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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 27  |  Issue : 1  |  Page : 24-30

Assessment of fertility behaviors among women of reproductive age in a rural community, northwest Nigeria


1 Department of Community Medicine, College of Medicine, Kaduna State University, Kaduna, Nigeria
2 Department of Obstetrics and Gynecology, Bayero University, Kano, Nigeria
3 Department of Community Medicine, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria

Date of Submission13-Aug-2020
Date of Decision30-Jan-2021
Date of Acceptance04-Mar-2021
Date of Web Publication3-Dec-2021

Correspondence Address:
Jimoh M Ibrahim
Department of Community Medicine, College of Medicine, Kaduna State University, Kaduna.
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmh.IJMH_55_20

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  Abstract 

Background: High fertility is one of the primary determinants of rapid population growth, which can hinder socio-economic development. Age at first marriage is an important proximate determinant of fertility and one of the causes of high fertility level in developing countries where the practice of early marriage remains widespread. Objective: The objective was to assess the fertility behaviors among women of reproductive age in a rural community, in northwestern Nigeria. Materials and Methods: A cross-sectional descriptive community-based study with minimum sample size of 320 was conducted in 2019 using systematic sampling method. Results: The mean age (±SD) of females in the community was 26.9 (±SD 8.3) years. The mean age at first marriage was 15.31 (±SD 2.4) years, contraceptive use was 5.4%, and one-third of the women were in polygamous settings. The total fertility rate was 6.95 per woman. There was significant association between marriage type and number of marriages with the number of living children (P = 0.001). Conclusion: Majority of the women were under aged at first marriage, had very low rate of contraceptive use, and fertility rate was high among them. Marriage type of the respondents had a significant association with fertility. Policies and laws that prohibit child marriage are recommended, in order to encourage girl child education and improve female participation in decision-making with regard to fertility desire and behaviors.

Keywords: Contraception, family, fertility, mean, rate


How to cite this article:
Ibrahim JM, Adamou N, Olorukooba AA, Omole NV. Assessment of fertility behaviors among women of reproductive age in a rural community, northwest Nigeria. Int J Med Health Dev 2022;27:24-30

How to cite this URL:
Ibrahim JM, Adamou N, Olorukooba AA, Omole NV. Assessment of fertility behaviors among women of reproductive age in a rural community, northwest Nigeria. Int J Med Health Dev [serial online] 2022 [cited 2023 Jan 31];27:24-30. Available from: https://www.ijmhdev.com/text.asp?2022/27/1/24/331728




  Introduction Top


High fertility is one of the primary determinants of rapid population growth, which can hinder socio-economic development.[1] Thus efforts to reduce poverty and promote sustainable development have included an emphasis on strengthening family planning programs. To date, the majority of family planning programs have focussed on methods which address women’s family planning needs, as opposed to addressing both women and men as full partners in fertility decisions and responsibilities.[2] Several efforts have been made in order to understand the determinants of fertility because fertility is regarded as an important component of population change and, therefore, has attracted the interest of scholars and policy-makers.[3] At the Cairo and Beijing World Conferences on Women, delegates raised the problems of gender imbalance, reproductive rights and responsibilities, abuse of reproductive rights, and sexual violence.[4]

In Nigeria, women hardly have a say on matters relating to the timing of the next birth, the number of children, and when to stop childbearing. Because the views of women who bear the burden of pregnancy and childbirth are hardly sought, most often the number of children a woman bears is perceived to reflect the desired fertility of her husband and his relatives.[5] However, the relative decline in men’s resources due to economic downturn has increased women’s contribution to family resources as well as their participation in decision-making, including reproductive health matters.[6] As a result of these changes in the economic environments of households and increase in egalitarian cultures, a few studies have found that partners have discordant responses on reproductive health intentions and behaviors.[7],[8] Marriage age, which also refers to age at first marriage, is an important proximate determinant of fertility and indeed has not only been linked with democratic change in many parts of Europe and North America where fertility has stabilized at low levels, but has also been identified as one of the causes of high fertility level in developing countries of Africa and Asia where the practice of early marriage remains widespread.[9] It is widely believed that by delaying marriage, several hundreds of thousands of young girls will acquire improved education which will enable them to demand for basic human rights and participation in the workforce, which may likely cause positive changes in their fertility desire and ultimately their fertility behaviors.[10] There is therefore a nexus among age at first marriage, fertility behavior, and women’s empowerment.[10]

Nigeria is the tenth most populous country in the world and the largest in sub-Saharan Africa, with an estimated population of 182 million in 2015.[11] The potential growth of the population is due in part to the momentum created by Nigeria’s youthful age structure, with nearly two-thirds (64%) of the current population being below age of 25.[12] Despite the high fertility rate, acceptance and utilization of mother family planning methods are low.[4]

The problems associated with this rapid rate of population growth were recognized by the Nigerian government in 2004 as “having an adverse impact on living conditions, health, nutrition and wellbeing especially of mothers and children.” It was noted that “such population growth will put pressure on the health, education, housing and public services—water supply, roads etc, resulting in declining quality.” Per capita food production will decline resulting in food shortage; unemployment and insecurity will increase as well as the level of urbanization with resultant increase in urban slums, poverty, and crime.[13]

In Nigeria, women and girls have unequal economic, social, and political opportunities compared with men.[14] This is so and is sustained by Nigeria’s socio-cultural system that not only promotes women’s subordinate position, but also sustains inequality in decision-making positions in government.[15] Norms supporting high fertility remain deeply rooted in the cultural values of developing countries.[4] The fertility rate is influenced by age at first marriage, women’s educational attainment, husband’s educational attainment, infant and child mortality, contraceptive use, women’s workforce participation, residential location, family type, son preference, and standard of living.[4] The study therefore is aimed at determining the fertility behaviors among women of Doka community, Kudan Local Government Area (LGA) of Kaduna State.


  Materials and Methods Top


Study area

Doka is a rural community located in Kudan LGA of Kaduna State in the northern part of Nigeria. It is about 40 km from the ancient city of Zaria. The dwellers of the community are mainly Hausa and Fulani Muslims whose activities are guided by the tenets of Islam. They practice the extended family system and give out their daughters in marriage due to the firm belief that a girl should not have her second menstrual cycle in her parent home.[16] In their marriage system, the groom is expected to pay a dowry which is in accordance with the teaching of Islam.[16]

The community has an Arabic and Quranic school, a primary school, and a secondary school. The Primary Health Care (PHC) facility in the community offers antenatal care, delivery, immunization, and family planning services.[16] The main occupation of the inhabitants of the community is farming and a few people are artisans. The total estimated population of Doka community was 5801.[16]

Study design

A descriptive, cross-sectional community-based study was carried out from 19th December 2018 to 31st January 2019 among married women in Doka community. Inclusion criterion (among others) was married women of Doka community, and the people who were excluded from the study were non-residents of the community, members of the community not present at the time of survey, and those not willing to participate in the study.

Sample size determination

Sample size was calculated using Cochran’s formula for cross-sectional studies when the outcome variable is a proportion.[2] An absolute precision of 5% as well as a standard normal deviate at a confidence level of 95% corresponding to 1.96 was used in the computation. A proportion of couples who desire more children (27.6%) from a previous study was inserted into the formula for calculating single proportion.[7]

The required sample size (n) was calculated using the formula[2]





Finite population correction as well as adjustment for non-response of 10% was applied. A minimum sample size of 320 respondents was finally achieved for the study.

Sampling technique

Multistage sampling technique was applied in this study.

Stage 1: One ward, Doka was selected out of the 10 wards in Kudan LGA using simple random sampling method by balloting.

Stage 2: Doka community was selected out of the four communities that make up Doka ward using simple random sampling method by balloting.

Stage 3: The systematic random sampling technique was used following house numbering and household listing which gave the total households as 876, the minimum sample size was 320, and approximately sampling interval was calculated to be 3. Therefore, every third household was selected to pick the respondents until the required sample size was obtained.

Stage 4: One eligible female respondent was selected from each of the selected households and where there was more than one eligible respondent in a household, one respondent was selected using simple random sampling by balloting.

Data collection tool and procedure

Data were collected using a pretested structured interviewer-administered questionnaire modified, validated, and adapted from previous studies.[3],[5],[8],[10] The data collection was carried out by the researcher and four trained research assistants who were final year medical students of Ahmadu Bello University Zaria. The researcher supervised the overall data collection process and checked the filled questionnaires for consistency and completeness. The questionnaire comprised three sections that sought information on socio-demographic profile of the respondents, contraceptive use, and other fertility behaviors.

Data analysis

Data collected were coded, entered into the computer, and analyzed using Statistical Package for Social Sciences (SPSS, IBM Corporation USA) software version 23. Results were presented in tables and charts. Univariate analysis using frequencies, proportions, means, and standard deviations was used to represent single variables as appropriate. Bivariate analysis was carried out using χ2 or Fisher’s exact test to determine the association between independent variables and dependent variables. Statistical significance was set at p-value of 0.05.

Ethical considerations

Ethical approval was obtained from Kaduna State Ministry of Health, permission was sought from Kudan LGA Council, and informed consent was obtained from all the eligible respondents. The study participants were informed about the purpose of the study and were also informed that they could voluntarily withdraw from the study at any time. Respondents were assured of confidentiality and the data obtained were stored in a password-protected computer that was only accessible to researchers.


  Results Top


Socio-demographic characteristics of women

The mean age of respondents was 26.94 (± SD 8.37) years [Table 1]. Frequency distribution of the age of women shows that 59 (18.3%) were within the age group of 15–19 years, whereas 16 (5%) were within the age group of 45–49 years. Regarding the educational status of the women, majority of them (166 (52%)) had only Quranic education, whereas 27 (8.5%) had secondary education and only four (1.3%) had tertiary education.
Table 1: Socio-demographic characteristics of the respondents

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In [Table 2], women currently using contraceptives were 17 (5.3%), women who had their first marriage as teenagers were 300 (94.1%), and the mean age at first marriage was 15.31 (± SD 2) years. About 116 (36.4%) were married before the age of 14 years. Two-thirds, i.e. 195 (61.1%), of the respondents were in monogamous marriage settings and only six (1.9%) of the women reported that their husband had four wives.
Table 2: Fertility behaviors of respondents

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In [Figure 1] in the last 1 year, age group 15–19 years had 16 live births, age group 20–24 years had 16 live births, 25–29 years had 22 live births, 30–34 years had 13 live births, 34–39 years had five live births, 40–44 years had one live birth, and 45–49 years had one live birth. The total live births in the last 1 year preceding the survey in the community were 74.
Figure 1: Live births among women in Doka community in the last 1 year (n = 74)

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In [Figure 2], the age-specific fertility rate (ASFR) rose starting from age group 15–19 years (280/1000) and peaking at age group 25–29 years (310/1000) before declining. In [Figure 3], about one-third (31.8%) of women had 3-4 pregnancies in the community, while 17.8% of women had 5-6 pregnancies and 11.2% had 9-10 pregnancies. In [Table 3], the total fertility rate (TFR) was 6.95 children per woman, the crude birth rate (CBR) was 30/1000 population, and the general fertility rate (GFR) was 234.2 live births/1000 women. In [Table 4], there was statistically significant association between the marriage type of the women and the number of living children (P = 0.001). Also there was a statistically significant association between number of marriages and number of living children (P = 0.003). In addition, there was no statistically significant association between age at first marriage and number of living children (P = 0.6).
Figure 2: ASFR among women in Doka community

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Figure 3: Number of pregnancies among women of Doka community

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Table 3: Fertility rates in Doka community

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Table 4: Behavioral factors affecting fertility

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  Discussion Top


The contraceptive prevalence of women in the community was very low (5.3%) compared with the findings from three African peri-urban communities: Sebeta, Ethiopia (66.9%), Asawase, Ghana (12.6%), and Ipetumodu, Nigeria (29.4%).[17] The poor contraceptive use in this study might be due to high fertility desire, poor access to contraceptive commodities, and low literacy level. The contraceptive prevalence in Doka community differs substantially when compared with those of the aforementioned communities possibly because being a rural community, it lacks access to contraception due to very weak and non-responsive healthcare delivery system for contraceptive service typical in such areas. The high contraceptive prevalence in the cited peri-urban communities may be a reflection of the strong programmatic attention on contraception present in many urban areas where there is also high awareness and level of education relative to rural areas. The implication of low contraceptive use is that it may lead to population explosion in the nearest future, which can hinder socio-economic development and increase poverty level and thus hinder sustainable development. The World Health Organization (WHO) considers the prevalence of contraceptive use in a society as one of the determinants of women’s health and empowerment in that society.[18]

Age at marriage is of particular interest because it marks the beginning of regular exposure to the risks of pregnancy and childbearing, hence affecting fertility levels and population growth especially in countries with low contraceptive rates. In this study, the majority of the women (94.1%) married at the age of 19 years or below, and only 5.9% married at age 20 years and beyond. This proportion of early marriage is far higher than the other studies in Nigeria and Gambia.[10],[19] It is also far higher than a study in USA in which 31% of White women, 17% of Black women, and 10% of Hispanic women had their first marriage at the age of 16 years.[20] The social implication is that at such young ages, females are neither physically mature nor psychologically prepared to be mothers. Besides, marriage at an early age is mostly based on incomplete information and exaggerated expectations of husbands or wives and in-laws which make young brides feel uncomfortable about the marital union and may not take actions to avoid or delay pregnancy.[4] The young couples may not also have adequate knowledge about one another, leading to uncertainty about the future of their marriage. Furthermore, early marriage and the consequent early sexual debut are commonly associated with obstetric health complications such as obstructive labor, leading to elongated timing of first birth and fistula.[4]

In this study, almost two-thirds of the women were in monogamous marriages (61.1%) and only 38.9% of the married women were in polygamous unions which is similar to findings among Saudi women, in which two-thirds of the sample live in monogamous settings (65.6%) and the other third was in polygamous unions (33.8%).[18] But this study contrasts with findings in Kaduna, Nigeria and Gambia, which reported that the majority of the married women were in polygamous unions.[4],[19] The high proportion of women in monogamous union in this study might be due to very low socio-economic status associated with rural farmers, which may hinder their spouses (husbands) from marrying more wives when compared with men in urban areas. Women in polygamous unions in Gambia reported an average of 1.33 co-wives.[19] If the practice of monogamy is sustained within a community, this may reduce the competition for having many children among co-wives as is frequently obtainable in polygamous settings. Polygamy is a common practice in predominantly Hausa and Muslim settings in Nigeria, which seem to serve as an index of attainment and affluence as men grow older. Islam allows a man to marry up to four wives at a time, which could have profound effects on the number of children he fathers.[21]

In this study, the ASFR fluctuates starting from the age group of 15–19 years and peaks at 25–29 years before declining thereafter. CRB is 30/1000, GFR 234.2/1000, TFR is 6.95 per woman, while gross reproductive rate (GRR) is 4.32. This is similar to a study in Malumfashi, Katsina State, northwestern Nigeria, which reported that the ASFR rose starting from the age group of 15–19 years and peaked at 25–29 years before declining. The TFR was 7.97 children per women, the CBR was 34.8/1000, and the GFR was 188.9/1000 women.[22] This finding is not unexpected because fertility differs greatly between urban and rural areas in sub-Saharan Africa. Urbanization is frequently associated with lower fertility, explained in part through the effects of migration (including selection and spousal separation) and the effects of modernization and westernization associated with urban living.[23] A study found that over 15 years the gap between urban and rural TFR was widening for Benin, Cameroon, Nigeria, Tanzania, and Zambia.[24]

In this study, pregnancy was a common experience among currently married women with more than 89% reporting at least one pregnancy, which is almost similar to findings in which pregnancy was a common experience among currently married women and more than 93% reporting at least one pregnancy, with the mean number of living children being 5.2.[22] This may be due to high fertility rate among the respondents.

In this study, the association between the marriage type (monogamy or polygyny) of the women and the fertility was statistically significant. The women in monogamous union had more children than those in the polygamous setting which is consistent with another study which support the observation that women in polygamous unions have lower fertility than those in monogamous unions.[22] But a study in south western Nigeria reported that more couples in polygamous unions (71.4%) wanted more children than those in monogamous unions (58.4%).[5] In addition, there was a statistically significant association between number of marriages (married more than once) and number of living children. A woman who married more than once is likely to have children in all the marriages.


  Conclusion Top


There was low contraceptive use, very high under-aged marriages, and about two-thirds of the women are in monogamous unions. The TFR was 6.95 per woman. Marriage type of the respondents had a significant association with fertility. Policies and laws that discourage child marriage are recommended, in order to encourage girl child education and improve the socio-cultural and -economic status of women, thereby promoting female participation in decision-making with regard to fertility desire and behaviors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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