1

Factors affecting utilization of implants contraceptive methods among women in

reproductive age group attending family planning service in Serbo health center Jimma
zone, south west Ethiopia.




By :-TeferiGebru





A senior paper submitted Jimma University College of public health and medical sciences
department of nursing and midwifery in partial fulfillment of the requirement for the
Bachelor of Science degree in midwifery.














May, 2014
JIMMA, ETHIOPIA


2


Jimma University
College of public health and medical sciences
Department of nursing and midwifery




Factors affecting utilization of implants contraceptive methods among women
in reproductive age group attending family planning service in Serbo health
center Jimma zone, south west Ethiopia.
.

By: Teferi Gebru

Advisor S/r.MakedaSinaga (BSc, MPH/RH)





May, 2014
JIMMA, ETHIOPIA

3


ABSTRACT
Background- implants are a reversible long acting hormonal contraceptive contains progestin
which resemble the natural hormone progesterone in womans body these new contraceptive
implants are small thin flexible plastic rods each about the size of match sticks that release a
progestin hormone, either levenogestrel (jadelle and Sino-implant)or etonogesterel (implanon) in
the body.
Objectives-the objective of this study was to assess factors affecting utilization of implants
contraceptive methods among women in reproductive age group who attending family
planning service in serbo health center jimma, zone, south west Ethiopia.
Methods-Institution based cross sectional study was conducted from March 02/2014-May
02/2014. A total of 371 study subjects were included in study and . convenience sampling
method was employed to select the study participants only those family planning client who
visited this health center during study period The necessary data were collected by using
structured open and closed-ended questioners. The data collection was conducted by
interviewing the clients to get necessary information.The result was presented and summarized
by using tables.
RESULTS- A total of 371 study subjects were interviewed and that gave response rate of
100%.With regard to practice of implant, the overall prevalence of implant was
78 (21.02%). Among them, the majority 60(76.92%) were currently using
implanon followed by jadelle 18 (23.08%).There were no clients who used Sino-
plant. The prevalence of imp anon and jadelle users among the total 371 study
clients were (16.2%) and (4.9%) respectively. With regard to attitude towards
implant utilization among study client ,more than two-third of the
respondents wrongly believed that using implant can cause; irregular uterine
bleeding 114 (52.77%),cause pain during insertion and removal 114(52.77% ),
cause infertility 114 (52.77% ),cause low birth weight babies in future
pregnancies 114( 52.77% ), affects breast milk 97 (44.91%),available implants
are effective to prevent pregnancy 114 (52.77%) and cause spontaneous
abortion 114 (52.77%).

CONCLUSION AND RECCOMENDATION: It is evident that the contraceptive
implant was not fairly accepted by this group of family planning clients. further
study should be conducted to produce better evidence focusing on the service
providers, male partners, service delivering institutions and to identify factors
affecting or hindering utilization of implant.

4


Acknowledgment
First and for most, I would like to express my deepest gratitude and respect To my adviser
Sr.MakdaSinaga her necessary guidance and moral support in the process of preparing this paper
goes to beyond what I can Inscribe on this paper, it will engraved in my heart.
I would be also like to acknowledge Jimma University College of public health And medical
sciences for providing me with academic atmosphere that made It possible for me to success
fully completes the nursing and midwifery study that gave me lifelong knowledge on research.
I am deeply great full to my family members who give me continuous support inspiration to do
this research.

































5


Acronyms
WHO-world health organization
IUDS-intra uterinedevices
MDGS-millennium development goals
HIV-human immune deficiency virus
STDS-sexual transmuted disease
MCH-mother child health care
OPD-out patient department
CBE-community based education
FP-family planning
SRP-student research project































6


Table of contents
Title page
AbstractI
Acknowledgment..II
Acronyms..III
Table of contents...IV
List of tables..V
Chapter one: introduction.1
1.1Back ground information.1
1.2 Statement of the problem.3
1.3 Significance of the study..5
Chapter two: Literature review..6
Chapter three: objectives..10
3.1General objectives....10
3.2specific objectives....10
Chapter four: methods and materials.11
4.1study area and periods..11
4.2study design..11
4.3population..11
4.4sample size and sample technique.11
4.5study variable.12
4.6data collection method and instrument..12
4.7inclusion and exclusion criteria..13
4.8data analysis and processing..13
4.9result dissemination plan13
4.10ethical consideration.13
4.11data quality control..13
4.12Limitation of the study.13
4.13operational definition and definition of terms.14
Chapter five : work plan.15
Chapter six : project budget proposal...16
Chapter seven : dummy table17
Reference24
Questionare.27








7


List of tables

Table 1 Distribution of family planning clients by their socio demographic characteristics in
serbo health center, Jimmazone ,south west Ethiopia june 2014

Table 2 Distribution of family planning client by their practice of implant in Serbo health
center, Jimmazone,south west ethiopia,june,2014.,

Table 3:Distribution of family planning client by their attitude towards using implant in serbo
health center ,Jimma zone ,south west Ethiopia, June ,2014

Table 4 :Association of attitude towards implant usage by selected socio demographic
characteristics among family planning clients attending serbo health center,Jimmazone,south
west ethiopia,june,2014

Table 5 Association of practice of implant by selected socio demographic characterstics among
family planning clients attending serbo health center, Jimma zone ,south west Ethiopia
,june,2014
























8


CHAPTER ONE
1. INTRODUCTION
1.1 BACK GROUND INFORMATION
Hormonal contraceptive implants are a reversible long acting progestin which resembles the
natural hormonal progesterone in womens body. These new contraceptive implants are small
thin flexible plastic rods each about the size of matchsticks that release a progestin hormone,
either levenogestrel (Jadelle and sine-implant) or etonogesterel (implanon) in the body. It
inserted under the skin of women supper arm by trained professional and, can give continuous
protection for three to five years depending on the number of rods inserted (1).
The most common methods are jadelle, Sino implant (II) and Implanon. Jadelle and Sino
implants have nearly identical physical properties. Both are two-rod systems with active
ingredients of the same amount (75 mg of the progestin Lenovogestrelper rod (150 mg total )
each jadelle rod measures 45mm long by 2.4 mm outside diameter, while each Sino- implants
(II) rod measures 44mm by 2.4mm outside diameter. Implanon is a single rod implant that
contains 68mg of the progestin etonogestreland measures 44mm long by 2.0mm outside diameter
(2).
Regarding mechanism of action, implants work by releasing asmall amount of progestin
hormone steadily into the blood which prevents pregnancy by thickening the cervical mucus that
blocks sperm frommeeting and by preventing ovulation (release of eggs from the ovaries) to
various degrees (3).
According to world health organization, 2007 reports, implants are more than 99.9% effective
when inserted correctly, means that less than one woman in 1000, will get pregnant in the first
year of use. Implanon prevents ovulation in every cycle, throughout almost the entire three years
of its labeled length of use (4).
Studies have revealed that knowledge about hormonal implants vary widely among countries.
Among 42 countries with data from demographic and health surveys the percentage of married
women of reproductive age (15-49) year who had heard of hormonal implants range from as
allowas 2% inChadto 94% in Haiti. In 25 of the 42 countries less than half of the woman
surveyed had heard of implants (5)
Despite surprising technological advancement in modern contraceptive methods, uncontrolled
population growth and unintended pregnancy is a worldwide problem that affects women,
therfamilies and the societies as a whole. For example, among pregnant women in Africa and
9

south east Asia the riskof death during pregnancy and child bearing is up to 200 times higher
than that of women living in industrialized countries (6).
According to Ethiopian demographic and health surveys 2008, report the maternal mortality ratio
for Ethiopian women was 578 deaths per 100,000 live births, which is one of the highest figure
in the world (7). With apopulation of about 77 million in mid-2007, Ethiopia is the second most
populous country in Sub-Saharan Africa; the population is increasing at arate of about 2.5% per
annual, while fertility rate is 5.4 children per women. Apart from the high fertility, the large
variation in fertility between rural and urban areas and between regional states in Ethiopia calls
for attention (8).
Demographic research has shown that socio economic and cultural factors influence fertility
through biological and behavioral mechanisms such as the use of contraception, which has a
direct effect on fertility. But contraceptive use which plays the major role in influencing fertility
is very low in Ethiopia, (20%). In contrary to underutilization of modern contraceptive in the
country many women who want to space or limit child bearing are not able to do so; hence there
is a high unmet need for contraception in the country (9).
Thus, the main objective of this study is to assess married womens attitude, practice and factors
affecting utilization toward hormonal implant among Family planning clients attending Serbo
health center,Jimma, zone south west Ethiopia.














10


1.2. STATEMENT OF THE PROBLEM
In developing countries maternal mortality is the leading cause of death for women of
reproductive age (15 49 years). In some parts of sub Saharan African there are more than 1500
maternal death for every 100,000 live births. While In developed countries such as US this ratio
is 12 deaths per 100,000 live births (10).
According to world health organization(who), 2007 reports, (1) implants are more than 99.9%
effective when inserted correctly, means that less than one woman in 1000,will get pregnant in
the first year of use. Impl anon prevents ovulation in every cycle, throughout almost the entire
three years of its labeled length of use.(2)studies have revealed that knowledge about hormonal
implants very widely among countries, among 42 countries with data from demographic and
health surveys the percentage of married woman of reproductive age(15-49)year who had heard
of hormonal implant range from as allow as 2% in Chad to 94% in Haiti in25 of the countries
less than half of the woman surveyed had heard of implants.(3)according to Ethiopian
demographic and health surveys 2008,report the maternal mortality ratio for Ethiopian woman
was 578 deaths per 100,000 live births, which is one of the highest figure in the world.(4)with a
population of about 77 million in mid-2007,Ethiopia is the second most population country in
sub-Saharan Africa, the population is increasing at a rate of about 2.5% per annual, while fertility
rate is 5.4 children per woman apart from the high fertility the large variation in fertility
between rural and urban areas and between regional state in Ethiopia calls for attention.
In Ethiopia maternal mortality rate estimates /ranges/ between, 500-1,400 per 100,000 live births.
One out of seven in Ethiopia dies due to pregnancy and related causeswith more than 50%
resulting from unsafe abortion, thus making Ethiopian women at reproductive risk. Addressing
family planning to unmet need in Ethiopia is expected to avert 12, 782 maternal mortality, and
more than 1.1 million child deaths by the target date of 2015. Contraception plays a key role in
decreasing maternal mortality. They provide significant protection for women by preventing
unintended pregnancies, which often end in unsafe abortion (11).
Although, over the last two decades, Ethiopia has made great progress in increasing awareness
and knowledge of family planning; with more than 85% of currently married Ethiopia women
now know at least one contraceptive method. The contraceptive prevalence rate among married
women is only 15% and that of Oromia is (13.6%) which is farbelow the nation goal of the
Ethiopia population policy to be attained by the year 2015, (44%) (9). And almost all of these
users are using modern methodwith injectable and oral pills being the main method used. The
population policy which was adopted in 1993 has the objective of reducing the total fertility rate;
as well as raising the contraceptive prevalence to a national coverage of 44% by the year 2015. It
11

was focused on expanding the services to previously uncovered areas and by increasing the
number of health institutions and other outlets (12).
However, most previous studies in Ethiopia have shown that there is wide gap between
knowledge and use of modern contraception in Ethiopia meaning that knowledge about modern
contraception is relatively high when compared with utilization rate. On the other hand, although
all modern methods which provide wide range of protection from durations of as short as days to
permanent protection such as voluntary surgical sterilization, implants and IUDS are available in
the country, utilization is limited very much to the shorter term method (6).
Therefore, the major concern is which factors are contributing to the observed underutilization of
hormonal implants even if the couples desire to limit or space child bearing is high and which
strategies can best bring about changes to the current situation. Many factors may contribute to
this situation.However, this study focuses on socio- demographic factors, users attitude and
practices and barriers or factors affecting of utilizing the method. Hence, the main objective of
this study is to assess attitude, practice andfactors affecting utilization of implant contraception a
mongsfamily planning clients who attendedSerbohealth center,Jimma zone, south west
Ethiopia,2014.

















12

1.3. SIGNIFICANT OF THE STUDY
Since, family planning program welfare is very important to stabilize uncontrolled population
growth and, is one of the Millenniums development goals(MDGs), which is impossible without
effective contraception. Thus, this study is useful by identifying level of attitude practice and
barriers of implantable contraceptive service utilization for health planners and policy makers of
the town. In considering those factors to ensure better demographic outcome and family size,
this study has paramount importance to do comment on the coverage and level of implant
utilization: To contribute barriers that refrain family planning clients in the study area from
utilizing implants in Serbo health center. It is hoped to be used as a secondary source of
information for further study in the area and for community health workers in the future as a
reference material for another study.
The study also expected to suggest all possible options to reduce barrier of implant utilization
among family planning clients attending. Serbo health center,Jimmazone, south west Ethiopia.













13

CHAPTER TWO
2.1. LITERATURE REVIEW
There is greater unmet need for contraception among women who wish to be engaged in birth
spacing than women who wish to limit births. Demographic and health surveys data from 17
developing countries revealed that amongreproductive age women between 15 and 49 year old.
Demand for birth spacing was the most significant reason women gave to explain their demand
for family planning. Demand for birth spacing existed even among young women who wanted to
post pone their first birth (15).
Studies have shown that barrier to postpartum contraceptive use include; Husbands refusal, cost,
lack of access to contraception and education about family planning, religious oppositions and
cultural norms. Denial of contraceptive service to non-menstruating women presents an
additional barrierto contraceptive use (16).
Hormone releasing sub dermal implants, which are inserted under the skin of womens upper
arm, are safe, acceptable, effective and reversible form of contraception. Implants prevent
pregnancy for an extended period. After asingle administration no regular action by the users and
no routine clinical follow up are required (16). The most common types include implanon ( one
rod-system effective for three years), Jadelle (Two rods system effective for five years)and sins
implant (II)(two rods, system effective for four years (5). Furthermore, contraceptive implants
are highly effective comparably ineffectiveness of intrauterine, devices,female sterilizations and
vasectomy and there is immediate return of fertility after their removal (13).
Studies revealed that like, Norplant the new implants are highly effective and like, Norplant they
alter bleeding patterns. Their most improvement over Norplant is easier and quicker insertion
and removal. The main side effects of implant contraception also remain the same as those
reported by users of Depo-Proverainjectable related to disturbances in menstrual patterns.
Implants are more convenient needing replacement only after 3-5 years and prompt return of
fertility at any time after implant removal is another advantage over injectable long- acting (17).
Compared to non-users,users of implants could have reduced risk of ectopic pregnancies and
pelvic inflammatory diseases in some women, implants might help alleviate iron deficiency
anemia through reduced menstrual bleeding. Implanon might also help with dysmenorrheal and
can help treat symptomatic endometriosis (2).
14

Studies in multiple countries of women using implants have indicated, perception of implants
among users are favorable and that acceptance is high. Women who use implants have identified
ease of use and high effectiveness as the most desirable features. The majority of users reported
that difficulty or dissatisfaction with other method of contraception was a primary reason for
choosing implants. With most women reporting;previous use of three or more methods of birth
control. These women also considered convenience and ease of use is highly important in their
decision to use implants, even though use of the device required a minor surgical procedure for
insertion and removal (18).
Although, many women discontinue implant because of they want to become pregnant, side
effects are the primary reasons for early removal in most studies. Irregular or prolonged uterine
bleeding is by far the most common reason cited for early removal of implants (17). Others
reasons include headache, mood swings, weight gain, depression or nervous, acne, abdominal or
general discomfortand arm pain (13). In addition to the above facts, some women report
concerns and fear of pain with implant insertion and removal and problem of confidentiality due
to the potential visibility of implants (18). And also myths and misconceptions about implants
are common in some parts of the world and affect the acceptability of the method. Contrary to
common myths and misconceptions implants; dont cause cancer, permanent sterility,
spontaneous abortion, low birth weight babies in future pregnancies or negatively affect breast
milk. They also do not make user thin,cause death, or result in arm loss (19). The only condition
for which WHO recommended that implants shouldnt be used is current breast cancer (20).
Evidences indicate that many contraceptive methods produce changes in the menstrual cycle.
However such menstrual changes may vary across individuals, methods and duration of use,
complicating providers task of adequately counseling clients.For example, IUDs have been
associated with increased menstrual bleeding and cramping. In contrast the implant and the
injectable can cause irregularity in the menstrual cycle including extended periods of high
bleeding or temporary amenorrhea. They may also increase bleeding and whereas users of the
injectable become more likely to miss periods over time, implant users become less likely to
doso (21). Users attitude about side effects are strongly influenced by the quality of Information
and counseling provided. Evidences show that through pre-insertion counseling reduce their
early discontinuation of the method providers should address notonly menstrual
disturbancebutalso, the possibility of infection at the insertion site the fact that implants dont
protect against HIV or STDIs, and other contraceptive options (21)
15

In general, researches have stated that, women who are satisfied with their choice of
contraceptive method continued using their method longer than women who are not satisfied
with their method. Implants also have the highest continuation rate among users of reversible
contraceptive methods even after taking into account parity, age and fertility intentions (22). In
clinical trial between (85% to 99%)of women using implants continue to use the method for at
least 3 years and 40% to 76% continue using the methods for at least 5 years (23). Yet, there are
marked differences in continuation rates based on geographical areas with higher continuation
rate in studies conducted in developing countries compared with studies conducted in developed
countries (24).
On the other hand,finding from a national impact survey on obstacles to contraceptive use in
Pakistani revealed that a large proportion of women in the reproductive age group expressed a
desire to terminate child bearing but, were not using any method of contraception. The primary
reason claimed by the respondents for contraception nonuse among apparently motivated women
were the perception that family planning is unacceptable by religious groups, fear of side effects
on health, opposition from husbands and the limited availability of family planning services were
some of the reasons claimed by the respondents (25).
Similar study from a qualitative finding in Senegal suggest that womans fertility intention might
influence their willingness to tolerate the contraceptive side effects Among long term
contraceptive users in Bolivia those with four or more children in addition women who believed
that menstruation was important to maintain good health were more likely than others to
discontinue the methods (26)
In Ethiopia, the result of the survey done in Gondertownand the surrounding peasant association
revealed that the overall modern contraceptive prevalence rate was 28.6% (35.6% for urban and
11.00 for the rural areas the most important reasongiven by 53.4% of the female respondents for
not using modern contraceptive was theneed for more children. The same factor was mentioned
by 34.4% of the female ever use reported to have discontinued taking contraceptive for different
reasons. The main one being the need to have more children about 19% of the female
respondents reported that the sexual abstinence was the reason for not using
moderncontraceptive (27).
The same finding from study conducted in Dembia district has shown that the current
contraceptive prevalence rate in KollaDiba town was (22.5%) and are currently using modern
16

contraceptive. A (46.6%) of whom, who had ever used implant discontinued taking,due to side
effects and to have more children (28).And also, community based study done in rural areas of
Jimma showed that current contraceptive prevalence rate of 7% among married women was
reported of which 65% had used pills, injectable (4.4%) and rhythm (23%) the reason given for
contraceptive nonuse was not known how to use, need for more children unavailability of a
contraceptive, fear of side effects, believed to go with nutritious food are some of the reasons
mentioned (29).
Yet, by focusing on clinical measures of bleeding or side effects or by limiting the study to a
single contraceptive method this study do little to explain the context in which menstrual side
effects leads to discontinuation of the method .Previous researches have shown that the fertility
intention of women are influenced by various demographic, socio economic and program factors
but there has been afew examination of the factors influencing variation in the use of modern
methods, like, implant contraceptive and womens attitude, practices and satisfaction in this
particular area. Hence, the main objective of this study is to assess the womens attitude and
experiences and factors affecting utilization of implants. This will help policy and decision
makers to implement program tailored to woman need concerning implants method use. The
study will also help as base line data for further study to be conducted and to make possible
recommendation.












17

CHAPTER THREE
3. OBJECTIVE
3.1. General Objectives
To assess factors affecting the utilization of implants contraceptive methods among women in
reproductive age group attending family planning service in Serbo health center Jimma zone,
south west Ethiopia

3.2. Specific objectives
To determine the attitude of women towards implants contraceptive methods
in Serbo health center,
To determine the practice of women towards implants contraceptive methods
in Serbo health center.
To identify factors affecting utilization of implants contracptive methods
among family planning users attending Serbo health center.,
















18

CHAPTER FOUR :
METHODS AND MATERIALS

4 Study Area and Periods
The study was conducted in Serbo town of Karsaworeda from March02/2014-
May02/2014.Karsaworeda is one of the eighteen administrative Woredae under Jimma zone,
Oromia regional state.
Serbotown is found at a distance of 17km from Jimma town and 338km from Addis Ababa in
south west direction of the Country.
The town is found on altitude of 1500-2000 meter above sea level. It has annual rainfall of
1300-1700mm with a temperature of 18-20
o
c.
The town has a total population of 5424 with a composition of 2747 and 2677 females and males
respectively and 1084 total number of house hold according to the population projection base on
2007/08.
The town has 1 health center, which consists of pharmacy, MCH, 2 OPD (adult and under
5),delivery room, and HIV service and inpatient room.
4.1.Study period
The study was conducted form, March 02/2014-May 02/2014
4.2. Study design
Cross sectional study design was used.
4.3.Population
4.3.1. Source Population
All family planning clients who visited Serbo health center
4.3.2. Study Population
selected women in reproductive age group attending family planning service in Serbo health
center during the study period.

4.4. Sample size and Sampling Technique

4.4.1 Sample size
Formatted: Font:
19


The sample size was calculated using single population proportion formula

(

where n= predetermined sample size

standard variance (1.96)

P= prevalence of utilization of contraceptive (50%) =0.5

Marginal error =5%

n= 384
since the total population of reproduction of age group is less than 10,000 finite correction
formula was employed.
Nf=

where nf final sample size N= Total no of reproductive age group

with this 10% of non-response rate was added. Therefore, the total final sample
size was 371.
4.4.2 Sampling technique
Non probability convenience sampling method was conducted
4.5. Study Variables
4.5.1. Independent Variables
Age
Religion
Marital Status
Income
Sex
Occupation
Education
Literacy Status
20

Parity
Attitude
Practice
4.5.2. Dependent Variable
Utilization of implant contraceptive methods
4.6. Data Collection Method and Instruments
A cross sectional survey was conducted by interviewing each family planning clients attending
Serbo health center using structured questionnaire by face to face interview. The data collection
tool were prepared in simple and understandable English language. The data were collected by
interviewing those legible clients for the study, training was given for the data collectors about
data collection and questionnaire were pretested . The English version questionnaire was
translated into local language which were understandable to the respondents during the
interview, and data collection was run over accordingly.

4.7. Inclusion and Exclusion Criteria.
Inclusion Criteria: All family planning clients attending Serbo health center was included in
the study.
Exclusion criteria: clients who not volunteer to participate in the study were excluded from the
study.
4.8. Data analysis and Processing
After data collection, the data were cleared, categorized, and checked for completeness before
analysis. Then the collected data were sorted manually using electronic calculators and compiled
accordingly. Later the finding was presented using frequency and percentage distribution and
statistical test was done using chi-square to determine association between implant service
utilization and different variables.
4.9 Result Dissemination Plan
After the end of the finding, the report will be given to JimmaUniversity CBE office, school of
nursing and midwifery, Serbo health center and other concerned bodies. It will also expected
that the result of this study will be disseminated to the public through media. Additionally, the
result may be presented on scientific conferences and published in scientific journals.
4.10. Ethical Considerations
21

Official letter was obtained from CBE office of JimmaUniversity to Serbo health center to ensure
voluntary participation. Then participants were clearly informed about the purpose of the study
and their right to participate or refuse was respected. The privacy and confidentiality of the
respondents relating to their information was kept accordingly.
4.11. Data Quality Control
In order, to ensure the quality of data, interviewers were trained before starting data collection.
The collected data were cross-checked by principal investigator as well as supervisors, at the end
of each days of data collection and invalid or incorrectly filled or collected data were recollected
correctly by respective data collectors. A week before the actual survey pre-test study was
carried out at MCH unit on FP clients 10% of the study subjects in Jimma University specialized
hospital to maintain accuracy of information and make necessary modification.
4.13. Operational definition and Definition of terms
Attitude: Way of feeling perception about something which influences behavior.
Positive Attitude: In this study attitude labels positive if a client strongly agrees greater than or
equal 60% to the positively stated attitudes questions in favor of implant method.
Negative Attitude: If a client strongly agree to the negatively stated or strongly disagree greater
than 60% to the positively stated attitude question in favor of implant method.
Contraceptive Implants: Are hormone releasing sub dermal implant which inserted under
skin,of womens upper arm.
Unintended Pregnancy: Is a pregnancy which occurs before having a plan to have a baby.
Unmet Need: Is the discrepancy between womens stated reproductive preference and their use
of contraception.
Need for Spacing: Is when women say they want to wait at least 2 years before having other
child.
Need for limiting: Is when they say they want to wait no more children.
Practice: Is previous and current Utilization of any available implant contraceptive method
.Good Practice: If the client answers greater than or equal to 60% implant questions correctly
she will be considered having good practices.
22

Poor Practices: If the client answers less than 60% implant questions she will be considered as
having poor practice.






















CHAPTER FIVE:
RESULTS
23


A total of 371 study subjects were interviewed and that gave a response rate of 100%. Out of the
total 371 study participants ,119 (32.08%) were between the age of 25-29 years and 87 (23.45%)
were between the age of 20-24 years. Concerning religion, the majority 176 (47.44%) of the
respondents were Muslim followed by orthodox Christian which account for 93 (25.06%).
regarding marital status of the respondents, about 196(52.83%) were married and 78 (21.02%)
were single. Regarding educational status, majority 144(38.81%) of the clients were illiterate
followed by read and write accounts 99 (26.68%).

With regard to ethnicity, the majority 136 (36.66%) were Oromo followed by Amhara which
stand for 112 (30.19%).In connection to occupational status, large number 168(45.28%) of study
subjects were house wives and 52 (14.02%) were farmers .As to monthly income, the majority
122(32.88%) of the clients obtained between 501 -1000 birr per month. Concerning parity status,
the large proportion 141(38.01%) of the study participants had between 3-4 alive children in the
house hold and 128 (34,50%) had between 1-2 children (see table -1 below).

Table 1: Distribution of family planning Clients by socio demographic characteristics in Serbo
health center, Jimma zone, south west Ethiopia, June, 2014.
Variables Characteristic N
o
%
Age
(in Years)
15 19 63 16.98
20 24 87 23.45
25 29 119 32.08
30 34 57 15.36
>34 45 12.13
Total 371 100
Religion
Muslim 176 47.44
Orthodox 93 25.06
Protestant 78 21.03
Others(catholic, free thinkers) 24 6.47
Total 371 100
Marital Status Married 196 52.83
Single 78 21.02
Divorced 46 12.40
Widowed 51 13.75
Total 371 100
Ethnicity

Oromo 136 36.66
Amahra 112 30.19
24

Gurage 71 19.14
Others (yem, Dawero, Sidama) 52 14.01
Total 371 100
Monthly Income
(in birr)
< 300 birr
70 18.87
300-500 105 28.30
501-1000 122 32.88
1001-1500 46 12.41
>1500 28 7.54
Total 371 100
Educational status
Can read and write 99 26.68
Illiterate 144 38.81
Grade 1-6 46 12.40
Grade 7-12 54 14.56
College/University 28 7.55
Total 371 100
Occupation Status
House wife 168 45.28
Student 44 11.86
Government employ 51 13.75
Merchant 43 11.59
Farmer 52 14.02
Other(servants,
bartender)
13 3.50
Total 371 100
Parity
<1 47 12.67
1-2 128 34.50
3-4 141 38.01
5+ 55 14.82
Total 371 100








II. Practice of implant among study subjects
With regard to practice of implant, the overall prevalence of implant was 78
(21.02%). Among them, the majority 60(76.92%) were currently using implanon
25

followed by jadelle 18 (23.08%).There were no clients who used Sino-plant. The
prevalence of implanton and jadelle users among the total 371 study clients
were (16.2%) and (4.9%) respectively.
Moreover, from the total 78(21.02%) respondents who were currently practicing
implant 63(80.76)% of the respondents were satisfied with the method , while
few 15(19.24)% complained discomfort .The main reasons cited for satisfaction
with implant were; Due to its long acting 24(38.09%),highly effective
14(22.22%) ,no routine follow up are required 13(20.63%) ,easy to use
9(14.29%) and 3 (4.77%) others like easy to use ,failure of other methods.
In contrast, regarding practice out of the total 371 family planning clients 75
(20.21%) had practiced implant before but were no longer using the method.
The major reason mentioned for discontinuation was; irregular
bleeding29(38.66%), desire to have more children23(30.67%) and 9 (12.02%)
developing other side effects such as continuous head ache, general body
weakness, depression, hungriness and weight loss.
Furthermore, more than eighty percent of the study participants were not
currently using implant. The major reason cited for non-use was the use of
other methods of contraceptive, fear of procedure during insertion and removal
,fear of developing side effects ,un availability of the services ,and not allowed
by husband which account for 42.23%, 20.60%, 14.53%, 12.50% and
10.14%respectively ( see table- 2 below).
Table 2:Distribution of family planning clients by practice of implant in Sero
health center, Jimma zone, south west Ethiopia, June, 2014
Practices Responses No %
Discontinued implant
practice
Yes 75 20.21
No 296 79.79
Total 371 100
Reason of non-use
implants
Fear of procedure during insertion
and removal
61 20.60
Using other method of contraceptive 125 42.23
Husband refusal 30 10.14
Un availability in near by 37 12.50
26

Fear of developing side effects 43 14.53
Total 296 100
Reason of
discontinuation of
implant
Developing other side effects 9 12.02
Desire to have more Children 23 30.67
Fear of infertility 13 17.33
Irregular uterine bleeding 29 38.66
Others 1 1.32
Total 75 100
Currently Using
implants
Yes 78 21.02
No 293 78.98
Total 371 100
Reason to prefer other
methods
Un available 43 14.53
It short period 46 15.54
Less side effect 78 26.35
Fear of infertility 99 33.44
Other(head ache back pain surgery) 30 10.14
Total 296 100
Source of information
to use implants
Husband 17 22.67
Media 23 30.67
Friends 7 9.33
Health workers 28 37.33
Total 75 100
Types of implants
Used
Implanon 60 76.92
Jaddle 18 23.08
Sino plant 0 0
Total 78 100
Satisfaction
Yes 63 80.76
No 15 19.24
Total 78 100
Reasons of
satisfaction
Easy to use 9 14.29
High effectiveness 14 22.22
Long acting 24 38.09
No Routine Follow up 13 20.63
Other 3 4.77
Total 63 100

III. Attitude towards implant utilization
With regard to attitude towards implant utilization among study clients ,more
than two-third of the total respondents wrongly believed that using implant
27

can result in; irregular uterine bleeding 114 (52.77%),cause pain during
insertion and removal 114(52.77% ), cause sterility 114 (52.77% ),cause low
birth weight babies in future pregnancies 114( 52.77% ),negatively affects
breast milk 97 (44.91%),available implants are effective to prevent pregnancy
114 (52.77%) and cause spontaneous abortion 114 (52.77%).
Concerning the level of attitudes, not more than one fourth of the total study
subjects had positive attitude towards practicing implant contraceptive.

They were asked for feeling and perception they had about side effects of
Implant and their future option of contraception use they told that irregular
bleeding due to the use of implant is severe 16 (38.64%), insertion and removal
of implant is highly painful 12 (27.5%) and 14 (33.86%) stated that using the
method causes general body weakness, dizziness, global head ache,
hungriness, got depression. Among the total 58 (85.29%) users of implant who
were satisfied, 40 (69.o5%) of them stated that they will continue using the
method.

Concerning source of information, the majority 19 (45.23%) of the clients
obtained information from health workers, 13 (30.95%) from mass media, 10
(23.80%) from husband and 3 (7.14%) from friends.

Table 3: Distribution of Family planning clients by attitude toward using
implant in Serbo health center, Jimma zone, south west Ethiopia, June,2014.
S.
N.
Attitude
Agree Neutral Disagree
NO %
N
O
%
N
O
%
1 Implants cause
sterility
11
4
52.77 16 7.4
1
86 39.81
2 Implants cause
spontaneous abortion.
11
4
52.77 18 8.3
3
84 38.89
3 The available implants
are effective to prevent
pregnancy.
96 44.44 6 2.7
8
11
4
52.77
4 Implants cause low
birth weight babies in
future pregnancy.
11
4
52.77 11 5.0
9
91 42.13
28

5 Insertion and removal
of implant causes
pain
11
4
52.78 2 0.9
3
10
0
46.38
6 Implants do not cause
users thin.
97 44.91 5 2.3
1
11
4
52.78
7 Implants do not
negatively affect
breast Milk.
97 44.91 5 2.3
1
11
3
52.31
8 Implant help a mother
regain strength before
her next baby.
99 45.83 3 1.3
9
11
3
52.32
9 Using implant causes
irregular bleeding.
11
4
52.77 7 3.2
4
95 43.99



















Although, there is no significant association (p>0.05) between family planning
clients attitude towards implant utilization and (monthly income, ethnicity,
age, religion parity and occupation). There is statistically significant association
(p<0.05) with their marital status and education (see table4 below).

29

Table 4: Association of attitude towards implant usage by selected socio
demographic characteristics among family planning clients attending Sebo
health center, Jimma zone, south west Ethiopia, June, 2014.
Va
ri
ab
le
s
Charac
teristic
No %
Positive
Attitude
Negative
Attitude
X
2

P=V
alue
No % No %
Ag
e
(in
Ye
ar
s)
15 19
20 24
25 29
30 34
>34
Total
63
87
119
57
45
371
16.98
23.45
32.08
15.36
12.13
100
17
22
30
18
13
100
26.98
25.28
25.21
31.57
28.88
26.95
46
65
89
39
32
271
73.02
74.72
74.79
68.43
71.12
73.05
1.17
0.88
4
Re
lig
io
n
Muslim
Orthodo
x
Protesta
nt
Others(
Chatolic
)
Total
176
93
78
24
371
47.44
25.06
21.03
6.47
100
41
27
19
9
96
23.29
29.03
24.35
3.75
25.87
135
66
59
15
275
76.71
70.97
75.65
96.25
74.13
2.88 0.41
1
M
ari
tal
St
at
us
Married
Single
Divorce
d
Widowe
d
Total
196
79
46
50
371
52.85
21.23
12.43
13.49
100
40
22
13
23
98
20.4
28.2
28.26
45.09
26.41
156
57
33
27
273
79.6
71.8
71.74
54.91
73.59
13.7
0.00
3
Et
hn
ici
ty
Oromo
Amhara
Gurage
Others
Total
136
112
70
53
371
36.65
30.19
18.87
14.29
100
31
31
18
20
100
22.79
27.67
25.71
37.73
26.95
105
82
52
32
271
77.21
72.33
74.29
62.27
73.05
4.76
0.19
0
M
on
thl
y
In
co
m
e
(in
bi
rr)
< 300
birr
300-
500
501-
1000
1001-
1500
>1500
70
105
122
46
28
18.87
28.31
32.88
12.37
7.55
22
17
39
13
8
31.42
16.19
31.96
28.26
28.57
48
88
83
33
20
68.58
83.81
68.04
71.74
71.43
8.57
0.07
3
Total 371 100 99 26.68 272 73.32
30

Ed
uc
ati
on
al
st
at
us
Can
read
and
write
Illiterat
e
Grade
1-6
Grade
7-12
College
/Univer
sity
Total
99
144
46
54
28
371
26.68
38.81
12.39
14.56
7.54
100
18
38
10
23
11
99
18.18
26.38
21.73
42.59
39.28
26.68
80
106
36
32
18
272
81.82
73.62
78.27
57.41
60.72
73.32
11.3
0.01
5
O
cc
up
at
io
n
St
at
us
House
wife
Student
Govern
ment
employ
Mercha
nt
Farmer
Other
Total
168
44
51
43
52
13
371
45.28
11.85
13.75
11.59
14.02
2.51
100
54
10
15
13
9
5
106
32.14
22.72
29.41
30.23
17.3
38.46
27.43
114
32
36
31
44
8
265
67.86
77.28
70.59
69.77
82.7
61.54
72.57
5.67
0.34
0
Pa
rit
y
<1
1-2
3-4
5+
Total
46
128
141
56
371
12.39
34.5
38.02
15.09
100
10
31
39
19
99
21.73
24.21
27.65
33.92
26.68
36
97
101
38
272
78.27
75.79
72.35
66.08ss
73.32
2.36
0.50
1









31





This finding showed that the existence of significant association between
practice of implant among family planning clients and their level of education
(p=0.015), and highly significant association with their marital status
(p=0.003).However, there is no significant association (p>o.o5) between the
clients and their (age, religion, occupational status, parity status and ethnicity
(see table 5 below).
Table 5: Association of practice of implant by selected socio demographic
characteristics among family planning clients attending Serbo health center,
Jimma zone, south west Ethiopia, June, 2014.
Variab
les
Characte
ristic
No %
Good
practice
Poor
practice X
2

P=Va
lue
No % No %
Age
(in
Years)
15 19
20 24
25 29
30 34
>34
Total
63
87
119
57
45
371
16.98
23.45
32.08
15.36
12.13
100
17
22
30
18
13
100
26.98
25.28
25.21
31.57
28.88
26.95
46
65
89
39
32
271
73.02
74.72
74.79
68.43
71.12
73.05
1.17 0.884
Religio
n
Muslim
Orthodox
Protestant
Others
Total
176
93
78
24
371
47.44
25.06
21.03
6.47
100
41
27
19
9
96
23.29
29.03
24.35
3.75
25.87
135
66
59
15
275
76.71
70.97
75.65
96.25
74.13
2.88 0.411
Marital
Status
Married
Single
Divorced
Widowed
Total
196
78
46
51
371
52.83
21.03
12.39
13.75
100
40
22
13
23
98
20.4
28.2
28.26
45.09
26.41
156
57
33
27
273
79.6
71.8
71.74
54.91
73.59
13.7 0.003
32

Ethnici
ty
Oromo
Amhara
Gurage
Others
Total
136
112
70
53
371
36.65
30.19
18.87
14.29
100
31
31
18
20
100
22.79
27.67
25.71
37.73
26.95
105
82
52
32
271
77.21
72.33
74.29
62.27
73.05
4.76 0.190
Monthl
y
Income
(in
birr)
< 300 birr
300-500
501-1000
1001-
1500
>1500
Total
70
105
122
46
28
371
18.87
28.31
32.88
12.37
7.55
100
22
17
39
13
8
99
31.42
16.19
31.96
28.26
28.57
26.68
48
88
83
33
20
272
68.58
83.81
68.04
71.74
71.43
73.32
8.57 0.073
Educat
ional
status
Can read
and write
Illiterate
Grade 1-6
Grade 7-
12
College/U
niversity
Total
99
144
46
54
28
371
26.68
38.81
12.39
14.56
7.54
100
18
38
10
23
11
99
18.18
26.38
21.73
42.59
39.28
26.68
80
106
36
32
18
272
81.82
73.62
78.27
57.41
60.72
73.32
11.3 0.015
Occup
ation
Status
House
wife
Student
Governme
nt employ
Merchant
Farmer
Other
Total
168
44
51
43
52
13
371
45.28
11.85
13.75
11.59
14.02
2.51
100
54
10
15
13
9
5
106
32.14
22.72
29.41
30.23
17.3
38.46
27.43
114
32
36
31
44
8
265
67.86
77.28
70.59
69.77
82.7
61.54
72.57
5.67 0.340
Parity
<1
1-2
3-4
5+
Total
46
128
141
56
371
12.39
34.5
38.02
15.09
100
10
31
39
19
99
21.73
24.21
27.65
33.92
26.68
36
97
101
38
272
78.27
75.79
72.35
66.08
73.32
2.36 0.501

33

CHAPTER SIX
6. DISCUSSION
An estimated358, 000 maternal deaths occurred worldwide in 2008, a 34%
decline from the levels of 1990. Despite this decline, developing countries
continued to account for the 99 % (355,000) of the deaths. Sub-Saharan Africa
and South Asia account for 89% (313,000) of global maternal deaths.
Fortunately, the vast majority of maternal newborn deaths can be prevented
with proven interventions to ensure that every pregnancy is wanted using
modern contraceptive and everybody is safe(10).
According to this study, the result showed that implant contraception
utilization among study participants in the study area was 21.02%. This is
relatively higher comparing with other studies conducted in three different
areas in Ethiopia which account (12%) for Mekele, (17%) for Jinka and (5%) for
ButaJira (26, 27).This might be due to the difference in the nature of study
area and access to information .The study was conducted in Serbo town,
Jimma zone where there is relatively good access to the health facilities. Jimma
towns community may have awareness of various health related issues due to
repeated awareness creation sessions by students of Jimma University over the
years through community based education.
However, despite cited prevalence of implant contraceptive utilization observed
among study subjects, large proportion (79.98%) of the study participants
contraception was depended on short acting method .The main reasons cited
for non-use was; using other methods of contraceptive, fear of procedure, fear
of developing side effects and non-availability which is similar with findings of
community based study done in rural areas of Jimma by Kaba M. (6, 29). There
was a significant association between poor practice of implant and socio-
demographic variables like educational status and marital status. The possible
reason why non-users were illiterate, those who had below 2 children, above 4
children and farmers was that illiterate women do not know the benefit of
implant contraceptive. While those who were farmer and may have a fear of
side effects and lack of information. Similar finding was reported by other
researchers (25).
34

Unlike the high prevalence of request for reinsertion of implant after 3 to 5
years of use, in other developing countries like Singapore (53%), this results
show almost zero rate. In connection to this the degree of satisfaction was very
high (77%). The main reasons mentioned for switching to implant contraceptive
among those Singaporean were contraception failure (11%) and experienced
side effects with other method of contraceptives (36%), (18). The possible
reasons for this differences might be due to the fact that in this study large
number of study subjects (74.54%) had negative attitudes towards the method
and misconceptions about its side effects for instant, they were believed that
implant delays pregnancy, insertion and removal of implant is painful, it
causes spontaneous abortion, and also it might be due to the nature of the
study area and access of information. Conversely, the findings were relatively
higher compared with finding from Jinka and EDHS, 2005reports (8, 26, and
27). This might be due to the difference in the study areas, access to the
information and the services. The main reason perceived for not practicing
implant was the use of other methods of contraceptives, fear of side effects, and
non-availability of service at the time of need and husbands disapproval which
is supported by reports from Pakistan (25).
Although statistically not significant, clients with positive attitude towards
implant and those who had good practice had the highest intention to use
implant contraception which is supported by another study that showed that
positive attitude of women to contraceptive was an important factors for
promoting use of long acting contraceptive (24).
The main source of information to use implant among family planning clients
in study area was community health workers which means most of study
participants had discussion with their health workers. Comparing with other
studies this result is consistent with findings from Butajira and Jinka (2
Limitation of the Study
Nature of the study design has its own limitation.it does not show the cause and effects of
the study

35


CHAPTER SEVEN
7. CONCLUSION AND RECCOMENDATION
7.1. Conclusion

It is evident that the contraceptive implant was not fairly accepted by
this group of family planning clients.
The majority of the women possessed misconception and rumors about
the method in that they believe that using implant causes spontaneous
abortion, causes infertility, because low birth weight babies in future
pregnancy and they agreed that insertion and removal of the method
causes pain.
The main reasons cited for discontinuation and nonuse were irregular
bleeding and the use of other methods contraceptive
The majority of the study subjects have negative attitude towards
practicing implant.
Study subjects who were non users of implant service were likely to be
illiterate, those who had below two children and above four and those
who were farmers who had poor understanding about the benefits and
effectiveness of the method and those who were disapproved by their
husband.
Negative attitude towards utilization of implant, clients who had two and
below children and clients educational and occupational status were
significantly associated.






36


7.2. Recommendations
The findings have implications for family planning programs to increase
contraceptive use for those specifically on implant. As to this finding, it
indicated that utilization of implant contraception is in adequate .To bring a
measurable impact based on these findings the following measure of
interventions are worth recommending.
1) Adequate counseling, early warning on possible side effects, and follow
up with an experienced health workers to manage any side effects that
arise are an important to achieve optional contraception.
2) Clients awareness on implant contraceptive service is to be improved
through health education communication and integration with health
workers
3) Health workers effectiveness and efficiency with in health facility is
recommended to improve misconceptions toward the method.
4) Refresher course for health workers regarding implant contraception
should be given regularly regarding reproductive issues
5) Client counseling particularly about side effects of the method has to be
given regularly.
In general adequate implant service utilization can be achieved through
an integrated effort with active involvement of the community and
collaboration of different sectors such as local NGOs working on
reproductive health and stake holders in the area.
Furthermore, further study should be conducted to produce better evidence
focusing on the service providers, male partners, service delivering institutions
and to identify factors affecting or hindering utilization of implant.




37


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40

QUESTIONNAIRE
JIMMA UNIVERSITY, COLLEGE OF PUBLIC HEALTH AND
MEDICALSCIENCESDEPARTMENT OF NURSING
Questionnaires on attitude and practice of implant contraceptives among
family planning Client attending Serbo health center, Jimma zone, south west
Ethiopia .
This questionnaire is designed to assess the level of attitude and practices of
implants among family planning Clients attending Serbo health center
The results of survey will be utilized in future planning and health services.
Investigator: TeferiGebru 4
th
year midwifery Student.
1. Do not leave any items of information without answer (for data
collectors).
2. You are kindly requested to run through each questions for (both
respondents and data collectors)
3. Your confidentiality will be kept accordingly (for respondents).
4. Put x mark to answer for corresponding prepared box (for data
collectors).
5. At the end of the questions ask comments (for data collectors).

41

PART I:Socio Demographic Characteristics.
1. Respondents age (in years)
2. N
o
of children ever born to you a, m b, f _______
3. What is your ethnicity?
a. Oromo
b. Amhara
c. Dawro
d. Gurage
e. Others specify
4. What is your educational status?
a. Illiterate
b. Can read and write
c. Elementary school (1-6)
d. Junior high school (7-12)
e. College/University
5. Current marital status
a. Single
b. Married
c. Divorced
d. Widowed
e. Other specify
6. If married what is your husbands educational status?
a. Illiterate
b. Can read and write
c. Elementary school (1-6)
d. Junior high school (7-12)
e. College/University
7. What is your main occupation
a. House wife
b. Farmer
c. Government employee
d. Student
e. Merchant others specify
8. What is your religion?
a. Muslim
b. Orthodox
c. Protestant
d. Others specify
e.
9. What is your monthly income in Birr?



42

PART II: Practice of Contraceptive
1. Are you currently using any contraceptive method?
a. Yes b. No
2. If yes what method of contraceptive are you using?
a. Oral pills
b. inject able
c. Implantable
d. IUDS, other specify_____
(If the answer is C go to Q. 9)
3. If you are using oral pills or inject able why you do prefer it?
a. Because, it causes no
infertility
b. Its short period
c. Less side effects
d. Other method is
unavailable
e. Other specify________
4. If Q. 1 is no have you ever used any modern contraception?
a. Yes b. No
5. If yes what method of contraception?
a. Oral Pills
b. Injectable
c. Implant
d. IUSD
e. Other specify
6. If used implant which type?
a. Implanon used for three years
b. Janelle effective for five years
c. Sino implant (II) effective
for four years
7. If ever used implant what was the main reason that you stopped using the
method?
a. Its expiry time
b. Desire to have more
children
c. Fear of infertility
d. Irregular or prolonged
uterine bleeding
e. Rumors they are not good
f. Other specify______
8. If never used implant what was the reason?
a. Fear of procedure during
insertion and removal
b. It cause users arm loss
c. Negatively affects breast
milk
d. It causes user thin
e. Un availability in the nearby, others specify_______.
9. If you are currently using Implants which method are you using?
a. Implanon one rod system
b. Jadelle (two rod system)
c. Sino implant (two rod system )
10. If yes you are using Implants who is your source of information to use
it?
a. Health workers
b. Husband
c. Friends
d. Others specify
11. Are you satisfied with this method?
a. Yes
b. No
12. If yes, what made you satisfied?
a. Easy of use
b. High effectiveness
c. Prevent pregnancy for extended period
d. No routine follow up are required
13. If no, what make you dissatisfied/Explain?
_____________________________________________________________________
_____________________________________________________________________
14. What do you suggest regarding Implant/Explain?
____________________________________________________________________
____________________________________________________________________
15. What is your future option concerning contraceptive?
____________________________________________________________________
_____________________________________________________________________



44

Part III: Questions to assess the attitude of Family planning Clients
toward contraceptive implants.
Instruction for the following question you will answer from the choice put
according to your answer in the box. (For data Collectors).
1. Agree
2. Neutral
3. Disagree
S.N Questions 1 2 3
1 Hormonal implants cause sterility
2 Hormonal implants causes spontaneous
abortion

3 The available hormonal implants are effective
to prevent pregnancy

4 HI cause low birth weight babies in pregnancy
future

5 Hormonal implants do not make users thin
6 Hormonal implants dont negatively affective
breast milk.

8 Implants cause irregular Uterine bleeding
9 Contraceptive implants help a mother regain
strength before her next baby.

10 Implants do not cause user arm loss