation and knowledge. These
scores are slightly higher than those reported from previous
studies in other countries. The main reason may be this study
indicated that understanding the different types of long acting
family planning and hormonal Contraceptives ,which are
American Journal of Health Research 2015; 3(4): 239-247
carried out by women of reproductive age groups are very
important as study finding women’s of reproductive age
group can be adjust their own need of contraceptives to direct
the needs of them, due to the women of reproductive age
groups their need and types of contraceptive .State to look at
then this suggests that those who participated in this study
had preferred one of LAFP but not all and the previous study
may assess their participants only by total types of family
planning methods. The majority of women used implants
(87%) followed by IUCD (13%) and the prevalence of
implants and IUCD users in Mekelle town is 10.6% and 1.5%
respectively. There is no study that documented factors
associated with very low use of LAFPs in Tigray region.
Jennifer wilder(2007) a result shown that 13% of the world’s
married women use the IUCD as their method of
contraception, implants still remains at low rate, despite the
fact that ,complications during pregnancy and childbirth are
the leading cause of death for women in Africa and voluntary
family planning empowers women and men to decided.
Urban IUCD users 6.7% and implants inserters are 3.8%
while rural 1.1% IUCD and 3.3% of them are
implants.(ACOG Committee opinon,2009).Coming to age
related implication ,CPR increases from age 15-19 to 2024,and then declines to 13 percent among women 45-49
years on the way the CPR in Ethiopia observed in the 2011
EDHS has doubled from that reported in the 2005 EDHS.
Study which was conducted by WHO, 2005, The Prevalence
of LAFP in Addis Ababa is 13.7% which is 10.9% and 2.8%
IUCD and Implants respectively and the prevalence of LAFP
in Dire Dawa is 12.7% in which IUCD and implants 4.7%
and 8% respectively. Finer et al (2012) .In the regional state
of Tigray the contraceptive users of any modern types is 21.2%
from this, IUCD users 2.1% and Implant inserters 5.65 and
women of 15-49 years not use any modern contraceptive
currently are 77.8%.The overall prevalence of any
contraceptive use in Mekelle town is only 37% and the
overall prevalence use of LAFP and permanent contraceptive
methods use is 12.3%; the prevalence of LAFP users’ are
12%.(20-27).
5. Conclusion
It is concluded from our study that different knowledge,
attitude and practice on family planning in Adigrat town,
Health facilities and lack of information may serve as an
important issue to be addressed .To Motivate the using
contraceptive and to clear the misconception about family
planning the recruitment programs, and Health information
communication Training and motivation about purpose of
LAFP should be strengthen. The women of reproductive age
group who have gotten LAFP and hormonal contraceptives
services should know that numerous screening measures are
implemented to ensure that family planning are safe for the
user and that is safe for using LAFP and any FP
contraceptive methods. omens of reproductive age groups
understand about a problem in the availability of necessary
materials and supplies for these who needs t use any
246
LAFP.There was a problem in the availability of necessary
materials and supplies for those who need any favorable
LAFP.There majority of respondents have to believe to use
LAFP any methods inconvenient place, inaccessible
emergency types of family planning and husband opposition.
It indicates the high risk practice and necessitates
intervention and low knowledge, attitude, and practice
including motivation on long acting family planning and their
factors.
Recommendation
The low motivation, awareness, attitude and practice on
long acting family planning but also any types of FP among
the women of reproductive age groups who have gotten
LAFP and hormonal contraceptive services in Adigrat town
is an indicative for in effectcient management system within
the health Bureau has to prepare a program for other service
provides for experience sharing in order to improve the
quality initiation. Furthermore, the health Institutes such as
Hospital, Health Center and other related institutes have to be
encouraged for better initiation and motivation. Educate all
women of reproductive age groups who have gotten LAFP
and hormonal contraceptive and also who are not user in
Adigrat town about the benefits and importance of long
acting and hormonal family planning methods. Behavioral
change communication and demonstration be done regularly
as part of the routine service and through the outreach
(School /Visits) program about optional family planning
practice to all women of reproductive age groups who come
to health institution and outreach services.
Acknowledgement
We acknowledge the professional assistance of Mekelle
University in undertaking this research .We would also like
to express our gratitude to Adigrat town Administration
Health Bureau, respective district health offices and health
facilities for their full cooperation to the study participants.
Our thanks also go to the data collectors and supervisors.
Author Contributions
WGT and YWH have made substantial contributions to
beginning and design, collection of data, analysis and
interpretation of data and in drafting the manuscript and
correcting the comment given by the advisors.
AFA, AA and KGG involved in revising the research paper
and the manuscript critically for important intellectual
context and approval of the final version to be published and
participated in its design and coordination. AFA participated
in the approval and funding process, participated in the
design of the study participated in its design and coordination.
AA and KGG had greater contribution in reviewing the
manuscript English and topography. And helped to draft the
manuscript.
247
Addis Adera Gebru et al.: Assessment of Factors Affecting Long acting of Family Planning Utilization in
Adigrat Town, Tigray, North-East Ethiopia
References
[1]
Takele, A., Degu, G., Yitayal,M(2012). Demand for long
acting and permanent methods of contraceptives and factors
for non-use among married women of Gobat own, Bale Zone,
and Southeast Ethiopia. Reproductive Health, 9:26
http://www.reproductive-health-journal.com/content/9/1/26
[13] Population growth rate http://www.about.com/gi/pages/patent.
(Accessed on July 11, 2012).
[14] Determinants of family
(Accessed in 2012).
planning
http://www.who.int/
[15] Dr-Mengstu-Asnake
http://www.Impatientoptimists.org/Authors/A/ (Accessed on
December 01, 2011).
[2]
EDHS (2011). Preliminary report, CSA and measure DHS
ORC Macro, 2011.
[16] National Collaborating Centre for Women’s and Children’s
Health Commissioned by the National Institute for Health and
Clinical Excellence, http://www. (Accessed October 2005).
[3]
World Population Data Sheet (2006). Retrieved by
http://www.Population Reference Bureau. (Accessed in 2006.
2005 Washington, DC)
[17] World population trends http//www.prob.org. (Published on
July 2012).
[4]
Hubacher, D., et al. (2007).Calculation based on methodology
described in Contraceptive implants in Kenya: Current status
and future prospects. Contraception 75(6):468–473.
[5]
Gebremariam,A .,Addissie,A(2014). Intention to use long
acting and permanent contraceptive methods and factors
affecting it among married women in Adigrat town, Tigray,
Northern
Ethiopia.
Reproductive
Health,
11:24
doi:10.1186/1742-4755-11-24
[6]
[7]
[8]
[9]
Mekonnen,G., Enquselassie,F., Tesfaye,G., Agumasie
Semahegn,A(2014). Prevalence and factors affecting use of
long acting and permanent contraceptive methods in Jinka
town, Southern Ethiopia: a cross sectional study. The Pan
African Medical Journal. 18:98. http://www.reproductivehealth-journal.com/content/11/1/24
Alemayehu, M ., Belachew,T., Tilahun, T(2012). Factors
associated with utilization of long acting and permanent
contraceptive methods among married women of reproductive
age in Mekelle town, Tigray region, north Ethiopia. BMC
Pregnancy
and
Childbirth
,12:6
http://www.biomedcentral.com/1471-2393/12/6
Wakhisi, AS., Barrette,G., Reidpath,D(2012). Factors
associated with use of long acting reversible contraceptives
among young women in the UK. Opinions and lifestyle survey
user meeting, London, 21st March, 2012.
Systematic Screening Tool; developed by Population Council
and adapted for postpartum use by JHPIEGO under the
ACCESS-FP project.
[10] Finer, L.B., Jerman, J., Megan L. Kavanaugh, M.L (2012).
Changes in use of long-acting contraceptive methods in the
U.S.,
2007–2009.
j.fertnstert.98
(4):893-897.
doi:10.1016/j.fertnstert.2012.06.027.
[11] EDHS(2005). Preliminary report, CSA and Measure DHS
ORC Macro, 2005
[12] Family Health International (2007). Ambaw Damtew Regional
Program Manager Pathfinder International/ Ethiopia Mengistu
A.,
Snake
M.D.,
M.P.H.Deputy
Country
Representative .Pathfinder International/Ethiopia Developed
and written by Jennifer Wilder Senior Technical
Communications
Advisor
Pathfinder
International
http://www.fhi.org (Accessed December 2007).
[18] Hailay Gebremichael, Fisaha Haile, Awrajaw Dessie, Alula
Birhane, Mussie Alemayehu, Henock Yebyo. Acceptance of
Long Acting Contraceptive Methods and Associated Factors
among Women in Mekelle City, Northern Ethiopia. Science
Journal of Public Health. Vol. 2, No. 4, 2014, pp. 349-355. doi:
10.11648/j.sjph.20140204.27
[19] Paul Kisia Malalu, Koskei Alfred, Robert Too, Amon Chirchir.
Determinants of Use of Modern Family Planning Methods: A
Case of Baringo North District, Kenya. Science Journal of
Public Health. Vol. 2, No. 5, 2014, pp. 424-430. doi:
10.11648/j.sjph.20140205.18
[20] Badal Ahmed Hassan, Edinam K. Glover, Olavi Luukkanen,
Ramni Jamnadass, Ben Chikamai. An Assessment of the
Socio-Economic and Ecological Impacts of Environmental
Changes on Rural Livelihood: A Study Across Addado,
Buhodle and Northern Galkaayo of Central and Northern
Somalia. Agriculture, Forestry and Fisheries. Vol. 3, No. 4,
2014, pp. 279-291. doi: 10.11648/j.aff.20140304.20
[21] Chandhick N, Dhillon BS, Kambo I, Saxena
NC(2003).Contraceptive knowledge, practices and utilization
of services in the rural areas of India (an ICMR task force
study). Indian J Med Sci 2003; 57:303.
[22] Sarah Petters (2008). A Thesis Submitted to the Faculty of the
Department of Population and International Health Harvard
School of Public Health in Partial Fulfillment of the
Requirements for the Degree of Masters of Science Boston,
Massachusetts (Accessed May, 2008).
[23] Controlling the world population. http://www.
Commandments by Robert T.Lee (Accessed 2004-11).
Ten
[24] Guinea-LAMPs-final Community Awareness of and Attitudes
toward Long Acting and Permanent Contraception in Guinea
http://www.rcog.org.uk (Accessed September 2006).
[25] Long acting permanent contraception an international
perspective. Volume 52, No. 4, http://www.fhi.org (Accessed
July/August 2007).
[26] Geography of Africa http://en.wikipedia.org/wiki/category:
(Accessed on Dcember1 2012).
[27] Population
in
Sub-Saharan
Africa
http://www.wikipediafoundation.org/ (Accessed in December
2012.