Abstract

PIP: An integrated health and family planning program, operated by the University of Ife Teaching Hospital, was assessed to determine the impact of the integrated approach on family planning service utilization among the predominantly Yoruba residents of the city. In Nigeria, family planning services are generally delivered in clinics which have little or no connection with medical facilities, and service utilization is low. In 1979 the hospital decided to include family planning as part of the routine medical services provided at its 8 clinics located within a 25 kilometer radius of the hospital. Staff members at the clinics were trained in family planning. Trained female fieldworkers conducted motivational activities to encourage the women in the community to use the family planning services of the clinic. The program provided women with an opportunity to obtain contraceptives in a familiar setting and as part of their routine medical care. Neither parental nor spousal consent was required. Yoruba men tend to oppose family planning. Data for the study was obtained from the records of the program's 1495 new acceptors served by the program during its first 2 years of operation. 50.6% of the acceptors were 25-34 years of age, and another 31.7% were between 35-44 years of age. Very few teenagers utilized the services. 96% of the wome were married and they had an average of 4.4 living children. 56% were Catholic, 25% were Protestant, and 16% were Muslim. 37% were illiterate, and another 42.5% could barely read or write. Most were wives of government workers or service men. 88% had never used a modern contraceptive, and 94.5% were not using a method at the time of their first clinic visit. 68.4% of the acceptors were referred to the clinic by the fieldworkers or other health personnel. Only 11.2% sought the services on their own. 85% of the acceptors choose oral contraceptives (OCs), 13% had IUDs inserted, 0.3% were sterilized, and the remaining 2% chose other methods. The low sterilization rate probably reflected the fact that spousal consent was required for sterilization. Side effects reported by the OC users included asthma (9.6%), headaches (5.2%), phlebitis (3.5%), jaundice (1.7%), chest pain (1.5%), depression (1.5%), scanty menses (0.8%), and high blood pressure (0.4%). Among IUD users, 10.8% had intermenstrual bleeding, 18.4% reported pelvic pain, and another 6.8% reported a variety of other problems. 42.1% of the acceptors wanted no more children, and the remainder wanted to avoid the hardships associated with traditional methods of spacing. Correlation analysis revealed that the total number of living children was negatively related to maternal education and that women with sons wanted significantly fewer additional children than women with fewer or no sons. 51% of the acceptors were continuing contraceptive use at the time of the study. The study confirmed the feasibility of an integrated approach. The findings should be of use to government officials who want to improve service utilization in the national family planning program.