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SCHOOL OF NURSING
RESEARCH PROPOSAL INTRODUCTION PART 1
ASSESMENT OF KNOWLEDGE AND PERCEPTION TOWARDS UTILIZATION OF MODERN FAMILY PLANNING METHODS AMONG FEMALE NURSING STUDENTS AT MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES,ILALA MUNICIPAL, DAR ES SALAAM.

NAME: HAIRUN TUNU LASHKU
REG NO: 2015-04-08560
PROGRAM: BScN GENERAL
SUPERVISOR: VICTOR CHIKWALA
COORDINATOR: Dr LILIAN MSELLE

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DEFINITION OF TERMS
Family planning: is allowing people to attain their desired number of children and determine the spacing of pregnancy (WHO, 2015)
Perception: the ability to see, hear or become aware of something through the senses. (Oxford dictionary 2018)
Knowledge: is the facts, information and skills acquired through experience or education; the theoretical or practical understanding of subject. (Oxford dictionary 2018)
Unmet needs: are women who are fecund and sexually active but are not any method of contraception, and report not wanting any more children or wanting to delay childbearing (WHO 2018)
Unintended pregnancy: is the pregnancy which occurs at time that a woman does not want to get it.

Contraceptives: a device or drug serving to prevent pregnancy.

CHAPTER ONE
INTRODUCTION
Background
Throughout the world, female students are exposed to the risk of unplanned pregnancies as a result of ineffective or non-use of modern family planning methods. This may result in failure to complete their education, inability to maintain gainful employment and making independent marital decision. Young students sexual activities are communal, municipal and public health concern ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.4102/curationis.v38i2.1535”, “ISBN” : “1500020001”, “ISSN” : “2223-6279”, “PMID” : “26842088”, “abstract” : “<p>Background: Unplanned pregnancies amongst students at higher education institutions are au00a0major concern worldwide, including South Africa. Apart from various social and psychologicalu00a0challenges, unplanned pregnancies affect studentsu2019 objectives of achieving academic success.u00a0Research undertaken in the United States of America (USA) indicates that around 80% ofu00a0female students in institutions of higher education between ages 18 and 24 are sexually active.Objectives: To assess and describe the use of contraceptives by undergraduate female studentsu00a0in a selected higher educational institution in Gauteng.Method: A cross-sectional, descriptive, quantitative design was used. A total of 400 femaleu00a0undergraduate students were requested to respond to a self-administered questionnaire.u00a0Stratified random sampling was used to select the participants. They were selectedu00a0systematically from two campuses. Data were entered using an excel sheet at the Departmentu00a0of Statistics, and analysed using the Statistical Analysis Software programme, (SAS versionu00a09.3), of the Department of Statisticsu2019 higher educational institutions.Results: A total of 74%females indicated they were sexually active, 79%of whom reportedu00a0using contraceptives. The most common used methods were oral contraceptives at 38%, andu00a025% for male condoms. The most commonly known methods were condoms at 84%, and theu00a0oral contraceptive at 68%. The knowledge of condom use to prevent sexually transmittedu00a0diseases was high at 91%.Conclusion: Inadequate knowledge and awareness on some contraceptive methods was found.u00a0Thus, educational programmes to increase studentsu2019 knowledge on the use of all contraceptiveu00a0methods are urgently needed</p>”, “author” : { “dropping-particle” : “”, “family” : “Coetzee”, “given” : “Maria H.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Ngunyulu”, “given” : “Roinah N.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Curationis”, “id” : “ITEM-1”, “issue” : “2”, “issued” : { “date-parts” : “2015” }, “page” : “1-7”, “title” : “Assessing the use of contraceptives by female undergraduate students in a selected higher educational institution in Gauteng”, “type” : “article-journal”, “volume” : “38” }, “uris” : “http://www.mendeley.com/documents/?uuid=6a76a9d9-6bdf-45a2-a683-fde63ee68e90” } , “mendeley” : { “formattedCitation” : “(Coetzee and Ngunyulu, 2015)”, “plainTextFormattedCitation” : “(Coetzee and Ngunyulu, 2015)”, “previouslyFormattedCitation” : “(Coetzee and Ngunyulu, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Coetzee and Ngunyulu, 2015). Family planning is an organized effort to assist people to have the number of children they want to space them as they choose ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Eze”, “given” : “B U”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Hope”, “given” : “Adhure”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “11”, “issued” : { “date-parts” : “2014” }, “page” : “182-190”, “title” : “Hindrances to effective usage of family planning methods among women in Adamokolo Lokoja Urban area of Kogi state , Nigeria”, “type” : “article-journal”, “volume” : “2” }, “uris” : “http://www.mendeley.com/documents/?uuid=0f34e128-815c-49ae-a21f-f446443dcc20” } , “mendeley” : { “formattedCitation” : “(Eze and Hope, 2014)”, “plainTextFormattedCitation” : “(Eze and Hope, 2014)”, “previouslyFormattedCitation” : “(Eze and Hope, 2014)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Eze and Hope, 2014). Also family planning allows people to attain their desired number of children and determine the spacing of pregnancies (WHO, 2015). There are different modern family planning methods which are short term such as pills, injections, barrier methods, spermicides, withdrawal and abstinence. Long term methods are intrauterine devices and Norplant as well as permanent methods tubal ligation and vasectomy ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Associates”, “given” : “Abt”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Sector”, “given” : “Private”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “One”, “given” : “Partnerships”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “0” }, “title” : “Collaborating and Supporting Organizations”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=dd640cf3-bc75-4ed2-b894-b2215c21238c” } , “mendeley” : { “formattedCitation” : “(Associates, Sector and One, no date)”, “plainTextFormattedCitation” : “(Associates, Sector and One, no date)”, “previouslyFormattedCitation” : “(Associates, Sector and One, no date)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Associates, Sector and One, no date).

It has been found that, family planning promote education and economic empowerment for women. When women use family planning methods control the birth interval, hence increasing their economy. Such as farming, trading, seeking for higher education level and being employed. Lack of awareness is found to be the main contribution factors which hinder family planning use in Uganda. Lack of adequate counseling in women about side effects of contraceptives use becomes one of challenges ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.11604/pamj.2015.20.10.5301”, “ISBN” : “1937-8688”, “ISSN” : “19378688”, “PMID” : “25995807”, “abstract” : “INTRODUCTION: Usage of family planning services in developing countries have been found to avert unintended pregnancies, reduce maternal and child mortality, however, it’s usage still remains low. Hence, the objective of this study was to investigate the factors that influence the decision of women in fertility age to go for family planning services.\n\nMETHODS: This was a descriptive cross-sectional study conducted in Talensi district in the Upper East Region of Ghana. Systematic random sampling was used to recruit 280 residents aged 15-49 years and data was analysed using SPSS version 21.0.\n\nRESULTS: The study revealed that 89% (249/280), of respondents were aware of family planning services, 18% (50/280) of respondents had used family planning services in the past. Parity and educational level of respondents were positively associated with usage of family planning services (P;0.05). Major motivating factors to the usage of family planning service were to space children, 94% (47/50) and to prevent pregnancy and sexual transmitted infections 84% (42/50). Major reasons for not accessing family planning services were opposition from husbands, 90% (207/230) and misconceptions about family planning, 83% (191/230).\n\nCONCLUSION: Although most women were aware of family planning services in the Talensi district, the uptake of the service was low. Thus, there is the need for the office of the district health directorate to intensify health education on the benefits of family planning with male involvement. The government should also scale up family planning services in the district to make it more accessible.”, “author” : { “dropping-particle” : “”, “family” : “Apanga”, “given” : “Paschal Awingura”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Adam”, “given” : “Matthew Ayamba”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Pan African Medical Journal”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2015” }, “page” : “1-9”, “title” : “Factors influencing the uptake of family planning services in the Talensi district, Ghana”, “type” : “article-journal”, “volume” : “20” }, “uris” : “http://www.mendeley.com/documents/?uuid=9d819832-c44e-4df5-9a94-c69159f0c784” } , “mendeley” : { “formattedCitation” : “(Apanga and Adam, 2015)”, “plainTextFormattedCitation” : “(Apanga and Adam, 2015)”, “previouslyFormattedCitation” : “(Apanga and Adam, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Apanga and Adam, 2015). According to the two survey conducted among university students in Uganda, findings indicate that student did not have access to reproductive health in spite of their engagement in high risk sexual behaviors. Findings also showed that quarter (25%) of university students had unmet need for contraceptives. In most African countries such as Uganda most university students who are unmarried and get unintended pregnancy seek abortion due to cultural and societal judgment ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1186/s12905-016-0286-6”, “ISBN” : “1290501602”, “ISSN” : “14726874”, “PMID” : “26818946”, “abstract” : “Background: In Uganda, the risk of unintended pregnancies and unsafe abortions remains high due to relatively low contraceptive use. There is paucity of data on knowledge, attitudes, perceptions and practices towards modern contraceptives and, sexual and reproductive health especially among the young female university students. Methods: A survey was conducted at Makerere University main campus in Kampala, Uganda during April 2014. A team of well-trained and experienced research assistants interviewed female undergraduate students who provided data on socio-demographic characteristics, knowledge, perceptions and attitudes and use of contraceptives, as well as other sexual and reproductive health practices. Users of any contraceptive method in the past 12 months were coded as u20181u2019 and none users as u20180u2019. The prevalence of contraceptive use was determined as the number of users divided by all female participants. Prevalence ratios (PRs) with their corresponding 95 % confidence intervals were used as measures of association between contraceptive use and associated factors. The PRs were obtained via a modified Poisson regression model using a generalized linear model with Poisson as family and a log link without an offset but including robust standard errors. All analyses were conducted with Stata version 13. Results: A total of 1,008 females responded to the survey; median (IQR) age was 21(20, 21) years, 38.6 % in year 2 of study, and nearly three quarters (72.3 %) were of Christian faith. Knowledge of any contraceptives was almost universal (99.6 %) but only 22.1 % knew about female condoms. Perceived acceptability of contraceptive use at the university (93 %) or being beneficial to male partners too (97.8 %) were high. Nearly 70 % had ever engaged in sexual intercourse and 62.1 % reported sexual intercourse in the past 12 months. Overall, 46.6 % reported current contraceptive use, with male condoms (34.5 %) being the commonest methods. Factors associated with higher contraceptive use were being in year 2, consensual union or perception that contraceptives are for females only. However, being evangelical/SDA or perception that contraceptive use is wrong was associated with lower contraceptive use. Overall, 9 % reported ever being pregnant, 2 % were pregnant at the time of the survey and a third (33.8 %) knew of a pregnant friend. About 40 % of ever pregnant respondents reported ever trying to terminate the pregnancy. Conclusions: Knowledge, perceived acceptau2026”, “author” : { “dropping-particle” : “”, “family” : “Nsubuga”, “given” : “Henry”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Sekandi”, “given” : “Juliet N.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Sempeera”, “given” : “Hassard”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Makumbi”, “given” : “Fredrick E.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “BMC Women’s Health”, “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2016” }, “page” : “1-11”, “publisher” : “BMC Women’s Health”, “title” : “Contraceptive use, knowledge, attitude, perceptions and sexual behavior among female University students in Uganda: A cross-sectional survey”, “type” : “article-journal”, “volume” : “16” }, “uris” : “http://www.mendeley.com/documents/?uuid=73dc4029-aa03-4ac9-aa0f-896023e43e85” } , “mendeley” : { “formattedCitation” : “(Nsubuga ;i;et al.;/i;, 2016)”, “plainTextFormattedCitation” : “(Nsubuga et al., 2016)”, “previouslyFormattedCitation” : “(Nsubuga ;i;et al.;/i;, 2016)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Nsubuga et al., 2016).

Pre-marital sexual activities seem to be increasing among higher education students in countries such as Asia and Africa, due to factors such as rapid urbanization and exposure to mass media. Nearly half of all pregnancies in the United States are unintended, the highest of this instance occurs between 18-24 years of age. Sexually active women are at the highest risk of contracting sexually transmitted diseases. The highest occurrence of unintended pregnancies and HIV/STIs contractions can be prevented through contraceptives use ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “abstract” : “PURPOSE: The purpose of this study was to examine and to understand undergraduate students’ contraceptive attitudes and its effects on contraceptive use to further enhance the education regarding unwanted pregnancies and sexually transmitted diseases (STDs). DESIGN AND METHODS: A descriptive study to understand contraceptive attitudes while exploring demographics and sexual behaviors as well as the incorporation of the Contraceptive Attitude Scale (CAS). The researchers utilized an online survey system to distribute surveys electronically. RESULTS: Most students had a positive attitude regarding contraception. IMPLICATIONS: Nurses at college health facilities can focus on educating the college population since their age group is likely to engage in risky behavior.”, “author” : { “dropping-particle” : “”, “family” : “Heisler”, “given” : “Katrina and”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Eron”, “given” : “Danielle M”, “non-dropping-particle” : “Van”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2012” }, “page” : “39”, “title” : “A descriptive study of undergraduate contraceptive attitudes among students at the University of New Hampshire”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=f6bf247b-f930-49c9-ad83-fb4fc23412a2” } , “mendeley” : { “formattedCitation” : “(Heisler and Van Eron, 2012)”, “plainTextFormattedCitation” : “(Heisler and Van Eron, 2012)”, “previouslyFormattedCitation” : “(Heisler and Van Eron, 2012)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Heisler and Van Eron, 2012). Study in South Africa reported that the lack of adequate knowledge and awareness of effectiveness of modern family planning among higher education female students, result in non-utilization of contraceptives. 2-8 percent of 2.1 million higher educations afflicted with HIV/AIDS. Eventually contribute to high unplanned pregnancy rates. Several factors were identified as contributing factors to non-utilization of modern family planning methods. These were lack of knowledge, religion, poor access to contraceptives services, peer pressures, alcohol and substances abuseADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.4102/curationis.v38i2.1535”, “ISBN” : “1500020001”, “ISSN” : “2223-6279”, “PMID” : “26842088”, “abstract” : “<p>Background: Unplanned pregnancies amongst students at higher education institutions are au00a0major concern worldwide, including South Africa. Apart from various social and psychologicalu00a0challenges, unplanned pregnancies affect studentsu2019 objectives of achieving academic success.u00a0Research undertaken in the United States of America (USA) indicates that around 80% ofu00a0female students in institutions of higher education between ages 18 and 24 are sexually active.Objectives: To assess and describe the use of contraceptives by undergraduate female studentsu00a0in a selected higher educational institution in Gauteng.Method: A cross-sectional, descriptive, quantitative design was used. A total of 400 femaleu00a0undergraduate students were requested to respond to a self-administered questionnaire.u00a0Stratified random sampling was used to select the participants. They were selectedu00a0systematically from two campuses. Data were entered using an excel sheet at the Departmentu00a0of Statistics, and analysed using the Statistical Analysis Software programme, (SAS versionu00a09.3), of the Department of Statisticsu2019 higher educational institutions.Results: A total of 74%females indicated they were sexually active, 79%of whom reportedu00a0using contraceptives. The most common used methods were oral contraceptives at 38%, andu00a025% for male condoms. The most commonly known methods were condoms at 84%, and theu00a0oral contraceptive at 68%. The knowledge of condom use to prevent sexually transmittedu00a0diseases was high at 91%.Conclusion: Inadequate knowledge and awareness on some contraceptive methods was found.u00a0Thus, educational programmes to increase studentsu2019 knowledge on the use of all contraceptiveu00a0methods are urgently needed</p>”, “author” : { “dropping-particle” : “”, “family” : “Coetzee”, “given” : “Maria H.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Ngunyulu”, “given” : “Roinah N.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Curationis”, “id” : “ITEM-1”, “issue” : “2”, “issued” : { “date-parts” : “2015” }, “page” : “1-7”, “title” : “Assessing the use of contraceptives by female undergraduate students in a selected higher educational institution in Gauteng”, “type” : “article-journal”, “volume” : “38” }, “uris” : “http://www.mendeley.com/documents/?uuid=6a76a9d9-6bdf-45a2-a683-fde63ee68e90” } , “mendeley” : { “formattedCitation” : “(Coetzee and Ngunyulu, 2015)”, “plainTextFormattedCitation” : “(Coetzee and Ngunyulu, 2015)”, “previouslyFormattedCitation” : “(Coetzee and Ngunyulu, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Coetzee and Ngunyulu, 2015).

Unintended pregnancies have significant consequences and occur most frequent among adolescent, low income groups and women from minority groups. Improving contraceptives among high risk groups is the key to reducing rates of unintended pregnancies in population. Previous studies suggest that there is variation noted at 44.7% by rural women and 29.9% by urban women. Knowledge should provide valid and reliable information on the utilization of family planning methodsADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.3934/publichealth.2015.4.655”, “ISSN” : “2327-8994”, “PMID” : “29546129”, “abstract” : “This study aims to explore and examine the conjectures surrounding the utilization of family planning services among currently married couples of childbearing age in Renk County. This study has adopted a qualitative method to collect data on factors affecting the utilization of family planning services through focus group discussions and in-depth interviews, in rural and urban areas of Renk County. It targeted married women, men as well as unmarried men and women. The researchers conducted nine focus group discussions and nine interviews at both Jelhak (rural setting) and Renk (urban setting). The results suggested that the people of Renk County prefer to have large families and therefore choose not to use family planning methods. The data collected was analyzed by means of thematic analysis. This included the construction of a thematic framework, coding, editing and categorization of available data as well as the creation of sub-themes. The result also suggested that perception is a main factor that affects utilization of family planning services with a majority of the people in Renk and Jelhak preferring to have many children in order to increase the family size for some reasons. These are linked to religion, social stigma and taboo that are attached to childless people or users of family planning methods for birth control purposes. The responses revealed some variation in perception between rural (Jelhak) and urban (Renk) areas. Respondents from Renk area reported that some people use family planning services for 656 AIMS Public Health Volume 2, Issue 4, 655u2013666. economic reasons that involve alleviation of financial difficulties and provision of better education when the family size is small. On the other hand, rural people from Jelhak perceive family planning to be socially un-acceptable. Furthermore, men and women of Jelhak reported that after each birth of a child, married couples avoid sexual relationship for a period of two years as means of family planning. Women of both Urban and Rural settings reported intentions to use conventional methods of family planning without the knowledge of their spouses.”, “author” : { “dropping-particle” : “”, “family” : “Amen Mohammed Ahmed”, “given” : “Waled”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Boutros Shokai”, “given” : “Sara”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Hassan Abduelkhair”, “given” : “Insaf”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Yahia Boshra”, “given” : “Amira”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “AIMS Public Health”, “id” : “ITEM-1”, “issue” : “4”, “issued” : { “date-parts” : “2015” }, “page” : “655-666”, “title” : “Factors Affecting Utilization of Family Planning Services in a Post-Conflict Setting, South Sudan: A Qualitative Study”, “type” : “article-journal”, “volume” : “2” }, “uris” : “http://www.mendeley.com/documents/?uuid=3c969135-2b83-4661-a34a-15615ff90194” } , “mendeley” : { “formattedCitation” : “(Amen Mohammed Ahmed <i>et al.</i>, 2015)”, “plainTextFormattedCitation” : “(Amen Mohammed Ahmed et al., 2015)”, “previouslyFormattedCitation” : “(Amen Mohammed Ahmed <i>et al.</i>, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Amen Mohammed Ahmed et al., 2015).

Family planning is of great importance is such a way it helps in preventing unwanted pregnancies, unsafe abortion, reduce maternal mortalities and prevent sexually transmitted diseases such as HIV/AIDS, globally the demand for unmet need increases especially in Africa. In Tanzania unmet need for family planning is estimated to be 22% among married women aged 15-49 years and 23.5% among young women aged 20-24 year ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1097/00001888-196911000-00043”, “ISBN” : “0275-5122 (Print)\r0275-5122 (Linking)”, “ISSN” : “0275-5122”, “PMID” : “12310238”, “abstract” : “In Egypt the population is expanding at a rate of 100,000 more people each month. Some demographers predict that by the year 2000, the population may reach 70-74 million. The Coptic Evangelical Organization for Social Service (CEOSS), established in 1954, uses a community development approach to provide health programs, which include family planning, projects in literacy, agriculture, religion, and leadership development. Once CEOSS agrees to work in a village, its staff members and community leaders form a committee to identify the tasks to be undertaken. Then, a team of young “motivators” is sent to the village to initiate projects. If the village requests a family planning program, the motivators arrange for clinics to be held in the village and for a visiting doctor to provide services. They distribute the contraceptives the clinic physician prescribes and keep records tracking users. In the effort to carry out the family planning program, the motivators identify women in the village who are leaders. The women, to qualify as family planning workers, must be at least age 19 or 20, believe in the importance of family planning, and be regular contraceptive users. The motivators train the women workers in the methods of family planning, record keeping, and distribution of contraceptives. Once a family planning program has been established, the village leaders take over responsibility for contraceptive distribution. CEOSS currently has 5000 family planning users in the 25 villages in which it works. Family Planning International Assistance has budgeted $78,000 for CEOSS in 1981.”, “author” : { “dropping-particle” : “”, “family” : “Kerr”, “given” : “M”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Planned parenthood review”, “id” : “ITEM-1”, “issue” : “11”, “issued” : { “date-parts” : “2014” }, “page” : “18-9”, “title” : “Family planning in Egypt.”, “type” : “article-journal”, “volume” : “44” }, “uris” : “http://www.mendeley.com/documents/?uuid=60021695-37f7-4df2-b827-e79acb0bf6ca” } , “mendeley” : { “formattedCitation” : “(Kerr, 2014)”, “plainTextFormattedCitation” : “(Kerr, 2014)”, “previouslyFormattedCitation” : “(Kerr, 2014)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Kerr, 2014). Despite of government of Tanzania having introduced the family planning methods to serve their people but still the total fertility rate is higher, about 5.2 birth per women,(WHO 2013). Tanzania demographic health survey (TDHS) showed that total fertility among rural women 6.0 higher than urban which are 3.8. Fertility rate also vary with education and economic status, women with no education have 3.3 more children than women with secondary education. Use of family planning to married women age 15-49 is 38%, while unmarried women age 15-49 is higher 54% (TDHS, 2015-16). There are so many factors that can hinder the use of family planning methods, such as lack of knowledge, social-cultural, beliefs/norms, economic status, perception and stigma ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Eze”, “given” : “B U”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Hope”, “given” : “Adhure”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “11”, “issued” : { “date-parts” : “2014” }, “page” : “182-190”, “title” : “Hindrances to effective usage of family planning methods among women in Adamokolo Lokoja Urban area of Kogi state , Nigeria”, “type” : “article-journal”, “volume” : “2” }, “uris” : “http://www.mendeley.com/documents/?uuid=0f34e128-815c-49ae-a21f-f446443dcc20” } , “mendeley” : { “formattedCitation” : “(Eze and Hope, 2014)”, “plainTextFormattedCitation” : “(Eze and Hope, 2014)”, “previouslyFormattedCitation” : “(Eze and Hope, 2014)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Eze and Hope, 2014).

In the developing countries millions of women in the reproductive age who do not use contraceptives prefer to postpone or limit their birth. This indicates their failure to take necessary decision to prevent and avoid unwanted pregnancy. Unmet need for family planning is defined as percentage of all fecund women who are married or living in union and thus presumed to be sexually active but are not using any methods of contraception. One of sequels of unmet need is unwanted pregnancy with its serious consequences. Sudan maternal mortality and fertility indicators are among the highest in the world which was 713 per 100000 live births ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1186/1471-2458-13-102”, “ISSN” : “14712458”, “PMID” : “23379387”, “abstract” : “In the developing countries millions of women in the reproductive age who don’t use contraceptives prefer to postpone or limit their birth. This indicates their failure to take necessary decision to prevent and avoid unwanted pregnancy. A community-based cross sectional household survey was conducted to investigate unmet need for family planning and associated factors and total demand for family planning in Kassala, Eastern Sudan between 1st May and 31st July 2012. A total of 812 married women were enrolled in this study. Their mean age and parity was 31.8 (7.3) and 3.4 (1.8) respectively. Ever use of contraception was 25.4% (206/812) and 26.2% (213/812) were currently using contraception. Unmet need for spacing was 15.1% while unmet need for limiting was 0.7%. The pregnant and amenorrheic women whose the pregnancy or birth was unwanted and mistimed were 105 (13%) and 130 (16%) respectively. Using Westoff model the total unmet need was estimated as 44.8%. The total demand for family planning was 71%.In logistic regression model, while age, age at marriage, parity, residence and experience of child death were not associated with total unmet need for family planning, women education ; secondary level (OR=7.8; CI=5.6-10.9; P=0.00), husband education ; secondary level (OR=1.9; CI=1.3-2.6, P = 0.00) and woman’s occupation; housewife (OR=4.3; CI=2.5-7.2; P=0.00) were associated with the total unmet need. Unmet need for family planning in Eastern Sudan was significantly higher among women with less than secondary education. Also; it is influenced by couple’s educational status and woman’s occupation. The results of this study necessitate the need for the programme managers to take into account the concept of reproductive health education.”, “author” : { “dropping-particle” : “”, “family” : “Ali”, “given” : “Abdel Aziem A”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Okud”, “given” : “Amira”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “BMC public health”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2013” }, “page” : “102”, “title” : “Factors affecting unmet need for family planning in Eastern Sudan.”, “type” : “article-journal”, “volume” : “13” }, “uris” : “http://www.mendeley.com/documents/?uuid=c50d7f4c-c003-4242-ae2c-3f8cc9d7b2c4” } , “mendeley” : { “formattedCitation” : “(Ali and Okud, 2013)”, “plainTextFormattedCitation” : “(Ali and Okud, 2013)”, “previouslyFormattedCitation” : “(Ali and Okud, 2013)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Ali and Okud, 2013).
The uptakes of modern family planning methods remain low in sub Saharan Africa including Ghana. The average contraceptives prevalence rate was estimated to be 6.2% related to national average. Globally 50 million women resort to induce abortion which result in higher maternal morbidity and mortalityADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Dodam”, “given” : “Konlan Kennedy”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Mohammed”, “given” : “Abdul-raheem”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Eneye”, “given” : “Adabara Helen”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Yeboah”, “given” : “Prince Appiah”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2017” }, “title” : “Knowledge and Perception of Ghanaian Adolescents about Family Planning”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=f61a47fb-2b1f-432a-b70c-113aa4b54e32” } , “mendeley” : { “formattedCitation” : “(Dodam <i>et al.</i>, 2017)”, “plainTextFormattedCitation” : “(Dodam et al., 2017)”, “previouslyFormattedCitation” : “(Dodam <i>et al.</i>, 2017)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Dodam et al., 2017).

Tanzania maternal mortality rate 398 per 100000 live births in urban, (WHO 2015).There are factors that can contribute on ineffective use of family planning methods such as culture, women hide their contraceptive hence reduce effectiveness of family planning. In regard to perception some women perceive on contraceptive usage as sexually immoral. Economic factors lack of contraceptive in government hospitals/dispensary. Many women have less knowledge on family planning methods. There are other factors that can contribute on ineffective use of family planning such as attitude, norms, religion and lack of facilities (WHO 2009).

According to the ministry of health instituted national policy guidelines and standard for family planning services and training state “that all males and female of reproductive age including adolescence irrespectively of their parity and marital status, shall have the right to access to family planning information, education and services”ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.11604/pamj.2015.20.10.5301”, “ISBN” : “1937-8688”, “ISSN” : “19378688”, “PMID” : “25995807”, “abstract” : “INTRODUCTION: Usage of family planning services in developing countries have been found to avert unintended pregnancies, reduce maternal and child mortality, however, it’s usage still remains low. Hence, the objective of this study was to investigate the factors that influence the decision of women in fertility age to go for family planning services.\n\nMETHODS: This was a descriptive cross-sectional study conducted in Talensi district in the Upper East Region of Ghana. Systematic random sampling was used to recruit 280 residents aged 15-49 years and data was analysed using SPSS version 21.0.\n\nRESULTS: The study revealed that 89% (249/280), of respondents were aware of family planning services, 18% (50/280) of respondents had used family planning services in the past. Parity and educational level of respondents were positively associated with usage of family planning services (P;0.05). Major motivating factors to the usage of family planning service were to space children, 94% (47/50) and to prevent pregnancy and sexual transmitted infections 84% (42/50). Major reasons for not accessing family planning services were opposition from husbands, 90% (207/230) and misconceptions about family planning, 83% (191/230).\n\nCONCLUSION: Although most women were aware of family planning services in the Talensi district, the uptake of the service was low. Thus, there is the need for the office of the district health directorate to intensify health education on the benefits of family planning with male involvement. The government should also scale up family planning services in the district to make it more accessible.”, “author” : { “dropping-particle” : “”, “family” : “Apanga”, “given” : “Paschal Awingura”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Adam”, “given” : “Matthew Ayamba”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Pan African Medical Journal”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2015” }, “page” : “1-9”, “title” : “Factors influencing the uptake of family planning services in the Talensi district, Ghana”, “type” : “article-journal”, “volume” : “20” }, “uris” : “http://www.mendeley.com/documents/?uuid=9d819832-c44e-4df5-9a94-c69159f0c784” } , “mendeley” : { “formattedCitation” : “(Apanga and Adam, 2015)”, “plainTextFormattedCitation” : “(Apanga and Adam, 2015)”, “previouslyFormattedCitation” : “(Apanga and Adam, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Apanga and Adam, 2015).

1.1 Purpose of the study
The purpose of the study is to asses knowledge and perception of modern family planning methods among female nursing students at MUHAS and to address the identified problems.

1.2 Problem statement
In developing countries, one in three women give birth before the age of 20. In sub Saharan Africa, unintended pregnancies occur every year half occurring among women age 15-24 years. It is evident that use of effective contraceptives methods prevent 90% of abortion,20%pregnancy related morbidity and 32% maternal death ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1186/s12905-016-0286-6”, “ISBN” : “1290501602”, “ISSN” : “14726874”, “PMID” : “26818946”, “abstract” : “Background: In Uganda, the risk of unintended pregnancies and unsafe abortions remains high due to relatively low contraceptive use. There is paucity of data on knowledge, attitudes, perceptions and practices towards modern contraceptives and, sexual and reproductive health especially among the young female university students. Methods: A survey was conducted at Makerere University main campus in Kampala, Uganda during April 2014. A team of well-trained and experienced research assistants interviewed female undergraduate students who provided data on socio-demographic characteristics, knowledge, perceptions and attitudes and use of contraceptives, as well as other sexual and reproductive health practices. Users of any contraceptive method in the past 12 months were coded as u20181u2019 and none users as u20180u2019. The prevalence of contraceptive use was determined as the number of users divided by all female participants. Prevalence ratios (PRs) with their corresponding 95 % confidence intervals were used as measures of association between contraceptive use and associated factors. The PRs were obtained via a modified Poisson regression model using a generalized linear model with Poisson as family and a log link without an offset but including robust standard errors. All analyses were conducted with Stata version 13. Results: A total of 1,008 females responded to the survey; median (IQR) age was 21(20, 21) years, 38.6 % in year 2 of study, and nearly three quarters (72.3 %) were of Christian faith. Knowledge of any contraceptives was almost universal (99.6 %) but only 22.1 % knew about female condoms. Perceived acceptability of contraceptive use at the university (93 %) or being beneficial to male partners too (97.8 %) were high. Nearly 70 % had ever engaged in sexual intercourse and 62.1 % reported sexual intercourse in the past 12 months. Overall, 46.6 % reported current contraceptive use, with male condoms (34.5 %) being the commonest methods. Factors associated with higher contraceptive use were being in year 2, consensual union or perception that contraceptives are for females only. However, being evangelical/SDA or perception that contraceptive use is wrong was associated with lower contraceptive use. Overall, 9 % reported ever being pregnant, 2 % were pregnant at the time of the survey and a third (33.8 %) knew of a pregnant friend. About 40 % of ever pregnant respondents reported ever trying to terminate the pregnancy. Conclusions: Knowledge, perceived acceptau2026”, “author” : { “dropping-particle” : “”, “family” : “Nsubuga”, “given” : “Henry”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Sekandi”, “given” : “Juliet N.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Sempeera”, “given” : “Hassard”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Makumbi”, “given” : “Fredrick E.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “BMC Women’s Health”, “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2016” }, “page” : “1-11”, “publisher” : “BMC Women’s Health”, “title” : “Contraceptive use, knowledge, attitude, perceptions and sexual behavior among female University students in Uganda: A cross-sectional survey”, “type” : “article-journal”, “volume” : “16” }, “uris” : “http://www.mendeley.com/documents/?uuid=73dc4029-aa03-4ac9-aa0f-896023e43e85” } , “mendeley” : { “formattedCitation” : “(Nsubuga ;i;et al.;/i;, 2016)”, “plainTextFormattedCitation” : “(Nsubuga et al., 2016)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Nsubuga et al., 2016) .

Despite of availability of free contraceptives offered by health centers, perception and lack of knowledge on the use of contraceptives is associated with the failure of modern family planning utilization. The high rate of underutilization of modern family planning cause multiple challenges for academic institutions across the world. These challenges such as unwanted pregnancies, unsafe abortion, sexually transmitted diseases, maternal mortality rate and high dropout by university students. Therefore by increasing knowledge and impacting positive perceptions towards utilization of available modern family planning methods empowers female nurses student to overcome the problem. Hence utilization of family planning reduces these consequences and improve well-being of female nursing students.

1.3 Objectives
1.3.1 Broad objective
To determine knowledge and perception towards utilization of family planning methods among female nursing students at MUHAS.1.3.2 Specific Objectives
1. To Identify female nursing students knowledge towards utilization of modern family planning methods at MUHAS.

2 To Determine female nursing student’s perception towards utilization of modern family planning methods at MUHAS.

1.4 Research questions
1. What is the knowledge of female nursing students at MUHAS about the concept of modern family planning methods?
2. What is the perception of female nursing students at MUHAS towards utilization of modern family planning methods?
1.5 Hypothesis
1.Female Student’s nurses at MUHAS with knowledge and positive perception on utilization are more likely to use modern family planning methods.

1.6 Conceptual framework
Conceptual framework is a written or visual presentation that explains either graphically or in narrative form the relationship of ideas or the main things to be studied can be the key factors, concepts or variables. (Oxford dictionary, 2010)
The conceptual framework of the study examines the utilization of family planning at MUHAS among female nursing students; there are possible factors which cause underutilization of family planning such as lack of knowledge about family planning, negative perceptions, Economic status, religion beliefs and availability of family planning methods. Dependent variable and independent variable these variables are interrelated in the cause of problem statement. When there is lack of knowledge and negative perception on utilization of family planning methods, there will be low utilization of modern family planning methods.

Conceptual framework diagram
2303780292100Under-utilization of family planning
00Under-utilization of family planning
Dependant variable
399288025069800195072025069800
Independent variable
-30988269113Knowledge deficit
Negative Perception
Religious beliefs
Economic status
Unavailability of contraceptives
00Knowledge deficit
Negative Perception
Religious beliefs
Economic status
Unavailability of contraceptives
427888413081Unwanted pregnancy
Unsafe abortion
Mortality rate
Sexually transmitted infections
00Unwanted pregnancy
Unsafe abortion
Mortality rate
Sexually transmitted infections
Independent variable
1.7 Literature review
1.7.1 Perception
Perception is the ability to see, hears, or become aware of something through the senses, (Oxford dictionary, 2011). People of Sudan perceived family planning as follows; some of them wanted large family size with many children, and other people wanted more children for agriculture and work purpose, other wanted to keep women and children healthy. Only small number of people wishes to use family planning for economic purpose, they wanted their children to be educated and raise their income. Most people with negative perception regarding utilization of family planning services are found in rural area whereby they fear about side effect of modern contraceptives, some of them were complaining of unavailability of family planning services, some of them indicated that it was only found in private sectors so it was cost full for them to buy. This study indicated low utilization of modern family planning due to affordability and availability services ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.3934/publichealth.2015.4.655”, “ISSN” : “2327-8994”, “PMID” : “29546129”, “abstract” : “This study aims to explore and examine the conjectures surrounding the utilization of family planning services among currently married couples of childbearing age in Renk County. This study has adopted a qualitative method to collect data on factors affecting the utilization of family planning services through focus group discussions and in-depth interviews, in rural and urban areas of Renk County. It targeted married women, men as well as unmarried men and women. The researchers conducted nine focus group discussions and nine interviews at both Jelhak (rural setting) and Renk (urban setting). The results suggested that the people of Renk County prefer to have large families and therefore choose not to use family planning methods. The data collected was analyzed by means of thematic analysis. This included the construction of a thematic framework, coding, editing and categorization of available data as well as the creation of sub-themes. The result also suggested that perception is a main factor that affects utilization of family planning services with a majority of the people in Renk and Jelhak preferring to have many children in order to increase the family size for some reasons. These are linked to religion, social stigma and taboo that are attached to childless people or users of family planning methods for birth control purposes. The responses revealed some variation in perception between rural (Jelhak) and urban (Renk) areas. Respondents from Renk area reported that some people use family planning services for 656 AIMS Public Health Volume 2, Issue 4, 655u2013666. economic reasons that involve alleviation of financial difficulties and provision of better education when the family size is small. On the other hand, rural people from Jelhak perceive family planning to be socially un-acceptable. Furthermore, men and women of Jelhak reported that after each birth of a child, married couples avoid sexual relationship for a period of two years as means of family planning. Women of both Urban and Rural settings reported intentions to use conventional methods of family planning without the knowledge of their spouses.”, “author” : { “dropping-particle” : “”, “family” : “Amen Mohammed Ahmed”, “given” : “Waled”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Boutros Shokai”, “given” : “Sara”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Hassan Abduelkhair”, “given” : “Insaf”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Yahia Boshra”, “given” : “Amira”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “AIMS Public Health”, “id” : “ITEM-1”, “issue” : “4”, “issued” : { “date-parts” : “2015” }, “page” : “655-666”, “title” : “Factors Affecting Utilization of Family Planning Services in a Post-Conflict Setting, South Sudan: A Qualitative Study”, “type” : “article-journal”, “volume” : “2” }, “uris” : “http://www.mendeley.com/documents/?uuid=3c969135-2b83-4661-a34a-15615ff90194” } , “mendeley” : { “formattedCitation” : “(Amen Mohammed Ahmed ;i;et al.;/i;, 2015)”, “plainTextFormattedCitation” : “(Amen Mohammed Ahmed et al., 2015)”, “previouslyFormattedCitation” : “(Amen Mohammed Ahmed ;i;et al.;/i;, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Amen Mohammed Ahmed et al., 2015).
A cross sectional study was done in Uganda 2014 among female students at Makerere University concerning about perception of family planning were by 1008 female university were enrolled, 23.6% perceived that modern contraceptive services were not accessible,24.4% said it was not easy to discuss with partener,21.3% perceived that contraceptives were not for poor people,20.1% it was wrong to use contraceptives,6% contraceptives were for female only. Among the sexually active students one in five were engaged in unsafe sex leading to high risk of unintended pregnancy and sexually transmitted diseases ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1186/s12905-016-0286-6”, “ISBN” : “1290501602”, “ISSN” : “14726874”, “PMID” : “26818946”, “abstract” : “Background: In Uganda, the risk of unintended pregnancies and unsafe abortions remains high due to relatively low contraceptive use. There is paucity of data on knowledge, attitudes, perceptions and practices towards modern contraceptives and, sexual and reproductive health especially among the young female university students. Methods: A survey was conducted at Makerere University main campus in Kampala, Uganda during April 2014. A team of well-trained and experienced research assistants interviewed female undergraduate students who provided data on socio-demographic characteristics, knowledge, perceptions and attitudes and use of contraceptives, as well as other sexual and reproductive health practices. Users of any contraceptive method in the past 12 months were coded as u20181u2019 and none users as u20180u2019. The prevalence of contraceptive use was determined as the number of users divided by all female participants. Prevalence ratios (PRs) with their corresponding 95 % confidence intervals were used as measures of association between contraceptive use and associated factors. The PRs were obtained via a modified Poisson regression model using a generalized linear model with Poisson as family and a log link without an offset but including robust standard errors. All analyses were conducted with Stata version 13. Results: A total of 1,008 females responded to the survey; median (IQR) age was 21(20, 21) years, 38.6 % in year 2 of study, and nearly three quarters (72.3 %) were of Christian faith. Knowledge of any contraceptives was almost universal (99.6 %) but only 22.1 % knew about female condoms. Perceived acceptability of contraceptive use at the university (93 %) or being beneficial to male partners too (97.8 %) were high. Nearly 70 % had ever engaged in sexual intercourse and 62.1 % reported sexual intercourse in the past 12 months. Overall, 46.6 % reported current contraceptive use, with male condoms (34.5 %) being the commonest methods. Factors associated with higher contraceptive use were being in year 2, consensual union or perception that contraceptives are for females only. However, being evangelical/SDA or perception that contraceptive use is wrong was associated with lower contraceptive use. Overall, 9 % reported ever being pregnant, 2 % were pregnant at the time of the survey and a third (33.8 %) knew of a pregnant friend. About 40 % of ever pregnant respondents reported ever trying to terminate the pregnancy. Conclusions: Knowledge, perceived acceptau2026”, “author” : { “dropping-particle” : “”, “family” : “Nsubuga”, “given” : “Henry”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Sekandi”, “given” : “Juliet N.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Sempeera”, “given” : “Hassard”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Makumbi”, “given” : “Fredrick E.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “BMC Women’s Health”, “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2016” }, “page” : “1-11”, “publisher” : “BMC Women’s Health”, “title” : “Contraceptive use, knowledge, attitude, perceptions and sexual behavior among female University students in Uganda: A cross-sectional survey”, “type” : “article-journal”, “volume” : “16” }, “uris” : “http://www.mendeley.com/documents/?uuid=73dc4029-aa03-4ac9-aa0f-896023e43e85” } , “mendeley” : { “formattedCitation” : “(Nsubuga ;i;et al.;/i;, 2016)”, “plainTextFormattedCitation” : “(Nsubuga et al., 2016)”, “previouslyFormattedCitation” : “(Nsubuga ;i;et al.;/i;, 2016)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Nsubuga et al., 2016).

Also a study was done in Ghana a cross-sectional design of perception about contraceptives methods 150 university students were recruited in 2017, 40% perceived family planning is a bad practice, while 60% were aware of family planning believed family planning is good practice. Some students believed that modern family planning is safe for their reproductive health while others believed it was not safe. There was positive and negative perception towards utilization of modern family planning ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Dodam”, “given” : “Konlan Kennedy”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Mohammed”, “given” : “Abdul-raheem”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Eneye”, “given” : “Adabara Helen”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Yeboah”, “given” : “Prince Appiah”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2017” }, “title” : “Knowledge and Perception of Ghanaian Adolescents about Family Planning”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=f61a47fb-2b1f-432a-b70c-113aa4b54e32” } , “mendeley” : { “formattedCitation” : “(Dodam ;i;et al.;/i;, 2017)”, “plainTextFormattedCitation” : “(Dodam et al., 2017)”, “previouslyFormattedCitation” : “(Dodam ;i;et al.;/i;, 2017)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Dodam et al., 2017).
A cross section study in Nigeria was conducted 2014 to evaluate perception of modern family planning among students in Delta state University, 500 students were enrolled 47.4% had abortion, 18.7% felt it promotes promiscuity,19.6% perceived contraceptives allowed women to pursue their career where by 44% believed contraceptives are essential tools for family planning. There is evidence which shows unplanned pregnancies were increasing since the rate of abortion was high, access to utilization of contraceptives should be improved. There is high risk of increasing maternal mortality rate as well as disruption of academic career. Majority of students had negative perception toward utilization of modern family planning ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “abstract” : “There is evidence to show that unplanned pregnancies are on the increase among women in Nigeria. It is true that one of the ways to improve reproductive health is by enhancing access to contraception. This study was to evaluate knowledge, perceptions and practices of contraception among 500 staff and students of a university in south-south Nigeria. A descriptive cross-sectional study was carried out in the Abraka and Oleh Campuses of Delta State University using appropriately designed, validated and pre-tested questionnaire. Data was analyzed with SPSS version 20. Respondents were students (70%), males (47.8%), aged 21-30 (48.9%) and Christians (90.9%). 84% of the respondents had good-to-excellent knowledge of contraceptives; 75.1% were sexually-active; contraceptive use prevalence was 58.2%; main reasons for non-use of contraceptive were hatred for it an intolerable side-effects. Condoms and oral pills were the preferred methods and safety, reliability and accessibility were proffered as reasons for choice; 17.3% had experienced contraceptive failure which resulted in abortion (47.4%). Pharmacy shops, health centers and Chemist shops were the sources for procuring contraceptive products; Family/friends, television and health professionals were sources of information about contraception; 46.7% did not experience side-effects; marital status was correlated with contraceptive knowledge and use. This study recommends that family planning should be vigorously promoted in a country like Nigeria with a high fertility, maternal and child mortality rates.”, “author” : { “dropping-particle” : “”, “family” : “Eniojukan”, “given” : “Joshua”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Ofulue”, “given” : “Ijeoma”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Okinedo”, “given” : “Prince”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “UK Journal of Pharmaceutical and Biosciences”, “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2016” }, “page” : “71-81”, “title” : “Knowledge, Perception and Practice of Contraception among Staff and Students in a University Community in Delta State, Nigeria”, “type” : “article-journal”, “volume” : “4” }, “uris” : “http://www.mendeley.com/documents/?uuid=66ef9748-0982-4b47-9507-bbb049d78c3e” } , “mendeley” : { “formattedCitation” : “(Eniojukan, Ofulue and Okinedo, 2016)”, “plainTextFormattedCitation” : “(Eniojukan, Ofulue and Okinedo, 2016)”, “previouslyFormattedCitation” : “(Eniojukan, Ofulue and Okinedo, 2016)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Eniojukan, Ofulue and Okinedo, 2016).

A particular study among 500 university students of Nigeria show that 84% had excellent knowledge of contraceptives, 17.3% contraceptive failure which resulted in abortion 47.4%. There is high (98%) knowledge level but 54% use these methods, a study among undergraduates in Tanzania also revealed that students had good knowledge of contraceptives with 58.8% of sexually active that ever used contraceptives and 41.5% were current users. Some other studies among students have reported much lower level of contraceptives knowledge and lower rates of utilizationADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “abstract” : “There is evidence to show that unplanned pregnancies are on the increase among women in Nigeria. It is true that one of the ways to improve reproductive health is by enhancing access to contraception. This study was to evaluate knowledge, perceptions and practices of contraception among 500 staff and students of a university in south-south Nigeria. A descriptive cross-sectional study was carried out in the Abraka and Oleh Campuses of Delta State University using appropriately designed, validated and pre-tested questionnaire. Data was analyzed with SPSS version 20. Respondents were students (70%), males (47.8%), aged 21-30 (48.9%) and Christians (90.9%). 84% of the respondents had good-to-excellent knowledge of contraceptives; 75.1% were sexually-active; contraceptive use prevalence was 58.2%; main reasons for non-use of contraceptive were hatred for it an intolerable side-effects. Condoms and oral pills were the preferred methods and safety, reliability and accessibility were proffered as reasons for choice; 17.3% had experienced contraceptive failure which resulted in abortion (47.4%). Pharmacy shops, health centers and Chemist shops were the sources for procuring contraceptive products; Family/friends, television and health professionals were sources of information about contraception; 46.7% did not experience side-effects; marital status was correlated with contraceptive knowledge and use. This study recommends that family planning should be vigorously promoted in a country like Nigeria with a high fertility, maternal and child mortality rates.”, “author” : { “dropping-particle” : “”, “family” : “Eniojukan”, “given” : “Joshua”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Ofulue”, “given” : “Ijeoma”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Okinedo”, “given” : “Prince”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “UK Journal of Pharmaceutical and Biosciences”, “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2016” }, “page” : “71-81”, “title” : “Knowledge, Perception and Practice of Contraception among Staff and Students in a University Community in Delta State, Nigeria”, “type” : “article-journal”, “volume” : “4” }, “uris” : “http://www.mendeley.com/documents/?uuid=66ef9748-0982-4b47-9507-bbb049d78c3e” } , “mendeley” : { “formattedCitation” : “(Eniojukan, Ofulue and Okinedo, 2016)”, “plainTextFormattedCitation” : “(Eniojukan, Ofulue and Okinedo, 2016)”, “previouslyFormattedCitation” : “(Eniojukan, Ofulue and Okinedo, 2016)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Eniojukan, Ofulue and Okinedo, 2016)
1.7.2 Knowledge
Lack of knowledge among women in Sudan, most girls lack knowledge of family planning services because most of them are illiterate. Hence women lack confidence and cannot make their own decision and also affected by culture of Sudan in which girls did not get chance to attend the school. Lack of education among couples is the determinant of unmate need for usage of family planning services. The educated women have better access to health facilities and information about contraception. Education is an important factor of family planning services hence husband must be involved in education concerning to family planning method. It is agreed that women with higher education are better informed about family planning methods than the peer with low educationADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.11604/pamj.2015.20.10.5301”, “ISBN” : “1937-8688”, “ISSN” : “19378688”, “PMID” : “25995807”, “abstract” : “INTRODUCTION: Usage of family planning services in developing countries have been found to avert unintended pregnancies, reduce maternal and child mortality, however, it’s usage still remains low. Hence, the objective of this study was to investigate the factors that influence the decision of women in fertility age to go for family planning services.\n\nMETHODS: This was a descriptive cross-sectional study conducted in Talensi district in the Upper East Region of Ghana. Systematic random sampling was used to recruit 280 residents aged 15-49 years and data was analysed using SPSS version 21.0.\n\nRESULTS: The study revealed that 89% (249/280), of respondents were aware of family planning services, 18% (50/280) of respondents had used family planning services in the past. Parity and educational level of respondents were positively associated with usage of family planning services (P<0.05). Major motivating factors to the usage of family planning service were to space children, 94% (47/50) and to prevent pregnancy and sexual transmitted infections 84% (42/50). Major reasons for not accessing family planning services were opposition from husbands, 90% (207/230) and misconceptions about family planning, 83% (191/230).\n\nCONCLUSION: Although most women were aware of family planning services in the Talensi district, the uptake of the service was low. Thus, there is the need for the office of the district health directorate to intensify health education on the benefits of family planning with male involvement. The government should also scale up family planning services in the district to make it more accessible.”, “author” : { “dropping-particle” : “”, “family” : “Apanga”, “given” : “Paschal Awingura”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Adam”, “given” : “Matthew Ayamba”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Pan African Medical Journal”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2015” }, “page” : “1-9”, “title” : “Factors influencing the uptake of family planning services in the Talensi district, Ghana”, “type” : “article-journal”, “volume” : “20” }, “uris” : “http://www.mendeley.com/documents/?uuid=9d819832-c44e-4df5-9a94-c69159f0c784” } , “mendeley” : { “formattedCitation” : “(Apanga and Adam, 2015)”, “plainTextFormattedCitation” : “(Apanga and Adam, 2015)”, “previouslyFormattedCitation” : “(Apanga and Adam, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Apanga and Adam, 2015).

Several studies done in South Africa have found that lack of knowledge on contraceptives may lead to an increase rate of unplanned pregnancies. Estimates of the global incidence of unplanned pregnancy and pregnancy outcome were developed first in 1995 at that time about 38% were estimated to be unplanned pregnancies and more than half 22% ended in abortion. Of 208 million pregnancies occurred worldwide in 2008 estimated that 41% were unplanned pregnancies and 208 of these took place in developing world. In a study 2009 among college students in Nepal approximately 210 million pregnancies occur 75 million or 36% of which were unintended among the age 18 to 24 years old of women. Every year in sub Saharan Africa, about 14 million or 44% unplanned pregnancies occur aged 15 to 24 years. Having knowledge on utilization of modern family planning methods reduces the risk of unplanned pregnancies which lead to unsafe abortionADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.4102/curationis.v38i2.1535”, “ISBN” : “1500020001”, “ISSN” : “2223-6279”, “PMID” : “26842088”, “abstract” : “<p>Background: Unplanned pregnancies amongst students at higher education institutions are au00a0major concern worldwide, including South Africa. Apart from various social and psychologicalu00a0challenges, unplanned pregnancies affect studentsu2019 objectives of achieving academic success.u00a0Research undertaken in the United States of America (USA) indicates that around 80% ofu00a0female students in institutions of higher education between ages 18 and 24 are sexually active.Objectives: To assess and describe the use of contraceptives by undergraduate female studentsu00a0in a selected higher educational institution in Gauteng.Method: A cross-sectional, descriptive, quantitative design was used. A total of 400 femaleu00a0undergraduate students were requested to respond to a self-administered questionnaire.u00a0Stratified random sampling was used to select the participants. They were selectedu00a0systematically from two campuses. Data were entered using an excel sheet at the Departmentu00a0of Statistics, and analysed using the Statistical Analysis Software programme, (SAS versionu00a09.3), of the Department of Statisticsu2019 higher educational institutions.Results: A total of 74%females indicated they were sexually active, 79%of whom reportedu00a0using contraceptives. The most common used methods were oral contraceptives at 38%, andu00a025% for male condoms. The most commonly known methods were condoms at 84%, and theu00a0oral contraceptive at 68%. The knowledge of condom use to prevent sexually transmittedu00a0diseases was high at 91%.Conclusion: Inadequate knowledge and awareness on some contraceptive methods was found.u00a0Thus, educational programmes to increase studentsu2019 knowledge on the use of all contraceptiveu00a0methods are urgently needed</p>”, “author” : { “dropping-particle” : “”, “family” : “Coetzee”, “given” : “Maria H.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Ngunyulu”, “given” : “Roinah N.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Curationis”, “id” : “ITEM-1”, “issue” : “2”, “issued” : { “date-parts” : “2015” }, “page” : “1-7”, “title” : “Assessing the use of contraceptives by female undergraduate students in a selected higher educational institution in Gauteng”, “type” : “article-journal”, “volume” : “38” }, “uris” : “http://www.mendeley.com/documents/?uuid=6a76a9d9-6bdf-45a2-a683-fde63ee68e90” } , “mendeley” : { “formattedCitation” : “(Coetzee and Ngunyulu, 2015)”, “plainTextFormattedCitation” : “(Coetzee and Ngunyulu, 2015)”, “previouslyFormattedCitation” : “(Coetzee and Ngunyulu, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Coetzee and Ngunyulu, 2015)
A cross sectional study was done in mtwivila Tanzania to asses knowledge among women in 2014,a total of 96 women were in rolled in the study aged 19 -49. Knowledge of contraceptives was universal, women had knowledge about modern contraceptives by 97.9%, 63.3% were using at least one modern methods, 42.9% experienced side effects stopped. There is universal knowledge but not all of them were using. Women can have knowledge on family planning but the problem is utilizing the methods, high level of knowledge but poor utilization. There are other factors which hinder utilization of modern family planning methods apart from knowledge ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.11648/j.sjph.20170504.19”, “ISSN” : “2328-7942”, “abstract” : “This study was conducted in 2014 in Mtwivila, Tanzania. The objective of the study was to assess knowledge, perception and factors associated with use of modern contraceptive use among women. Simple random sampling technique was used to select a representative sample of 96 women aged 15-49 years. Data were collected through interviews, focus group discussions and documentary reviews. Findings show that knowledge of modern FP was almost universal (100% percent), although 79 (82.3 percent) claimed to have been using modern contraceptives methods. Much smaller proportion (17.7 percent) reported not to be using modern contraceptives during the time of interview. Most of the respondents (96%) had positive attitude on modern contraceptive use as 96 of all interviewed women stated contraceptives were effective for birth control and that they would recommend to a friend or a relative the use of modern contraceptive. However, 28% women reported having stopped using modern contraceptive of which 25% due to side effects. Chi-square confirmed the association of education, sources of information about contraceptives, occupation, household income, distance from the health center and husband’s involvement with the use of contraceptives among women. It is concluded that there is a good level of knowledge and a positive perception towards contraceptive use among women of reproductive age. Men involvement during sensitization on family planning would be an effective strategy toward sexual and reproductive health promotion.”, “author” : { “dropping-particle” : “”, “family” : “Elia Mosha”, “given” : “Peter”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Science Journal of Public Health”, “id” : “ITEM-1”, “issue” : “4”, “issued” : { “date-parts” : “2017” }, “page” : “335”, “title” : “Assessment of Knowledge and Perception Towards Modern Contraceptives Use Among Women of Reproductive Age in Mtwivila, Tanzania”, “type” : “article-journal”, “volume” : “5” }, “uris” : “http://www.mendeley.com/documents/?uuid=83e4c544-ff96-4d35-9b99-69d8afd2ff20” } , “mendeley” : { “formattedCitation” : “(Elia Mosha, 2017)”, “plainTextFormattedCitation” : “(Elia Mosha, 2017)”, “previouslyFormattedCitation” : “(Elia Mosha, 2017)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Elia Mosha, 2017).

1.7.3 Culture and religious
Religious and belief are among the factor which hinder the use of family planning methods. The church leaders had habit of preaching about family planning is against God wishes the word of God say that “increase and multiply and fill the face of world “also child birth is a gift from God and any method to prevent pregnancy is the same as rejecting to God?s word. People believe that God who sent these children will always provide the essential needs for them. Religion play major part in causing underutilization of contraceptives since some people have strong belief so It reduces the possibility of using these methods ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.3934/publichealth.2015.4.655”, “ISSN” : “2327-8994”, “PMID” : “29546129”, “abstract” : “This study aims to explore and examine the conjectures surrounding the utilization of family planning services among currently married couples of childbearing age in Renk County. This study has adopted a qualitative method to collect data on factors affecting the utilization of family planning services through focus group discussions and in-depth interviews, in rural and urban areas of Renk County. It targeted married women, men as well as unmarried men and women. The researchers conducted nine focus group discussions and nine interviews at both Jelhak (rural setting) and Renk (urban setting). The results suggested that the people of Renk County prefer to have large families and therefore choose not to use family planning methods. The data collected was analyzed by means of thematic analysis. This included the construction of a thematic framework, coding, editing and categorization of available data as well as the creation of sub-themes. The result also suggested that perception is a main factor that affects utilization of family planning services with a majority of the people in Renk and Jelhak preferring to have many children in order to increase the family size for some reasons. These are linked to religion, social stigma and taboo that are attached to childless people or users of family planning methods for birth control purposes. The responses revealed some variation in perception between rural (Jelhak) and urban (Renk) areas. Respondents from Renk area reported that some people use family planning services for 656 AIMS Public Health Volume 2, Issue 4, 655u2013666. economic reasons that involve alleviation of financial difficulties and provision of better education when the family size is small. On the other hand, rural people from Jelhak perceive family planning to be socially un-acceptable. Furthermore, men and women of Jelhak reported that after each birth of a child, married couples avoid sexual relationship for a period of two years as means of family planning. Women of both Urban and Rural settings reported intentions to use conventional methods of family planning without the knowledge of their spouses.”, “author” : { “dropping-particle” : “”, “family” : “Amen Mohammed Ahmed”, “given” : “Waled”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Boutros Shokai”, “given” : “Sara”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Hassan Abduelkhair”, “given” : “Insaf”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Yahia Boshra”, “given” : “Amira”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “AIMS Public Health”, “id” : “ITEM-1”, “issue” : “4”, “issued” : { “date-parts” : “2015” }, “page” : “655-666”, “title” : “Factors Affecting Utilization of Family Planning Services in a Post-Conflict Setting, South Sudan: A Qualitative Study”, “type” : “article-journal”, “volume” : “2” }, “uris” : “http://www.mendeley.com/documents/?uuid=3c969135-2b83-4661-a34a-15615ff90194” } , “mendeley” : { “formattedCitation” : “(Amen Mohammed Ahmed ;i;et al.;/i;, 2015)”, “plainTextFormattedCitation” : “(Amen Mohammed Ahmed et al., 2015)”, “previouslyFormattedCitation” : “(Amen Mohammed Ahmed ;i;et al.;/i;, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Amen Mohammed Ahmed et al., 2015)
In Tanzania some people do not support the utilization of modern family planning, one of participant in Handeni was quoted saying “God has given you the ability to reproduce children and this is gift from him, we cannot in way prevent pregnancy. There are people who work day and night to get pregnancy, now since God has given us ability to children lets have kids until the eggs are finished.”(Kerr,2014).

1.7.4 Unavailability of health services
Lack of services is a major factor affecting utilization of family planning services. According to the study done in Sudan. It was found that most health facilities had no family planning services. People of Jelhak claimed about family planning services were not available about six months at same point. Unavailability of family planning services caused many women not to utilize the modern methods this leading to unintended pregnancies. There was only one health center which provides family planning services at jelhak ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.3934/publichealth.2015.4.655”, “ISSN” : “2327-8994”, “PMID” : “29546129”, “abstract” : “This study aims to explore and examine the conjectures surrounding the utilization of family planning services among currently married couples of childbearing age in Renk County. This study has adopted a qualitative method to collect data on factors affecting the utilization of family planning services through focus group discussions and in-depth interviews, in rural and urban areas of Renk County. It targeted married women, men as well as unmarried men and women. The researchers conducted nine focus group discussions and nine interviews at both Jelhak (rural setting) and Renk (urban setting). The results suggested that the people of Renk County prefer to have large families and therefore choose not to use family planning methods. The data collected was analyzed by means of thematic analysis. This included the construction of a thematic framework, coding, editing and categorization of available data as well as the creation of sub-themes. The result also suggested that perception is a main factor that affects utilization of family planning services with a majority of the people in Renk and Jelhak preferring to have many children in order to increase the family size for some reasons. These are linked to religion, social stigma and taboo that are attached to childless people or users of family planning methods for birth control purposes. The responses revealed some variation in perception between rural (Jelhak) and urban (Renk) areas. Respondents from Renk area reported that some people use family planning services for 656 AIMS Public Health Volume 2, Issue 4, 655u2013666. economic reasons that involve alleviation of financial difficulties and provision of better education when the family size is small. On the other hand, rural people from Jelhak perceive family planning to be socially un-acceptable. Furthermore, men and women of Jelhak reported that after each birth of a child, married couples avoid sexual relationship for a period of two years as means of family planning. Women of both Urban and Rural settings reported intentions to use conventional methods of family planning without the knowledge of their spouses.”, “author” : { “dropping-particle” : “”, “family” : “Amen Mohammed Ahmed”, “given” : “Waled”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Boutros Shokai”, “given” : “Sara”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Hassan Abduelkhair”, “given” : “Insaf”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Yahia Boshra”, “given” : “Amira”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “AIMS Public Health”, “id” : “ITEM-1”, “issue” : “4”, “issued” : { “date-parts” : “2015” }, “page” : “655-666”, “title” : “Factors Affecting Utilization of Family Planning Services in a Post-Conflict Setting, South Sudan: A Qualitative Study”, “type” : “article-journal”, “volume” : “2” }, “uris” : “http://www.mendeley.com/documents/?uuid=3c969135-2b83-4661-a34a-15615ff90194” } , “mendeley” : { “formattedCitation” : “(Amen Mohammed Ahmed ;i;et al.;/i;, 2015)”, “plainTextFormattedCitation” : “(Amen Mohammed Ahmed et al., 2015)”, “previouslyFormattedCitation” : “(Amen Mohammed Ahmed ;i;et al.;/i;, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Amen Mohammed Ahmed et al., 2015). Therefore women suffer from unavailability of family planning methodsADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.3934/publichealth.2015.4.655”, “ISSN” : “2327-8994”, “PMID” : “29546129”, “abstract” : “This study aims to explore and examine the conjectures surrounding the utilization of family planning services among currently married couples of childbearing age in Renk County. This study has adopted a qualitative method to collect data on factors affecting the utilization of family planning services through focus group discussions and in-depth interviews, in rural and urban areas of Renk County. It targeted married women, men as well as unmarried men and women. The researchers conducted nine focus group discussions and nine interviews at both Jelhak (rural setting) and Renk (urban setting). The results suggested that the people of Renk County prefer to have large families and therefore choose not to use family planning methods. The data collected was analyzed by means of thematic analysis. This included the construction of a thematic framework, coding, editing and categorization of available data as well as the creation of sub-themes. The result also suggested that perception is a main factor that affects utilization of family planning services with a majority of the people in Renk and Jelhak preferring to have many children in order to increase the family size for some reasons. These are linked to religion, social stigma and taboo that are attached to childless people or users of family planning methods for birth control purposes. The responses revealed some variation in perception between rural (Jelhak) and urban (Renk) areas. Respondents from Renk area reported that some people use family planning services for 656 AIMS Public Health Volume 2, Issue 4, 655u2013666. economic reasons that involve alleviation of financial difficulties and provision of better education when the family size is small. On the other hand, rural people from Jelhak perceive family planning to be socially un-acceptable. Furthermore, men and women of Jelhak reported that after each birth of a child, married couples avoid sexual relationship for a period of two years as means of family planning. Women of both Urban and Rural settings reported intentions to use conventional methods of family planning without the knowledge of their spouses.”, “author” : { “dropping-particle” : “”, “family” : “Amen Mohammed Ahmed”, “given” : “Waled”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Boutros Shokai”, “given” : “Sara”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Hassan Abduelkhair”, “given” : “Insaf”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Yahia Boshra”, “given” : “Amira”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “AIMS Public Health”, “id” : “ITEM-1”, “issue” : “4”, “issued” : { “date-parts” : “2015” }, “page” : “655-666”, “title” : “Factors Affecting Utilization of Family Planning Services in a Post-Conflict Setting, South Sudan: A Qualitative Study”, “type” : “article-journal”, “volume” : “2” }, “uris” : “http://www.mendeley.com/documents/?uuid=3c969135-2b83-4661-a34a-15615ff90194” } , “mendeley” : { “formattedCitation” : “(Amen Mohammed Ahmed ;i;et al.;/i;, 2015)”, “plainTextFormattedCitation” : “(Amen Mohammed Ahmed et al., 2015)”, “previouslyFormattedCitation” : “(Amen Mohammed Ahmed ;i;et al.;/i;, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Amen Mohammed Ahmed et al., 2015).
References
ADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY Ali, A. A. A. and Okud, A. (2013) ‘Factors affecting unmet need for family planning in Eastern Sudan.’, BMC public health, 13, p. 102. doi: 10.1186/1471-2458-13-102.

Amen Mohammed Ahmed, W. et al. (2015) ‘Factors Affecting Utilization of Family Planning Services in a Post-Conflict Setting, South Sudan: A Qualitative Study’, AIMS Public Health, 2(4), pp. 655–666. doi: 10.3934/publichealth.2015.4.655.

Apanga, P. A. and Adam, M. A. (2015) ‘Factors influencing the uptake of family planning services in the Talensi district, Ghana’, Pan African Medical Journal, 20, pp. 1–9. doi: 10.11604/pamj.2015.20.10.5301.

Associates, A., Sector, P. and One, P. (no date) ‘Collaborating and Supporting Organizations’.

Coetzee, M. H. and Ngunyulu, R. N. (2015) ‘Assessing the use of contraceptives by female undergraduate students in a selected higher educational institution in Gauteng’, Curationis, 38(2), pp. 1–7. doi: 10.4102/curationis.v38i2.1535.

Dodam, K. K. et al. (2017) ‘Knowledge and Perception of Ghanaian Adolescents about Family Planning’, (1).

Elia Mosha, P. (2017) ‘Assessment of Knowledge and Perception Towards Modern Contraceptives Use Among Women of Reproductive Age in Mtwivila, Tanzania’, Science Journal of Public Health, 5(4), p. 335. doi: 10.11648/j.sjph.20170504.19.

Eniojukan, J., Ofulue, I. and Okinedo, P. (2016) ‘Knowledge, Perception and Practice of Contraception among Staff and Students in a University Community in Delta State, Nigeria’, UK Journal of Pharmaceutical and Biosciences, 4(1), pp. 71–81.

Eze, B. U. and Hope, A. (2014) ‘Hindrances to effective usage of family planning methods among women in Adamokolo Lokoja Urban area of Kogi state , Nigeria’, 2(11), pp. 182–190.

Heisler, K. and and Van Eron, D. M. (2012) ‘A descriptive study of undergraduate contraceptive attitudes among students at the University of New Hampshire’, p. 39. Available at: http://scholars.unh.edu/honors%0Ahttp://scholars.unh.edu/honors/8.

Kerr, M. (2014) ‘Family planning in Egypt.’, Planned parenthood review, 44(11), pp. 18–9. doi: 10.1097/00001888-196911000-00043.

Nsubuga, H. et al. (2016) ‘Contraceptive use, knowledge, attitude, perceptions and sexual behavior among female University students in Uganda: A cross-sectional survey’, BMC Women’s Health. BMC Women’s Health, 16(1), pp. 1–11. doi: 10.1186/s12905-016-0286-6.

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