Patterns of Contraceptive Usage and The Common

Reasons for Discontinuation of Contraceptive Use

in Women Attending the Family Planning Clinic of
Lagos University Teaching Hospital.
Introduction
The voluntary control of fertility is of great importance to
modern society and a human right issue. It is central to
gender equality and womens empowerment, and a key
factor in reducing poverty. Yet some 225 million women
who want to avoid pregnancy are not using safe and
effective family planning methods, and most of these
women with an unmet need for contraceptives live in 69
of the poorest countries on earth of which Nigeria is one.
From a global perspective, human survival is threatened
by population explosion without corresponding increase in
the available earth surface. It is postulated that at this
present rate, the population of the world will double in 40
years; and in several of the more socioeconomically
disadvantaged countries such as ours, populations will
double in less than 20 years.
Unplanned pregnancies account for 40% of the 210
million annual pregnancies worldwide.1 An estimated one
in five pregnancies is unplanned in Nigeria. 2 Family
planning prevents unintended pregnancies and induced
or unsafe abortions and its sequelae. 3 It is estimated that
90% of abortion-related and 20% of pregnancy-related
morbidity and mortality, along with 32% of maternal
deaths, could be prevented by use of effective
contraception.4 Another estimated annual 448 million
treatable sexually transmitted diseases and over 80% of
1

HIV infections worldwide could also be prevented if

women choose to use contraception5,6 as some
contraceptives confer protection against sexually
transmitted diseases. Only about 15% of women 7 in their
child bearing years embrace family planning in Nigeria
and 10% of world annual 20 million abortions with its
sequelae come from Nigeria.8
Contraception is the use of various devices, drugs,
agents, sexual practices or surgical procedures to prevent
pregnancy. Contraception is said to be as old as man. It
involves the use of modern methods such as oral
contraceptives, injectables, implants, intrauterine devices
and sterilization and traditional methods such as
withdrawal, periodic abstinence, charms and herbal
mixtures from traditional healers. On the average worldwide, nearly 9 in every 10 contraceptive users rely on
modern methods while only about 1 in every 10 relies on
traditional methods.9
The specific contraceptive methods that women use vary
substantially from country to country and even within one
country from region to region. The method mix in a
country is a reflection of many factors, including the
availability of various contraceptive methods and
people's awareness of them, cost, and where they can be
obtained. In addition, personal preferences, social norms,
gender preferences, women's education, rural or urban
residence and perceived acceptability of family planning
use affect contraceptive choices.10
Monitoring of family planning rates and trends is a tool for
evaluation of progress towards achievement of universal
access to reproductive health, which was a target in
2

millennium development goal (MDG) 5 and now a

suggested indicator for sustainable development goal 3.
It also indicates the investments needed and progress
expected from programmatic efforts to expand access to
effective contraceptive methods.
Global efforts to
improve women's and children's health and increase
access to family planning information, services, and
supplies mean a heightened demand for frequent,
comparable, and timely estimates of family planning
indicators to monitor progress. However, this is
challenging due to the paucity of data in our environment
as in most developing countries.
Aims
This study intends to identify the different methods of
contraceptive being used in the study population, the
commonly used methods in relation to the age and
sociodemographic status of the women as well as the
common reasons for discontinuation of the different
methods used.
Objectives
To identify the commonly used contraceptive
methods amongst women who sought contraceptive
services in Lagos University Teaching Hospital during
the study period.
To determine the socio-demographic variables of
women who sought contraceptive services in Lagos
University Teaching Hospital during the study period.
3

 To determine the relationship between sociodemographic variables and contraceptive usage.

To identify the common reasons for discontinuation of
contraceptive in the study population.
Materials and Methods
This was a 5- year retrospective study carried out at the
Lagos University Teaching Hospital, which serves as one
of the two tertiary/referral health facility for Lagos state
and its environs. The hospital has a family planning clinic
which opens from Monday to Friday every week and is not
referral dependent. The family planning notes of all 990
women who attended the clinic from 2 nd January, 2010 to
31st December 2014 were retrieved from the clinic record
library.
A structured form was used to extract the biodata,
methods of contraceptive used, parity level of education
and reason for discontinuation, and the data was
analyzed using Microsoft Excel 2013. The results of the
study were presented using descriptive frequencies.
Results
There were 990 contraceptive users during the period of
study. The mean age of contraceptive users was 33.69
years with a range of 16-51 years. About (81.13%) of the
women were in the age group 26 years to 40 years and
1.01% were less than 20years. Less than half (46.36%) of
the users had three to four deliveries while 3.54% were
nulliparous. The most preferred contraceptive was the
4

implant Jadelle (46.57%), followed by the intrauterine

copper device Copper T (21.625), Implanon (15.45%),
injectables (Depo provera-4.14%), combined oral
contraceptive pills (2.81%), female condom (0.10%).
Bilateral tubal ligation and vasectomy were not used.
Most (77.37%) of the contraceptive users had attained
tertiary levels of education, 18.28% and 4.35% attained
secondary and primary levels of education respectively.
Majority of these women (95.11%) were in some form of
paid employment. Most of the women (72.53%) continued
with the use of their chosen contraceptives and the
common reason for discontinuation was perceived or
obvious adverse effect (15.66%), 5.86% discontinued
because they planned to get pregnant while 5.95% gave
no reason for discontinuation.

Discussion
The findings of this study revealed a strong relationship
between the level of education, employment status and
the use of contraceptives which corroborates the findings
from a recent study Women's Education, Empowerment,
and Contraceptive Use in sub-Saharan Africa11More
educated women as well as women who were in any form
of paid employment are more likely to use
contraceptives.12 This may be because these group of
women tend to appreciate the importance and benefit of
family planning as well as reduced family size and the
impact on quality of life.
5

The highest frequency of users was in the age group 31

years to 35 years while the least was in the age group
less than 20 years. This trend brings about mixed feelings
as most of the women within 31-35 years also had 3-4
children alive, indicating that they are probably using
contraceptives because they have completed their family
size. On the other hand, only 1% of women under 20
years who are most likely more sexually active and not
prepared for pregnancy sought contraceptive use at the
study centre. This indeed is a disturbing trend in our
country Nigeria where more than 60% of teenagers were
sexually active and account for 60% of the 610,000
estimated induced abortions.3A review of studies of
young women, primarily unmarried women in subSaharan Africa, identified lack of access to family
planning education and information concerning how
contraceptive methods work as well as the social
disapproval associated with seeking contraceptive
services as underlying themes across the studies. 13There
is need therefore to come up with ways to access
contraceptive services with ease and confidentiality as
well as more education on how the different methods of
contraceptives work.
A surprising outcome of this study is the preference of the
women in this study group for the implant Jadelle unlike
what has been the common trend for intrauterine
contraceptive device.3,14
There is a need to further study how levels of education
influence the use of contraceptives

Conclusion
Expansion of access to contraception and reduction of
unmet need for family planning are key components to
improve reproductive health, therefore the need for
women to embrace contraception cannot be over
emphasized as socioeconomic conditions of families are
also improved since contraceptive usage means fewer
mouths to feed, clothe and less spending on childrens
education.

Age Distribution
The ages of the women ranging from 16-51 + years were
categorized into intervals of 5 years.

350

300

250

200

150

100

50

16-20

21-25

26-30

31-35

36-40

41-45

46-50 51and above

The chart above showed that the highest proportion of

contraceptive users was aged between 31 and 35 years
(35.35%), followed by those aged 36-40 (24.14%), 26-30
(23.64%) and those aged 51+ years and above (0.61%)
were ranked the least in the distribution. This indicates
that most women within the age group of 31-35 years
seek contraceptive service either because they have
completed their family size or need to plan their family. It
is therefore imperative that contraceptive services for
these group of women should be easily accessible.
Methods of Contraceptives Used
8

500
450
400
350
300
250
200
150
100
50
0

The table above shows a high disparity between the use

of the implant Jadelle (46.57%) and other methods.
Overall more than half (62.02%) of the population used
an implant, this was followed by the intrauterine devices
(25.96%),
injectables
(4.14%),
combined
oral
contraceptives (2.81%), female condom (0.1%). Bilateral
tubal ligation and vasectomy were uncommon.

Level of Education
This study sought to find if levels educational attainment
had any relationship with seeking contraceptive service.
9

Distribution of Contraceptive Users by Educational

Qualification
LEVEL
EDUCATION
Primary
Secondary
Tertiary
Total

OF FREQUENCY
43
181
766
990

PERCENTAGE
4.35
18.28
77.37
100.00

The table above shows that most of the women (77.37%)

who sought contraceptive services within the study
period attained tertiary levels of education, with another
18.28% attaining secondary levels and only 4.35% had
primary education. This shows a strong correlation
between levels of educational attainment and seeking
contraceptive care.

The occupational pattern

10

500
450
400
350
300
250
200
150
100
50
0

The table above show the occupational pattern of

contraceptive users with more of these women working in
the private sector (46.57%) followed by government
employees (28.07%), (20.51%) were self-employed
whereas the unemployed and retirees made up 3.54%
and 1.31% respectively. Again another strong relationship
between paid employment and use of contraceptive.

Number of Children Alive

11

4%

9%

41%

46%

1-2

3-4

5 and above

The table above reveals the child bearing pattern of the

contraceptive users. Most of the women (46.36%) had 3-4
children alive, followed by 1-2(40.71%), 9.39% had 5 or
more children and only 3.54% were nulliparous.

Common Reasons for

Contraceptive (n = 990)
12

Discontinued

Use

of

Reason
for Frequency
Discontinuation

Percentage

Desired
Pregnancy
Adverse Effects
No Reason
Continued Use
Total

58

5.86

155
59
718
990

15.66
5.95
72.53
100.00

From the table above it is evident that most (72.53%) of

the women in the study population continued with their
choice of contraceptive method during the study period.
About 15.66% discontinued due to perceived or real
adverse effects. The remainder discontinued either
because they desired to get pregnant (5.86%) or they
didnt have any reason (5.95%).

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