NURSES’ AND MIDWIFERY TRAINING COLLEGE, TAMALE

DIPLOMA IN REGISTERED MIDWIFERY/GENERAL NURSING PROGRAM

TOPIC: ACCESS TO AND UPTAKE OF FAMILY PLANNING SERVICES BY

FEMALE STUDENTS IN NURSES AND MIDWIVES TRAINING COLLEGE TAMALE

(TNMTC)

NAMES INDEX NUMBERS

IBRAHIM YUSSIF D21/2018/043

BENEDICTA SIDA AWINI ADAMS DM10/2018/048

RAHAMAN JAHARA BUGRI PNM2/2019/044

SUPERVISOR: MADAM LETITIA CHANAYIREH

JANUARY, 2021
NURSES’ AND MIDWIVES TRAINING COLLEGE, TAMALE

DIPLOMA IN REGISTERED MIDWIFERY/GENERAL NURSING PROGRAMME

ACCESS TO AND UPTAKE OF FAMILY PLANNING SERVICES BY FEMALE

STUDENTS IN NURSES AND MIDWIVES TRAINING COLLEGE TAMALE (TNMTC)

BY

NAMES INDEX NUMBER

IBRAHIM YUSSIF D21/2018/043

BENEDICTA SIDA AWINI ADAMS DM10/2018/048

RAHAMAN JAHARA BUGRI PNM2/2019/044

RESEARCH WORK SUBMITTED TO THE NURSES’ AND MIDWIVES’ TRAINING

COLLEGE, TAMALE IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR

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AWARD OF DIPLOMA IN REGISTERED GENERAL NURSING (MIDWIFERY)

CERTIFICATE

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iv
 ABSTRACT

Our study was designed to determine the access to and uptake of family planning services by

female students in nurses and midwives training college tamale. It was found that, few studies

have been carried out on female students and their access to and uptake of family planning

service in the school, not a single document concerning a similar study in Ghana has been

published.

The global incidence of unplanned pregnancies amongst students at higher educational

institutions every year continues to rise up despite the high awareness and knowledge on regular

modern contraceptives and emergency contraceptives among students in the higher educational

levels (WHO, 2013). Despite the immense contraceptive benefits for students in higher

educational institutions(Gbagbo, 2019).

Studies in Africa, have generally documented low knowledge and awareness levels of effective

contraceptive use amongst higher educational students (Ahmed et al. 2012). Several factors

including age, culture, ethnicity, religion, poor access to contraceptive services, peer pressure

and lack of partner support were identified as contributing to the non-utilizations of

contraceptives in tertiary institutions(Gbagbo, 2019). In a study amongst 15 to 24 year old South

African women, it was estimated that only 52.2% of sexually experienced women are patronizing

contraceptives (Macphail, et al. 2007)

In designing the instrument of the study, the objectives were used as indicators. It was made in

such a way that; the questionnaire should reflect the reality of the objectives. Similarly, literature

review was obtained from various sources to serve as basis for determining validity and

reliability of the study. Questionnaires were the adapted method in gathering the required data.

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Tables and figures was used in the presentation of data and conclusions as well as

recommendations was made using the data analyzed.

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 ACKNOWLEDGEMENT

We wish to thank the Almighty Allah for granting us HIS mercies and blessings with the

knowledge and understanding of putting this piece of work together successfully.

We also express a high level of gratification to the principal of the nurses’ and midwifery

training college, Tamale, Mr. Abdulai Abdul Malik.

Also, our heartfelt gratitude’s go to our noble and supervisor, Madam Letitia Chanayireh, a Tutor

at the Nurses And Midwifery Training College Tamale, for her guidance, immeasurable

suggestion in this dissertation.

Many thanks also to the respondents for their corporation during data collection and to our

parents and relatives for their support both morally and financially.

Finally, we wish to express our heartfelt gratitude to all and sundry who in one way or the other

help us during this course. We say a big thank you and may God bless us all.

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 DEDICATION

We dedicate this work to the Almighty God/Allah who makes everything possible.

We also dedicate it to our parents, tutors and all our love ones for their care and support and also

encouragement. A special dedication to our supervisor for her guidance and support.

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 TABLE OF CONTENTS

DECLARATION............................................................................................................................iii

ABSTRACT...................................................................................................................................iv

ACKNOWLEDGEMENT..............................................................................................................vi

DEDICATION..............................................................................................................................vii

LIST OF TABLES..........................................................................................................................xi

LIST OF FIGURES.......................................................................................................................xii

CHAPTER ONE..............................................................................................................................1

1.0 Introduction............................................................................................................................1

1.1 Background Of The Study.....................................................................................................1

1.2 Statement Of The Problem.....................................................................................................4

1.3 Purpose Or General Objective Of The Study.........................................................................7

1.4 Specific Objectives................................................................................................................7

1.5 Research Questions................................................................................................................7

1.6 Operational Definition...........................................................................................................8

Chapter Two....................................................................................................................................8

2.0 Review Of Related Literature..............................................................................................10

2.1 Factors Influencing The Decisions Of Female Students In The Uptake Of Family Planning

Services......................................................................................................................................10

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 2.2 Barriers In The Utilization Of Family Planning Services By Female Students...................12

2.3 The Impact Of Family Planning Services On Female Students...........................................15

Chapter Three................................................................................................................................19

Methedology And Study Design................................................................................................19

3.0 Introduction..........................................................................................................................19

3.1 Type Of Study Design..........................................................................................................19

3.2 Research Setting...................................................................................................................19

3.3 Study Population..................................................................................................................20

3.4 Sampling And Data Collection............................................................................................20

3.5 Inclusive Criteria..................................................................................................................21

3.6 Exclusive Criteria.................................................................................................................21

3.7 Tool And Method Of Data Collection.................................................................................22

3.8 Data Analysis.......................................................................................................................23

3.9 Reliability And Validity.......................................................................................................23

3.10 Ethical Consideration.........................................................................................................23

3.11 Limitation Of The Study....................................................................................................24

3.12 Overview Of The Study.....................................................................................................24

3.13 Proposed Budjet For The Study.........................................................................................25

3.14 Sources Of Fund For The Study........................................................................................25

Chapter Four..................................................................................................................................25
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Data Analysis.................................................................................................................................26

4.0 Introduction..........................................................................................................................26

4.1 Summary Of Socio-Demographic Data...............................................................................26

4.2 The Factors Influencing The Decision In The Uptake Of Family Planning........................30

4.3 Barriers To The Utilization Of Famaily Planning Service By Female Students In Tnmtc. 37

4.4 The Impact Of Family Planning Services On Female Students...........................................43

Chapter Five...................................................................................................................................51

5.0 Discussion, Conclusion And Recommendations.................................................................51

5.1 Discussion............................................................................................................................51

5.1.1 Socio-Demographic Data..................................................................................................51

5.1.2 Factors Influencing The Decisions Of Female Students In The Uptake Of Family

Planning Services.......................................................................................................................53

5.1.3 Barriers In The Utilization Of Family Planning Services By Female Students................54

5.1.4 The Impact Of Family Planning Services On Female Students........................................55

5.2 Conclusion...........................................................................................................................56

5.3 Recommendation.................................................................................................................57

References..................................................................................................................................58

Appendix........................................................................................................................................61

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 LIST OF TABLES

Table 1a frequency distribution of respondents’ socio-demographic data N(118).......................35

Table 2 Which of the method you /your partner used?.................................................................42

table 3 barriers to the utilization of famaily planning service by female students in tnmtc..........46

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 LIST OF FIGURES

Figure 1 do you have knowledge about family planning N(130)..................................................39

Figure 2 do you have access of family planning in your school?..................................................39

Figure 3 how many alive children do you have?...........................................................................40

Figure 4 did you use FP methods during your last pregnancy?.....................................................40

Figure 5 Have you/your partner ever used family planning method before?................................41

Figure 6 Reasons for not applying family planning?.....................................................................42

Figure 7 would you like to use family planning method in the future?.........................................43

Figure 8 what was your first source of information about this service?........................................43

Figure 9 are you currently using any contraceptive method?........................................................44

Figure 10 is the family planning services always available?........................................................45

Figure 11 where is the family planning service located?..............................................................45

Figure 12 By what means do you get to the family planning Centre?..........................................46

Figure 13 to the best of your knowledge, are you aware of someone that has lost his/her life as a

result of family planning?..............................................................................................................48

Figure 14 I feel in control of my career choices because of family planning services?................49

Figure 15 I know that my children are/will be healthy because of family planning?..................49

Figure 16 Family planning has helped me reach where I am today?...........................................50

Figure 17 I know that family planning services have contributed to the economic growth of the

country?.........................................................................................................................................50

Figure 18 My health and wellbeing is guaranteed by family planning?........................................51

Figure 19 Family planning helped in the preventions of STIs?.....................................................52

Figure 20 Does your family planning reduced the risk of ovarian and endometrial cancers?......53
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Figure 21 Family planning has helped in the prevention of the transmission of HIV/AIDS from

mother-to-child (PMTCT).............................................................................................................54

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 CHAPTER ONE

1.0 INTRODUCTION

1.1 BACKGROUND OF THE STUDY

The global incidence of unplanned pregnancies amongst students at higher educational

institutions every year continues to shoot up despite the high awareness and knowledge on

regular modern contraceptives and emergency contraceptives among students in the higher

educational levels (WHO, 2013). Despite the immense contraceptive benefits for students in

higher educational institutions(Gbagbo, 2019). There is no direct positive correlation between

the universal awareness, knowledge and use of contraceptives which challenges global health

efforts. The poor utilization of contraceptives in tertiary institutions is associated with many

interrelated factors ranging from personal to institutional setbacks (Gbagbo, 2019). This

eventually contributes to high unplanned pregnancy rates which is estimated to have contributed

to about 8 to 30 million annual pregnancies worldwide (Adhikari, 2009). Global estimates have

also shown that about 210 million pregnancies occur annually across the world. 75 million (or

about 36%) of the 210 are unplanned or unwanted pregnancies (Singh et al., 2010). Students

between the ages of 18 to 25 years old record the highest rates of unplanned or unwanted

pregnancies in the world’s tertiary institutions. A situation associated with multiple challenges

across the world for countries, academic institutions and the individuals involved (Vermaas,

2010).

There has been increase in uptake of family planning services worldwide, with over 80 % of

women of reproductive age in the world using various methods (Wood, 2006). According to

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UNFPA (2012) uptake of family planning services in third world countries increased from 1980-

2005 but still remains low as compared to developed countries. In developing countries

contraceptive use in Asia was 66%, 73% in Latin America and Caribbean, while only 22 % of

the women of the reproductive age in Africa are reported to have used contraceptives in their

lifetime (UNFPA, 2012).

Studies in Africa, have generally documented low knowledge and awareness levels of effective

contraceptive use amongst higher educational students (Ahmed et al. 2012). Several factors

including age, culture, ethnicity, religion, poor access to contraceptive services, peer pressure

and lack of partner support were identified as contributing to the non-utilizations of

contraceptives in tertiary institutions(Gbagbo, 2019). In a study amongst 15 to 24 year old South

African women, it was estimated that only 52.2% of sexually experienced women are

patronizing contraceptives (Macphail, et al. 2007). About 80% of undergraduate students at

higher educational institutions are sexually active, it is important that they have access to safe,

accessible and adequate family planning services in the schools contraceptive services (Bryant,

2009).

In Kenya family planning awareness is at 95% and 97% for men and women respectively due to

massive campaigns. However the uptake of family Planning service remains very low.

According to Kenya Demographic Health Survey (2013) the level of awareness on contraceptive

varies among the different methods. Modern methods are more familiar to adolescents and young

female adults than traditional methods; 95 percent of females know at least one modern method,

and only 69 percent know a traditional method. Although there is a safe and effective family

planning method for every woman that can enable her to protect her health and that of her

children, many young females do not use contraceptives(Paschal Awingura Apanga1,&, 2015).
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According to (Williamson et al. 2009) lack of awareness, lack of access, misconceptions and

negative social norms are some of the factors that affect the use of contraceptive among young

females. Studies conducted in Kenya have shown that uptake of family planning among the

female youths is affected by a number of factors. (Okech et al. 2011) reported factors among

urban slum women include partner’s approval, quality of the services, friendliness of the staff

administering the services and the woman’s knowledge about family planning services. On the

other hand KDHS (2009, 2014) identified education, marital status, woman’s income, and other

demographic and socio-economic status as factors that affect utilization of family planning

services. Unprotected sexual intercourse can lead to an unwanted adolescent pregnancy, which is

often considered a serious social and public health problem (Gomes et al. 2006; Mestadet al.

2011). Contraceptive usage by adolescents has been perceived to be influenced by various

factors, including, socioeconomic status, knowledge about contraceptives, attitudes about issues

related to contraceptives, residential area, educational status, counseling received about

contraceptives, attitudes of the contraceptive providers, cultural values, beliefs and norms

according to the Department of Health (DoH 2001; Kanku & Mash 2010). Although national

surveys on family planning Ghana Statistical Service (2014) have extensively looked at

contraceptive uptake in Ghana, little is known about contraceptive uptake among students in

Ghanaian colleges.

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1.2 STATEMENT OF THE PROBLEM

Globally, an estimated 56.3 million abortions occurred each year over the period 2010–2014.

(Chae et al., 2017) This article focuses on low- and middle-income countries (LMICs)which

account for approximately 86% of all abortions .(Chae et al., 2017) Although little variation

exists in abortion incidence across major geographical regions, it does vary widely by sub region

and within countries by subgroups of women. (Chae et al., 2017) Differential abortion levels

stem from variation in the level of unintended pregnancies, and variation in the likelihood that

women with unintended pregnancies obtain abortions. The incidence of unintended pregnancies,

in turn, is determined most immediately by the level of unmet need for contraception and

effectiveness of contraceptive use.(Chae et al., 2017) while variations in seeking abortions could

be determined by a range of factors including differences in the opportunity cost of giving birth,

strength of motivation to avoid having a child, knowledge of abortion sources, ability to pay for

an abortion, and the ease of access to abortion care .(Chae et al., 2017) Although legal in some

LMICs, abortion remains highly restricted in most of Africa and Latin America and the

Caribbean (LAC), and parts of Asia (Chae et al., 2017). The majority of women in LMICs, aside

from China and India where abortion is legal under broad criteria, live in settings with highly
xviii
restrictive abortion laws (Chae et al., 2017). Many of these women obtain abortions in an unsafe

manner, raising their risk of abortion-related morbidity and mortality. In such contexts, certain

subgroups of women, such as urban and wealthier women, may have better access to safer

clandestine abortion services compared to rural and poorer women. Knowledge of the

characteristics of women obtaining abortions could shed light on the subgroups of women

especially in need of services to help reduce the incidence and consequences of unintended

pregnancies and unsafe abortion. Previous studies have examined the sociodemographic profile

of women having abortions in some LMICs [6–8], but in most cases, data are not representative

of the cross-section of women obtaining abortions. For example, many country-specific studies

are limited in geographical scope, often focusing on a specific city, region/province, or

urban/rural area (Chae et al., 2017)or a specific subgroup of women, such as young, unmarried

women or tertiary students (Chae et al., 2017). Other studies have investigated the

characteristics of women who report ever having an abortion, including women who had

abortions long before the time of the survey (Chae et al., 2017). These findings can be

misleading if a woman is classified according to her characteristics at the time of the survey, and

these characteristics differ from those at the time of her abortion. The present study addresses the

limitations of past studies by analyzing and synthesizing data, collected in large scale surveys

over the last decade or so and are in most cases nationally representative, on the characteristics

of women obtaining induced abortions in 28 LMICs. Since this study was published, there has

been worldwide change in the demographic and socioeconomic composition of women of

reproductive age, attitudes and preferences regarding family formation, and access to

reproductive health services, particularly in LMICs. Together, these shifts suggest that the

characteristics of women seeking abortions may have also changed. For example, in many

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countries, age at first marriage has increased and, as a consequence, so have levels of premarital

sex. (Chae et al., 2017) Furthermore, girls are attending school longer and more women are

working. (Chae et al., 2017) motivating desires to delay childbearing and have greater control

over the timing of births. The increased desire for smaller families and greater control over birth-

spacing has been seen particularly in Asia, Europe, and, where desired family size has fallen

considerably. (Chae et al., 2017) These demographic changes may have resulted in more women

now considering a pregnancy as unwanted when it might have been considered as wanted twenty

years ago. Moreover, women’s access to safe abortion services has grown with increasing

liberalization of abortion laws in some countries (e.g. Nepal and Ethiopia) and growing

availability of misoprostol in contexts where abortion still remains highly restricted. We

anticipate that study findings will help program planners and policymakers better direct

improvements in contraceptive services to those population groups that have the highest levels of

abortion. In countries where abortion is highly restricted, we expect that findings will highlight

the importance of improving access to post abortion care and safe abortion services, in particular

for vulnerable population subgroups. (Chae et al., 2017)

Family planning enhances efforts to improve family health. However, traditional beliefs,

religious barriers, misconceptions and the lack of male involvement have weakened family

planning interventions. Research has confirmed a high "unmet 4 need" for family planning in

sub-Saharan Africa (WHO, 2012)(John Cleland, 2011). While the 2008 Ghana Demographic and

Health Survey reports that about 35% of married women have an unmet need for family

planning; 22% for spacing and 13% for limiting. The root causes of this unmet need are largely

unknown though there is great social and demographic significance (GSS/GHS/ICF Macro,

2009). Unwanted pregnancy and its outward consequences on physical and psychological

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wellbeing of adolescent girls and young adult women is a problem in our colleges. Unwanted

pregnancy is one of the main factors for unsafe abortion. Every year on average about 210

million throughout the world became pregnant. About 40-50 million of those women result to

abortion, 30 million of them are in developing countries. Of 40- 50 million abortions performed

annually in the world, 20 million are thought to be unsafe. Since Ghana is one of the developing

countries abortion is a major problem. In Ethiopia unsafe abortion accounts 54% of all direct

obstetric death and most of those who die are poor, single, women under 20 years of age. The

practice of emergency contraception is almost inexistent in Tamale. Tamale reproductive health

needs assessment showed, there is little knowledge or information available about emergency

contraceptives in Tamale. The major factor limiting the use of emergency contraceptive was

inadequate information about effectiveness of emergency contraceptive, its available and

unfavorable opinions about its safety. Even though there is increased need for use of EC, still

some women consider EC as abortificant (24.7%), encourage promiscuity and sexual

irresponsibility (33.3%) where as 42% approved the use of EC for management of rape victim.

Regardless of the cause, unwanted pregnancy and its negative consequence can be prevented by

using contraception and emergency contraceptives.

The study therefore sought to investigate into the level of access to and uptake of family

planning services by female students in Tamale Nurses and midwives training college.

1.3 PURPOSE OR GENERAL OBJECTIVE OF THE STUDY

The main aim of the study was to assess the access to and uptake of family planning services by

female students in TNMTC

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1.4 SPECIFIC OBJECTIVES

To assess the factors influencing the decision of female students in the uptake of family planning

services.

To determine the barriers affecting the utilization of family planning service by female students

in TNMTC in their studies.

To assess the impact of family planning services on female students in TNMTC

1.5 RESEARCH QUESTIONS

In reference to the specific objectives of the study, the following research questions were asked;

What are the factors influencing the decision of female students in the uptake of family planning

services?

What are the barriers in the utilization of family planning service by female students in TNMTC?

What is the impact of family planning services on female students in TNMTC?

1.6 OPERATIONAL DEFINITION

1. ACCESS – Ability to Obtain Something or Communicate To With Someone

UPTAKE-The Rate of Using or Taking Something

TNMTC- Nurses' and Midwives' Training College Tamale

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FAMILY PLANNING- it is an educational, comprehensive medical or social activities which

enable individuals, to determine freely the number and spacing of their children and to select the

means by which this may be achieved.

UNWANTED PREGNANCY- The pregnancy which occur unwillingly or unplanned.

CONTRACEPTIVE- Device or method that prevents pregnancy.

EMERGENCY CONRACEPTIVE (EC) - A drug or device used after unprotected sexual

intercourse to prevent pregnancy.

UNSAFE ABORTION- Abortion often conducted by lay people in non-sterile condition.

UNFPA-United Nations Fund for People Activities

UN- United Nation

UNICEF- united Nations children’s fund

OCP- oral contraceptive pill

PMTCT- prevention of mother to child transmission

PNM- post Nac midwifery

DM- Diploma Midwifery

HIV- Human Immune Virus

AIDS- Acquire Immune Deficiency Syndrome

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 CHAPTER TWO

2.0 REVIEW OF RELATED LITERATURE

The literature review will comprise studies which are similar to the current research topic.

Information shall be sourced from books, journals, internet as well as other research work related

to the above. The review will be according to the following headings with respect to the specific

objective of the study.

2.1 FACTORS INFLUENCING THE DECISIONS OF FEMALE STUDENTS IN THE

UPTAKE OF FAMILY PLANNING SERVICES.

In using the Andersen’s behavioral model of health service use and contraceptive use, factors

that affect the utilization of health services can be grouped into Environmental and personal

characteristics (Sileo, 2014).

The ABM includes factors in the health care system and external environment, including

physical, political, and economic components, in its framework to explain the use of health

services(Sileo, 2014). Throughout the literature in developing countries, economic

underdevelopment and poverty are contextual factors identified as determinants of contraceptive

use and the uptake of sexual health services (Sileo, 2014). The upstream factor of poverty is

often manifested as structural barriers in the environment or health system. With limited health

services available in many settings, especially in rural areas, proximity to the clinic is a major

barrier to women(Sileo, 2014). Person characteristics: Predisposing characteristics include

demographic, social, and psychological factors that predispose individuals towards health service

use nonuse (Sileo, 2014). Biological factors such as age and sex are included in the model at this

level (Andersen, 1995; Andersen & Newman, 1973). In support of the influence of such
xxv
predisposing characteristics on health behavior, research indicates that younger adult women are

more likely to use contraceptives than older adult women(Sileo, 2014), which could be a

reflection of less need for contraceptives or more traditional beliefs about family size and the

lack of acceptability of contraceptive use among older women. However, contradictory data

exists indicating contraceptive use may increase among older women after reaching their ideal

family size or experiencing the economic burdens of childrearing (Agyei & Migadde, 1995), a

notion supported by research demonstrating women with more children are more likely to use

contraceptives (Okech, Wawire, & Mburu, 2011). In Uganda, contraceptive use increases with

increasing levels of age (UBOS & IFC International Inc., 2012). Other predisposing factors

identified by Andersen (1995) include individual factors such as education, job status, ethnicity,

family/relationship status, and religion. A sizable amount of evidence from both postpartum and

non-postpartum samples exists to suggest women with higher education and literacy are more

likely to use contraceptives than their less educated counterparts (Ankomah, Anyanti, &

Oladosu, 2011; Okech, Wawire, & Mburu, 2011; UNFPA, 2010; Warren et al., 2013). In sub-

Saharan Africa, urban women are twice as likely to be using contraceptives that those in rural

areas (34 percent versus 17 percent, respectively) (UNFPA, 2010), a pattern reflected in Uganda

and across resource- limited settings (UBOS & IFC International Inc., 2012). Furthermore,

qualitative studies in Uganda indicate that one’s religion has a strong influence on family

planning; Ugandans identifying as both Catholic and Muslim cite their religion as a major

reason.

According to many studies done by researchers it has shown that about 60% of women or

females students feared that God would become very provoked with them if they practice or

patronize the family planning(FP).

xxvi
Family planning methods may challenge bio cultural beliefs. Some female students believes that

it is healthy or safe to menstruate every month and therefore refused to use family planning in

the school, and to them if you use the family planning especially the injectable it mostly results

to irregular bleeding/amenorrhea. Class, ethnicity, status, age and gender all shapes students

experiences with family planning and reproductive health services in the school.

Students may fear disrespectful or discrimination treatment. According to a study by National

Coordinating Agency for Population and Development (2010), identified various contributory

factors to unmet needs of family planning which were: Fertility –related issues, opposition to use

by partners or students lack of knowledge and method related.

Many adolescents and providers described adolescents’ fear of others finding out they had

attended family planning services(Bawah et al., n.d.). In particular they were afraid of their

parents, of being teased or talked about by friends, and being the victim of school 'gossip’. Some

were also concerned that their partner would think that they had an STI or had been unfaithful if

they knew they had attended family planning services. The lack of privacy at hospitals, schools

FP units and government clinics was emphasized, resulting in fear of being seen by friends,

relatives or community members(Sileo, 2014).

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2.2 BARRIERS IN THE UTILIZATION OF FAMILY PLANNING SERVICES BY

FEMALE STUDENTS

Family planning is widely acknowledged as an important intervention towards achieving

Millennium Development Goals (MDGs) four (4) and five (5) as it has proven to reduce

maternal and child mortality (Cates et al., 2010). Family planning can prevent unwanted

pregnancies and unsafe abortions. Some family planning methods such as condom usage can

protect individuals from Sexually Transmitted Infections (STIs) including HIV/AIDS (Cates et

al., 2010). Family planning has also been found to promote gender equality as well as promote

educational and economic empowerment for women (Lauria et al., 2014). Despite the enormous

benefits of family planning services, the uptake of the service still remains low in Sub-Saharan

Africa (Cates et al., 2010). This has resulted into high rates of unwanted pregnancies, unplanned

deliveries, unsafe abortions and maternal mortalities in Sub-Saharan Africa of which Ghana is no

exception (Malini et al., 2014). The low uptake of family planning is largely blamed on many

factors. It has been observed that the awareness of the availability of family planning services

has a great influence on the uptake of family planning services (Kabagenyi et al., 2014).

Additionally, even though some women are aware of the availability of family planning services,

they are not properly informed about the various forms of family planning methods and how they

work (Gaetano et al., 2014). Some of the women who went for family planning services were not

adequately counselled on the side effects of some of the family planning methods (Gaetano et al.,

2014). For example, in Uganda, some women stopped using contraceptives after they

experienced what they perceived were side effects of the contraceptives. Although most people

are aware of the benefits of family planning services, they complained that it was difficult to

xxix
access family planning services as such services were provided by health facilities that were far

from their homes (Gaetano et al., 2014). In addition, religious inclination has been noted to be a

major constrain to the uptake of family planning services in Africa (Gaetano et al., 2014). Also,

some individuals perceived that family planning services were meant for only married couples

whilst others fear that they will become sexually promiscuous if they go for family planning

services once they cannot become pregnant (Abdool et al., 2014). In Ghana, some efforts have

been made by the government of Ghana and non-governmental organizations through the

implementation of various programs to improve the coverage of family planning services in the

country. Although some successes have been chucked in the area of awareness of family

planning services in the country, the unmet need for family planning still remains high (Abdool

et al., 2014). The Ghana Demographic and Health Survey (GDHS) observed that a large number

of women have an unmet need for family planning as the acceptor rate for family planning

services remains low (Awingura, 2015). It is on this note the Ghana Health Service argues that

the lives of mothers and children will be improved and maternal mortality reduced if family

planning acceptor rate is improved (Awingura, 2015). Similarly, the Talensi district in Upper

East Region (UER) of Ghana is not spared from this predicament as the acceptor rate for family

planning services also remains low. The Talensi district offers free family planning services to

clients in most of the health facilities in the district (Awingura, 2015). Despite the provision of

free family planning services, the district reported 19% family planning acceptor rate in 2013,

which is currently below the Ghana Health Service national family planning acceptor target rate

of 23.3% (GHS, 2013). The regional annual health report showed an increase in teenage

pregnancies as well as unsafe abortions in the Talensi district (GHS, 2013). Three maternal

deaths were recorded in the Talensi district in 2011 as a result of unsafe abortions (GHS, 2013).

xxx
The increase in teenage pregnancies and unsafe abortions as well as the maternal mortalities that

occurred could have been prevented if uptake of family planning services were improved.

2.3 THE IMPACT OF FAMILY PLANNING SERVICES ON FEMALE STUDENTS

Family planning since its introduction has presented enormous impact in different spheres of life.

The benefits of family planning have become increasingly recognized worldwide, including

improved health, economic, and social outcomes for women and families, as well as public

health, economic, and environmental benefits at the population-level. At the individual-level, the

health benefits for women and infants include the prevention of pregnancy- related health risks

and deaths in women, reductions in infant mortality and the rate of unsafe abortions, the

prevention of the transmission of HIV/AIDS from mother-to-child (PMTCT), and prevention of

sexual transmission of HIV and sexually transmitted infections (STI) between partners (WHO,

2013). Family planning also has significant economic benefits for families and for society as a

whole (Gribble, 2012). By slowing the growth of a population, women have more earning

potential and families are able to devote more resources to each child, resulting in reductions of

poverty (Gribble, 2012; UNFPA, 2005)(Sileo, 2014). It is also clear that access to family

planning has a beneficial impact on several of the newly proposed global development

objectives. For example, with regard to sustainable livelihoods and job growth, family planning

programs has reduced unwanted fertility in resource-poor settings. This, in turn, allows women

greater opportunities to participate in paid employment and to increase their productivity and

earnings. Furthermore, when women are employed or have more control over household

incomes, they tend to spend more than men do on food, health, clothing and education for their

children and this expenditure can generate improvements in household nutrition, health and

education(Petruney et al., 2014).

xxxi
Birth Control Advances Women’s Economic Empowerment and Educational Opportunities:

Highlighting the fact that birth control is a top economic driver for women, Bloomberg

BusinessWeek recently listed contraception as one of the most transformational developments in

the business sector in the last 85 years(Parenthood, 2015).Fully one-third of the wage gains

women have made since the 1960s are the result of access to oral contraceptives.

Being able to get the pill before age 21 has been found to be the most influential factor in

enabling women already in college to stay in college (Adam et al., 2013).

College enrollment was 20 percent higher among women who could access

the birth control pill legally by age 18 in 1970, compared with women who could not, and

women who could access the pill before having to decide whether to pursue higher education

obtained an average of about one year more of education before age 30.6 Between 1969 and

1980, the dropout rate among women with access to the pill was 35 percent lower than women

without access to the pill(Parenthood, 2015). And finally, young women’s legal access to the pill

before age 21 led to a significant (2.3 percent) increase in the women who were college

graduates, and young women with legal pill access were able to both have children and pursue

higher education. (Adam et al., 2013). Family planning /Birth Control Prevents Cancer

Deaths:

Oral contraceptive use has consistently been found to be associated with a reduced risk of

ovarian and endometrial cancers according to National Cancer Institute, 2012(Parenthood, 2015).

While unmarried adolescents have a higher unmet need for contraceptives than married women

of their same age (Blanc et al. 2009; MacQuarrie 2014; UN 2014), many of them do not make

use of contraceptive methods due to lack of access (Chandra-Mouli et al. 2014; Greene and

Merrick 2015). This happens despite the fact that the consequences of unwanted conceptions are

xxxii
more severe for them: unintended childbearing, unsafe abortion, maternal and child mortality,

school dropout, reduced earning potential, and lower educational achievements for the present

and the next generation (Hindin et al. 2016; Neelofur-Khan and WHO 2007; Santhya and

Jejeebhoy 2015; UN 2013; WHO 2010). In this respect, changing contraceptive behavior seems

more achievable than changing sexual behavior in adolescents (ICRW 2014). Unintended

pregnancies to unmarried adolescents are also precipitating factors of early marriage in many

societies. An indicator of this is the proportion of first births to married adolescents occurring

less than eight months after marriage: The incidence of post conception marriage measured in

this way among women aged 20–24 years giving birth before they are 20 years old ranges

between 10% and 40% in Latin America and Africa (UN 2013). Early unions are more likely to

result in the gender-based health and human rights violation of forced marriage (Banerji, Martin,

and Desai 2008; UNICEF 2001, 2005; WHO 2011) and reinforce gender inequality (Raj and

Boehmer 2013).

Indeed, the prevalence of induced abortion, due to either lack of access or contraceptive failure,

and the use of unsafe informal methods in termination attempts highlights the need for the

continued provision of contraceptives and access to safe and affordable pregnancy termination

services (Gipson and Hindin 2008; Polis et al. 2016). For this reason, the 2012 London Summit

on Family Planning states the need of bringing modern contraceptive methods to women and

girls recognizing the importance of family planning as a robust path to change the world (Family

Planning 2020 2015), in addition to lower health costs and other social benefits (Chandra-Mouli

et al. 2014; Greene and Merrick 2015). Nevertheless, despite agreement on its importance,

adolescents often lack access to contraceptives, facing many barriers in acquiring contraceptives

and in using them correctly and consistently (Chandra-Mouli et al. 2014). But not only lack of

xxxiii
access to contraceptives is a problem. Many adolescents have no access to sex education leading

to a lack of knowledge regarding the risks of the early sexual debut (Kirby 2011). Findings

suggest that success in avoiding adolescent pregnancy often depends not only on the use of a

contraceptive method but also on access to health services, education, and information (Gurr

2014). As a result, despite increasing adolescent contraceptive use, their periods of consistent use

are shorter and contraceptive failures more frequent than for older women (Blanc et al. 2009; UN

2014)

xxxiv
 CHAPTER THREE

METHEDOLOGY AND STUDY DESIGN

3.0 INTRODUCTION

This chapter deals with the research design, research setting, population, sample size and

sampling procedure. It also describes the instrument for data collection pre-test of instrument,

ethical consideration, data collection procedure/data analysis techniques, ethnical consideration

and study limitation.

3.1 TYPE OF STUDY DESIGN

This was a descriptive cross section study directed towards assessing the access to and uptake of

family planning services by female students in TNMTC. As a cross sectional study, it gave on

spot results of the female student nurses’ reactions and responses towards family planning

services. Due to short time allocation and financial constraints a cross sectional study, among

others, was considered the best for this study.

3.2 RESEARCH SETTING

A cross-sectional study was conducted at the Tamale Nurses and Midwives Training College in

the Northern Region of Ghana. The Nurses and Midwives Training College Tamale is a nursing

training school in the Tamale metropolis, located in Dohinayilli community. It was established

in 1974 .The College is one of the oldest health training institutions in the region. It currently

runs three-year diploma programs in nursing and midwifery. It shares boundaries with the

Tamale Teaching Hospital and the St Charles minor seminary senior high school. Majority of the

students are Christians and Muslims.

xxxv
3.3 STUDY POPULATION

The study populations was only female student nurses and midwives in 2 nd year of the college

including the post basics midwifery students.

3.4 SAMPLING AND DATA COLLECTION

SAMPLE SIZE

The sample size was 130 female students, who were been selected using convenience sampling

from the study population. Being a convenience sampling, an online questionnaire (e-

questionnaires) designed using Google Forms was administered to each students.

n=N/1+N (e) ²

n- Is the sample size

N-is the target population

e is the error

n-?

N=168

e=0.05

n=168/1+168(0.05)²

n=168/1+168(0.0025)

n=168/1+0.42

n=168/1.42
xxxvi
n=118.31

n=118

Adding 10% of the sample size to cater for the spoiled or wrongful answered questions

10/100 x 118 +118

0.1 x 118 =11.8

11.8 + 118=129.8

130

Therefore the sample size we used was 130

3.5 INCLUSIVE CRITERIA

The inclusion criteria included the second year student offering Diploma nursing program, post

basics and Registered Midwives, willingness to participate in the study. Those that were on

campus during the time of study.

3.6 EXCLUSIVE CRITERIA

Male students that were on campus were not included on the day of the study and those of (3 rd

years diploma nurses and third years midwives) who were not on campus that day were not

included too. The 1st year students too were not included due to the inability to get them to

answer the questionnaire.

xxxvii
3.7 TOOL AND METHOD OF DATA COLLECTION

Purposive sampling method was used to sample 130 students from the midwifery and the RGN

as well as the post basic program. The students were acquainted with the objective and purpose

of the study and informed of their rights during the study.

The questionnaire was reviewed appropriately for construct and content validity. It was piloted

on 10 2nd -year nursing and midwifery students to ascertain the clarity and practicability of the

questions and to identify poorly constructed items and ambiguities that may be encountered

during the data collection. Suggested changes from the review and pilot study were made before

the actual data collection.

A questionnaire comprised of 35 close ended questions designed and administered through

Google forms. This is because schools were closed down which had consequently put students

far from reach for the administration of a physical questionnaire. Midwives likewise were at

various far away districts for clinical practice. Google forms is an online survey administration

tool that allows researchers to collect data from respondents via a personalized survey. Clear and

meaningful objectives were set for the study in order not to bring about ambiguity, confusion and

misinterpretation of terms by respondents. In addition, work on the topic by other researchers

were consulted and convenient respondents were selected for reliability, concepts and the

instrument was clarified and systematic approach was used.

The questionnaire was structured into sections:

Section (A) consisted of particulars of participants.

Section (B) was made to assess the factors influencing the decision of female students in

the uptake of family planning services.

xxxviii
 Section (C) was made to assess the barriers in the utilization of family planning service

by female students in TNMTC.

Section (D) was made to assess the impact of family planning services on female students

in TNMTC

3.8 DATA ANALYSIS

The collected data from the Google forms was automatically connected to Google sheets for the

data analysis. It was subsequently exported to Microsoft excel and SPSS and transported to

Microsoft word, presented in frequency table and charts. Interpretations of the cumulated data

was also done to give further explanation of the quantitative data.

3.9 RELIABILITY AND VALIDITY

The questionnaire was undergone a pretest on a pilot bases using ten(10) female students, to

ascertain how adequate the questionnaire is and needed modification was done to ensure

information to be collected are valid and reliable.

3.10 ETHICAL CONSIDERATION

An introductory letter was received from the Nurses' and midwives' training college, tamale for

the research to be done. Appropriate measures was put in place to ensure that the rights of the

participants are protected at all times.

They were given any information needed, both verbally and in writing which enabled them to

make an informed decision. Confidentiality of participants was also maintained by allowing

participants to answer questionnaire privately and at their own convenience. A participant could

decide not to take part or withdraw from the study at any time without affecting her training and

services received from the institution. Also, for confidentiality of information from participants,

xxxix
measures were put in place to ensure data collected and analyzed including the completed

questionnaires was kept at the school’s archive, where they would be kept for 5 years before

being destroyed.

3.11 LIMITATION OF THE STUDY

The research was limited to the sample size indicated for the study due to the limited time

allocated as well as inadequate funds for the study.

3.12 OVERVIEW OF THE STUDY.

The study comprised the following chapters:

Chapter one

This chapter served as an introduction to the study. It comprised of the background of the study,

the statement of the research problem, the purpose of the study, the objectives, and the

significance of the study and operational definition of words or terms.

Chapter two

This chapter was made up of the review of related data. It involved the review of international

literature and local literature related to the research topic.

Chapter Three

This part was about the method and design that was adopted for the study.

Chapter Four

This was the analysis of the data collected and interpretation of the cumulated data.

Chapter Five

This is the final chapter and it included the discussions of the research findings in relation to the

literature review. It also includes the summary and conclusions of the research, avenues for

future research and recommendations by the researchers.

xl
3.13 PROPOSED BUDJET FOR THE STUDY

Internet cost - 150 Ghana cedis

Photocopies - 150 Ghana cedis

Printing - 250 Ghana cedis

Analysis of data - 200 Ghana cedis

Total = 750 Ghana cedis.

3.14 SOURCES OF FUND FOR THE STUDY

Funds mainly came from the contributions of each member of the research team.

Proposed date of starting and ending

Starting: 01/11/20

Ending: 25/01/21

xli
 CHAPTER FOUR

DATA ANALYSIS

4.0 Introduction

This chapter reports the findings from this study under the following themes: socio-

demographic data: the factors influencing the decision of female students in the uptake of

family planning services, the barriers in the utilization of family planning service by

female students in nurses and midwifery training college tamale, impact of family

planning services on female students in nurses and midwifery training college tamale.

4.1 Summary of socio-demographic data

This has been presented under a heading of which was objective of this study. The

presentation is in tables, figures and narrative forms.

Table 1a frequency distribution of respondents’ socio-demographic data N(130)

Variable Frequency Percentage (%)

AGE

18-24 80 62

25-34 46 35

35-45 4 3

PROGRAMME

RGN 28 22

xlii
RM 72 55

PNM 30 23

CLASS D21 27 21

DM10 73 56

PNM2 30 23

FAMILY SIZE

3 or More 90 69

2 22 17

1 18 14

AGE OF YOUNGEST

CHILD IN THE FAMILY

>5 78 60

<5 52 40

RELIGION

Christianity 53 41

Islam 76 58

Traditionalist 1 1
xliii
MARITAL STATUS

Single 97 75

Married 29 21

Divorced/Separated 4 4

ETHNICITY

Dagomba 58 45

Hausa 14 11

Akan 27 21

Others 31 23

TOTAL 130 100

Source: Field Data, 2020

From table above of 130 respondents, the sample age distribution showed that 62% of

the respondents were within an age range of 18-24 years, 35% were within 25-34 years

and 3% within 35-45 years. With regards to the programed of study, 55% of responded

were Register midwifery students, 23% were PNM students and 22% were RGN

students. For the class category, 21% were students from D21 class, 56% were from

DM10 class and the remaining 23% were from the PNM2 class. With regards to the

family size 69% were from 3 or more, 17% were from the family size of 2, and 14% were
xliv
from 1 or less.in relation to their age of youngest 60% were from ages >5 and 40 were

from the ages <5.it also showed that 41% of the respondents were Christians, 58% were

Muslims(Islam) , and 1% were traditionalist.in relation to their marital status 75% were

singles, 21% were married respondents, and the remaining 4% were divorced/separated.

With regards to respondent’s ethnicity 45% were Dagombas, 11% were Hausa people,

21% were Akan’s, and the reaming 23% were other tribes such as Gonjas, Frafras,

Mamprusis, Dagattis, Grunsi, and Ewes etc.

xlv
4.2 THE FACTORS INFLUENCING THE DECISION IN THE UPTAKE OF FAMILY

PLANNING

Figure 1a frequency distribution of respondents’ socio-demographic data N(130)

Do you have knowledge about family

planning?

8% Do you have knowledge

about family planning? Yes
Do you have knowledge
about family planning? No

92%

Source: field data, 2020

From the above figure, 92% of the respondents went for yes and 8% went for no when they were

asked whether they have knowledge about family planning.

Figure 2 do you have access of family planning in your school

xlvi
Source: field data, 2020

From the above figure, 40.8% of the respondents went for yes, 42.3% of the respondents went

for no and 16.9% of the respondents went for don’t know when they were asked about do you

have access of family planning center in the school.

Figure 3 how many alive children do you have

xlvii
Source: field data, 2020

The outcome of the result showed that 25 of the respondents have one alive child, majority of the

respondents do not have children at all(94), and 11 of the respondents have more than one alive

child.

Figure 4 did you use FP methods before your last pregnancy

used family planning before your last pregnancy?

No
21%

Yes
79%

Source: field data, 2020

From the above figure 21% of the respondents used family planning before their last pregnancy

and 79% did not used family planning before their last pregnancy.

Figure 5 Have you/your partner ever used family planning method before

xlviii
Source field data, 2020

From the above figure 33.1% of the respondents went for yes, 53.1% of the respondents went for

no and 13.8% went in for not sure.

Figure 6 Reasons for not applying family planning

Reasons for not applying

89
family planning
54 45
60
26 8
30 41.5% 68.5% 34.6% 20% 6.3%
0
frequency

Due to pressure of partner

Other
Don't know it's signance
Due to fear of side effects
Due to religious beliefs

variables
If you do not apply family planning
methods, what are the reasons?
Series1 Series2 Series3 Series4

Source field data, 2020

xlix
The figure 4.2.6 showed that 54 of the respondent went in for due to religious beliefs, 89 went in

For due to fear of side effects, 45 went in for pressure of partner, 26 respondents went in for

those who don’t know the significant and 8 respondents went in for others, when they were

asked reasons for not applying family planning.

Table 2 which of the method you /your partner used?

Response Frequency Percentage (%)

Condoms 69 53

Pills (OCP) 21 16

Injectable 20 15

Others 20 16

TOTAL 130 100

Source: field data, 2020

From the table above, 53% went for condoms, 16% of the respondents went in for pills (OCP),

15% went in for injectable and the remaining 16% went for others such as implanton, within the

16 some also said they don’t know, others too said they have never used it.

Figure 7 would you like to use family planning method in the future?

l
Source field data, 2020

From the figure above when the participants were asked about whether they would like to use

family planning method in the future, 10.8% chose no, 61.5% went in for yes 27.7% went in for

maybe.

Figure 8 what was your first source of information about this service

li
Source field data, 2020

Out of the participants who knew about contraceptives and family planning 54 reported the

health worker/facility were their major source of information followed by mass media at 40,

friends were 35 and school source were the least with 1 as depicted in Figure 8

Figure 9 are you currently using any contraceptive method?

lii
Source field data, 2020

Out of the participants who are currently using any contraceptives methods 92 reported no 33

went for yes and 5 respondent went for not sure. As depicted in Figure 9.

4.3 BARRIERS TO THE UTILIZATION OF FAMAILY PLANNING SERVICE BY

FEMALE STUDENTS IN TNMTC

Figure 10 is the family planning services always available

liii
Source field data, 2020

From the above figure 10, when the respondents were asked about the availability of family

planning services? 84(64.6%) went for yes, 26(20%) went for no and the remaining 20(15.4%)

chose not sure

Figure 11 where is the family planning service located?

liv
Source field data, 2020

The figure 11, showed that 90 of the respondents went in for within the hospital premises, 16 of

them went in for close to the hospital premises, 14 of them also went in for far from the hospital

premises and 10 of the respondents went in for within the school premises, when they were

asked where is the family planning service located.

Figure 12 by what means do you get to the family planning Centre?

lv
Source field data, 2020

From the above figure12, the respondents were asked about by what means do they get to the

family planning Centre, 67 of the respondents said they foot to the Centre, 40 of them said they

used the public transport and 23 of them said they go by private transport.

lvi
Table 3 barriers to the utilization of family planning service by female students in tnmtc

Question Response Frequency Percentage

4.3.4 Have you ever been denied Yes 19 14.6

Family Planning Services before?

No 105 80.8

Not Sure 6 4.6

Yes 80 61.5

4.3.5 Is the family planning

Service hours convenient for No 21 16.2

you?

Not Sure 29 22.3

4.3.6 Does your religion permits Yes 62 47.7

you to use family planning?

No 43 33.1

Not Sure 25 19.2

lvii
4.3.7 Is there a specific family Yes 82 63.1

planning method that you prefer

and is this method available to No 32 24.6

you at the family planning center?

Not Sure 16 12.3

4.3.8 Do your family support the Yes 82 63.1

use of contraceptives?

No 29 22.3

Not Sure 19 14.6

4.3.9 Do you have to pay any Yes 67 51.5

fees/ money for using the family

planning services? No 45 34.6

Not Sure 18 13.8

lviii
TOTAL 130 100

Source field data, 2020

From the above table, 14.6% went for yes, 80.3% went for no and 4.6% were not sure when they

were asked have they ever been denied Family Planning Services before. Also 61.5% went for

yes, 16.2 went for no and 22.3 were not sure when asked Is the family planning Service hours

convenient for you. Moreover, 47.7% went for yes, 33.1% went for no and 19.2% were not sure

when they were asked whether their religion permits you to use family planning. In addition

63.1% went for yes, 24.6% chose no and 12.3% were not sure when they were asked whether

there is a specific family planning method that they prefer and is this method available to them at

the family planning center. From the table above, when the respondents were asked whether their

family’s support the use of contraceptives, 63.1% chose yes, 22.3% chose no and 14.6% chose

not sure. Finally 51.5% chose yes, 34.6% chose no, and 13.8% chose not sure when they were

asked whether they have to pay any fees/money for using the family planning services.

lix
4.4 THE IMPACT OF FAMILY PLANNING SERVICES ON FEMALE STUDENTS

Figure 13 to the best of your knowledge, are you aware of someone that has lost his/her life

as a result of family planning?

Source field data, 2020

From the above figure, the respondents were asked to their best of knowledge are they aware that

someone has lost his/her life as a results of family planning. 15.4% went for yes, 79.2% went in

for no and 5.4% said maybe.

Figure 14 I feel in control of my career choices because of family planning services?

lx
Source field data, 2020

From the above figure 14, the respondents were asked whether they feel in the control of their

career choices because of family planning services. 43.1% went in for neutral, 21.5% of the

respondents agreed, 13.8% strongly agreed, 13.8% of them disagreed and 7.7% strongly disagree

Figure 15 I know that my children are/will be healthy because of family planning?

lxi
Source field data, 2020

From the above figure, 50 of the respondents agreed, 32 went for neutral, 24 strongly agreed, 16

disagreed and 7 strongly disagreed. When they were asked if they know that their children

are/will be healthy because of family planning.

Figure 16 Family planning has helped me reach where I am today?

Source field data, 2020

The figure above showed that 39 were not sure whether family planning has helped them reach

where they are today, 59 of the respondents chose no and 32 of them also chose yes when they

were asked that family planning has helped me reach where I am today.

lxii
Figure 17 I know that family planning services have contributed to the economic growth of

the country?

Source field data, 2020

From the above figure, the respondents were asked whether they know that family planning

services has contributed to the economic growth of the country. 49 went in for not sure, 72 of the

respondents chose yes, and 9 of them said no.

lxiii
Figure 18 My health and wellbeing is guaranteed by family planning?

Source field data, 2020

From the above figure, the respondents were asked whether their health and wellbeing is

guaranteed by family planning. 33 went in for neutral, 46 of the respondents agreed, 27 of them

disagreed, 5 strongly disagreed and 19 of them strongly agreed.

lxiv
Figure 19 Family planning helped in the preventions of STIs

Source field data, 2020

From the above figure, the respondents were asked whether family planning helped in the

preventions of STIs. 19 went in for neutral, 50 of the respondents agreed, 18 of them disagreed,

11 strongly disagreed and 32 of them strongly agreed.

Figure 20 Does your family planning reduced the risk of ovarian and endometrial cancers?

lxv
Source field data, 2020

From figure 20 above, 59 of the participants chose yes, 42 of them went in for maybe and 29 of

the participants chose no when they were asked does family planning reduced the risk of ovarian

and endometrial cancer.

Figure 21 Family planning has helped in the prevention of the transmission of HIV/AIDS

from mother-to-child (PMTCT)

lxvi
Source field data, 2020

From the above figure 4.4.9 showed that 54 of the respondents went in for no, 53 of them chose

yes and 23 of them chose maybe when they were asked about how family planning has helped in

the prevention of the transmission of HIV/AIDS from mother-to-child (PMTCT).

lxvii
 CHAPTER FIVE

5.0 DISCUSSION, CONCLUSION AND RECOMMENDATIONS

In this chapter, a thorough discussion on the findings of the study is dealt with, in order to make

conclusions and recommendations in the subsequent texts. The recommendations and

conclusions of the study were drawn in relation to some findings that are supported with

literature from similar studies by other researchers.

5.1 Discussion

5.1.1 Socio-demographic data

In this study a 130 questionnaire were distributed to the study participants by using the Google

forms and all of them were returned giving a response rate of 100.0%. The sample age

distribution showed that 62% of the respondents were within the age range of 18-24 years, 35%

were within 25-34 years and 3% within 35-45 years. A similar studies conducted by (Coetzee et

al., 2011) found that a total of 111 female undergraduate students participated in a study

providing a response rate of 54.24%. The participants’ age distribution was between 18 and 20

years at 47.71% and 21 to 24 years at 52.29%. Concerning educational status, all the participants

(78.3%) were not able to read and write, 15.4% had attained primary education and 2.2% had

attained secondary education.(Beyene et al., 2019) but in this current study all the 100%

participants were able to read and write and 100% out of them had attained tertiary levels

because we carried the research work on students nurses in tamale nurses and midwives training

college. Out of the total 130, relation to their marital status 75% were singles, 22% were married

respondents, and the remaining 4% were divorced/separated. Similarly in another study by

lxviii
(Coetzee et al., 2011) a majority of participants, 92.79% were single and 7.21% were married.

Most (67.1%) of the respondents were from households with family sizes ranging from one to

four.(Idowu et al., 2017) which is similar to our study in which almost half 69% of respondents

had a family size of three or more.

Regarding respondent’s religion, Muslims were dominated at 58% followed by Christians 41%

and only 1% were traditionalist and in a study that was not in line with ours, the predominant

religion of participants were Christian at 92.72%. The rest of the participants, 7.28%, indicated

various religions which included Hindu, Judism, Moslem and Scientology. (Coetzee et al., 2011).

lxix
5.1.2 Factors influencing the decisions of female students in the uptake of family planning

services.

More than half 92% of the study participants had knowledge about family planning and also,

out of the participants who knew contraceptives and family planning 54 reported the health

worker/facility were their major source of information followed by mass media at 40, friends

were 35 and school source were the least with 1, which was in line with another study in which

almost all the respondents 94 had heard of family planning with social media being the

commonest source of information 27 (Gbagbo, 2019).

In our study, when participants who were aware of contraceptives and family planning were

asked about the which of the method you /your partner used, about 53% of them knew condoms,

followed by oral pills (OCP)16% , Injectable by 15% in that order but 16% though have heard of

contraceptives and family planning did not know any method(s) but in a dissimilar study, it was

noted, the method of contraceptive most commonly used was oral contraceptives at 38%,

followed by the condom at 25%. Almost 40% of participants indicated that they did not

consistently use contraceptives.(Coetzee et al., 2011),

The study findings revealed that 41.5% of the respondent went in for due to religious beliefs,

68.5 went in For due to fear of side effects, 34.6% went in for pressure of partner, 20%

respondents went in for those who don’t know the significant and 6.3 respondents went in for

others, when they were asked reasons for not applying family planning. Which was in another

study reasons for and against using family planning. Respondents who were of the view that FP

was not helpful (25.0%) had either not used any family planning method before (28.0%) or had

ever suffered unpleasant negative side effects (20.0%) following family planning usage or

religious believed is against family planning (2.0%).

lxx
5.1.3 Barriers in the utilization of family planning services by female students

The study findings unveiled that majority 64.6% out of the study participants, reported family

planning services is always available. 90 reported family planning services were provided within

the hospital premises. Among those who uses the services 67 of the participants access it by foot,

40 of them uses it through public transport and 23 of them said they go by using private

transport. In another study it was revealed that students are aware of the benefits of family

planning services, they complained that it was difficult to access family planning services as

such services were provided by health facilities that were far from their homes (Gaetano et al.,

2014). Among those who were not patronizing the service 47.7% participants reported that their

religion permits the use of family planning, in another study by (Gaetano et al., 2014). Which is

not in line with ours says that religious inclination has been noted to be a major constrain to the

uptake of family planning services in Africa.

lxxi
5.1.4 The impact of family planning services on female students

The study found that 50 of the participants agreed that family planning do help in the prevention

of sexual transmitted infections (STIs) and 54 of the participants said family planning cannot

helped in the prevention of the transmission of HIV/AIDS from mother-to-child (PMTCT). In

line with another study which says that At the individual-level, the health benefits for women

and infants include the prevention of pregnancy- related health risks and deaths in women,

reductions in infant mortality and the rate of unsafe abortions, the prevention of the transmission

of HIV/AIDS from mother-to-child (PMTCT), and prevention of sexual transmission of HIV and

sexually transmitted infections (STI) between partners (WHO, 2013).

Regarding the decreased in the risk of ovarian and endometrial cancer majority (59) of the

participants used family planning to prevent or reduce the risk of ovarian and endometrial cancer

Similarly in another study, Oral contraceptive use has consistently been found to be associated

with a reduced risk of ovarian and endometrial cancers according to National Cancer Institute,

2012(Parenthood, 2015). Our findings also revealed that 54.4 of the participants strongly agreed

that family planning services has contributed to the economic growth of the country. Which is in

line with a study by (Gribble, 2012; UNFPA, 2005)(Sileo, 2014) By slowing the growth of a

population, women have more earning potential and families are able to devote more resources

to each child, resulting in reductions of poverty.

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5.2 conclusion

The study sought to determine the access to and uptake of family planning services by female

students in nurses and midwives training college tamale (tnmtc). The study was specifically to;

 To assess the factors influencing the decision of female students in the uptake of family

planning services.

 To determine the barriers affecting the utilization of family planning service by female

students in TNMTC in their studies.

 To assess the impact of family planning services on female students in TNMTC

1. More than three quarters 92 of the study participants have knowledge about family

planning. Out of the participants who had knowledge about family planning 41.5%

reported the health worker/facility were their major source of information followed by

mass media at 30.8% followed by friends at 26.9% and school source was the least 0.8%.

2. The study findings unveiled that majority 84(64.6%) out of the study participants,

reported family planning services were always available.

3. Among those who patronize the service 62 (47.7%) participant reported their religion

permits the use of family planning.

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5.3 Recommendation

1. Schools that do the family planning should provide directional boards for easy location of

the family planning units in the school.

2. The principal of the school should make the cost of family planning services free for

students to easily access it in the school.

3. Health workers/practitioners should educate women/female students about the benefits of

family planning.

4. There should be bye-laws in the community/school to sanction individuals who

discriminately stigma those who visits the family planning unit in the school/community.

5. Additionally, we recommend that further studies and analysis can be carried out from the

institution with respect to female student’s access to and up taking of family planning

service in the school.

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REFERENCES

Adjei G, Enuameh Y, Asante KP, Baiden F, Nettey OEA, Abubakari S, et al.(2015) Predictors of

abortions in Rural Ghana: a cross-sectional study. BMC Public Health.15 (202).

Agrawal S. (2008) Determinants of induced abortion and its consequences on women’s

reproductive health: Findings from India’s National Family Health Surveys. Calverton,

Maryland, Macro International, MEASURE DHS.

Ashimi AO, Amole TG, Abdullahi HM, Jibril MA, Iliyasu Z. (2017) Determinants of Pre-service

Knowledge and Use of Emergency Contraception by Female Nursing and Midwifery

Students in Northern Nigeria. J Basic Clin Reprod Sci.p. 122–8.

Bawah, A. A., Akweongo, P., Simmons, R., & Phillips, J. F. (n.d.). 54 Studies in Family

Planning Women’s Fears and Men’s Anxieties: The Impact of Family Planning on Gender

Relations in Northern Ghana. Studies in Family Planning, 30, 56–57.

Baschieri, A. and Hinde, A. (2007). The proximate determinants of fertility and birth intervals in

Egypt: An application of calendar data. Demographic Research 16(3): 59–96. doi:10.4054

Bell, A. and Jones, K. (2015). Explaining fixed effects: Random effects modeling of time-series

cross-sectional and panel data. Political Science Research and Methods. doi:10.1017

Blanc, A. and Way, A. (1998). Sexual behavior and contraceptive knowledge and use among

adolescents in developing countries. Studies in Family Planning 29(2): 106– 116.

Blanc, A., Tsui, A., Croft, T., and Trevitt, J. (2009). Patterns and trends in adolescents’

contraceptive use and discontinuation in developing countries and comparisons with adult

women. International Perspectives on Sexual and Reproductive Health. doi:10.1363.

Chae, S., Desai, S., Crowell, M., Sedgh, G., & Singh, S. (2017). Characteristics of women

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 obtaining induced abortions in selected low- and middle-income countries. doi.org/10.1371

Docs Editor Help: Create a survey using Google Forms. [Google Inc.].

https://support.google.com/docs/answer/6281888?hl-en&ref_topic-6063584 (2020).

Accessed 28 october 2020

Gbagbo, F. Y. (2019). Family planning among undergraduate university students : a CASE study

of a public university in Ghana. BMC Women’s Health, 3, 1–9.

John Cleland, R. N. & E. M. Z. (2011). WHO | Family planning in sub-Saharan Africa: progress

or stagnation? WHO.doi.org/10.2471.

Parenthood, P. (2015). Access to Contraception Has Also Led to More College-Educated Women

Pursuing Advanced Professional Degrees.

Paschal Awingura Apanga1,&, M. A. A. 1Ghana. (2015). Factors influencing the uptake of

family planning services in the Talensi District, Ghana. PanAfrican Medical Journal, 8688,

1–9.doi.org/10.11604.

Petruney, T., Wilson, L. C., Stanback, J., & Cates, W. (2014). Family planning and the post-2015

development agenda. Bull World Health Organ, 92.doi.org/10.2471.

Sileo, K. M. (2014). Determinants of Family Planning Service Uptake and Use of

Contraceptives among Postpartum Women in Rural Uganda Recommended Citation.

https://opencommons.uconn.edu/gs_theses/602

Singh S, Darroch JE. (2012) adding it up: Costs and benefits of contraceptive services. New

York: Guttmacher Institute and UNFPA.

Singh S, Wulf D, Hussain R, Bankole A, Sedgh G.(2009) Abortion worldwide: a decade of

uneven progress. New York: Guttmacher Institute.

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Sedgh G, Bearak J, Singh S, Bankole A, Popinchalk A, Ganatra B, et al.(2016) Abortion

incidence between 1990 and 2014: global, regional, and sub-regional levels and trends.

The Lancet. 388 (10041):258–267.

UNFPA. Motherhood in childhood: facing the challenge of adolescent pregnancy. (2013) New

York: United Nations Population Fund.

Wellings K, Collumbien M, Slaymaker E, Singh S, Hodges Z, Patel D, et al. Sexual behaviour in

context: a global perspective. Lancet.doi.org/10.1016

Westoff C. (2010) Desired number of children: 2000–2008 (DHS Comparative Reports 25).

Calverton: ICF Macro.

WHO. Emergency contraception [Internet]. 2018 [cited 2018 May 19].

WHO/RHR and JHSPH/CCP (2018). Family Planning: A Global Handbook for Providers (2018

Update). 3rd edition. Baltimore and Geneva: CCP and WHO. 8–460 p.

Yue K, O’Donnel C, Sparks PL. (2010) the effect of spousal communication on contraceptive

use in Central Terai, Nepal. Patient Educ Couns.; 81(3):402-408.

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APPENDIX

A Questionnaire For Data Collection On The Access To And Uptake Of Family Planning

Services By Female Students In Nurses And Midwives Training College Tamale (TNMTC).

Dear respondent, this questionnaire is intended to seek your views on your access to and uptake

of family planning services. Please be assured that your responses are completely anonymous

and treated with strict CONFIDEDNTIALITY, therefore your name is not required. Please be

informed that in the course of your answering this questionnaire if you feel the need not to

continue you are at liberty to do so. We highly anticipate your response given with utmost

sincerity to the questions.

SECTION A

PARTICULARS OF PARTICIPANTS

1. Age in years: [ ] 18-24 [ ] 25-34 [ ] 35-45

2. Program [ ] RGN [ ] RM [ ] PNM

3. Class [ ] D21 [ ] DM10 [ ] PNM2

4. Family size: [ ]1 [ ]2 [ ] 3 or more

5. Age of youngest child in the family (in years): [ ] <5 [ ] >5

6. Religion: [ ] Islam [ ] Christianity [ ] Traditional

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 Others (specify)…………………..

7. Marital status: [ ] Single [ ] Married [ ] Divorced/Separated

8. Ethnicity: [ ] Akan [ ] Dagomba [ ] Hausa

Others (specify)…………………

SECTION B

ASSESSING THE FACTORS INFLUENCING THE DECISION OF FEMALE

STUDENTS IN THE UPTAKE OF FAMILY PLANNING

9. Do you have knowledge about family planning? [ ] Yes [ ] No

10. Do you have access of family planning center in your school [ ] Yes [ ] No [ ] Don’t

know

11. How many alive children do you have now? [ ] Do not have children at all [ ]I have

alive children

[ ] Other

12. Did you use FP methods during your last pregnancy? [ ] Yes [ ] No

13. Have you (your partner) ever used family planning method before? [ ] Yes [ ] No

[ ] Not sure

14. If you do not apply family planning methods, what are the reasons? [ ] Due to religious

belief [ ] Due fear side effect [ ] Due to pressure of partner

[ ] Others

15. Which the method you /your partner used? [ ] Condom [ ] Pill (Ocp) [ ] Injectable

[ ] Other

16. Would you like to use family planning method in the future? [ ] Yes [ ] No [ ] maybe

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 17. What was your first source of information about this service? [ ]Health worker/facility [

] Mass media [ ]Friends

[ ] schools

18. Are you currently using any contraceptive method? [ ] Yes [ ] No [ ] Not sure

19.

SECTION C

FACTORS AFFECTING THE UTILIZATION OF FAMAILY PLANNING SERVICE BY

FEMALE STUDENTS IN TNMTC

20. Is the family planning services always available? [ ] Yes [ ] No [ ]Not sure

Where is the family planning service located?

[ ] Within the hospital premises [ ] Close to the hospital premises

[ ] Far from the hospital premises [ ] Within the school premises

21. By what means do you get to the family planning Centre?

[ ] By foot [ ] By public transport [ ] By Private transport.

22. Have you ever been denied Family Planning Services before? [ ] Yes [ ] No [ ]

Not sure

23. Is the family planning Service hours convenient for you? [ ] Yes [ ] No [ ]Not sure

24. Does your religion permits you to use family planning? [ ] Yes [ ] No [ ] Not sure

25. Is there a specific family planning method that you prefer and is this method available to

you at the family planning Centre? [ ] Yes [ ] No [ ] Not sure

26. Do your family support the use of contraceptives? [ ] Yes [ ] No [ ] Not sure

27. Do you have to pay any fees/ money for using the family planning services?

[ ] Yes [ ] No [ ] Not sure

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SECTION D

ASSESSING THE IMPACTS OF FAMILY PLANNING SERVICES ON FEMALE

STUDENTS IN TNMTC

28. To be the best of your knowledge, are you aware of someone that has lost his/her life as a

result of family planning?[ ] Yes [ ] No [ ] Maybe

29. I feel in control of my career choices because of family planning services

[ ] Disagree [ ] Strongly disagree [ ] Neutral [ ] Agree [ ] Strongly agree

30. I know that my children are / will be healthy because of family planning

[ ] Disagree [ ] Strongly disagree [ ] Neutral [ ] Agree [ ] Strongly agree

31. Family planning has helped me reach where I am today[ ] Yes [ ] No

32. I know that family planning services have contributed to the economic growth of the

country [ ] Yes [ ] No [ ] Not sure

33. I feel that my health and wellbeing is guaranteed by family planning

[ ] Disagree [ ] Strongly disagree [ ] Neutral [ ] Agree [ ] Strongly agree

34. Has family planning helped in the prevention of STIs?

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[ ] Disagree [ ] Strongly disagree [ ] Neutral [ ] Agree [ ] Strongly agree

35. Does family planning reduced the risk of ovarian and endometrial cancers

[ ] Yes [ ] No [ ] Maybe

35. Family planning has helped in the prevention of the transmission of HIV/AIDS from

mother-to-child (PMTCT) [ ] Yes [ ] No [ ] Maybe

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