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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


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Jimma University

College of public health and medical sciences

Department of nursing and midwifery

Factors affecting utilization of implants contraceptive methods among womenin reproductive age group attending family planning service in Serbo health

center Jimma zone, south west Ethiopia.

.

By: TeferiGebru

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

May, 2014

JIMMA, ETHIOPIA


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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 impanon 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. furtherstudy 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.


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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.


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Acronyms

WHO-world health organizationIUDS-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


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Table of contents

Title pageAbstractI

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....103.2specific 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.134.11data 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


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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 theirpractice 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


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CHAPTER ONE

1. INTRODUCTION1.1 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, uncontrolledpopulation 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


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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.


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1.2. STATEMENT OF THE PROBLEMIn developing countries maternal mortality is the leading cause of death for women of

reproductive age (1549 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


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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.


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1.3. SIGNIFICANT OF THE STUDY

Since, family planning program welfare is very important to stabilize uncontrolled populationgrowth 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. Serbohealthcenter,Jimmazone, south west Ethiopia.


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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).


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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 theirearly discontinuation of the method providers should address notonly menstrual

disturbancebutalso, the possibility of infection at the insertion site the fact that implan ts dont

protect against HIV or STDIs, and other contraceptive options (21)


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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 todiscontinue 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


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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.


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CHAPTER THREE

3. OBJECTIVE

3.1. General ObjectivesTo assess factors affecting the utilization of implants contraceptive methods among women inreproductive 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 methodsin Serbo health center,

To determine the practice of women towards implantscontraceptive methodsin Serbo health center.

To identify factors affecting utilization of implants contracptive methodsamong family planning users attending Serbo health center.,


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CHAPTER FOUR :

METHODS AND MATERIALS

4Study 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 18-20oc.

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 under5),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:


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The sample size was calculated using single population proportionformula

( )

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 samplesize 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


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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

toolwereprepared in simple and understandable English language. The data were collected by

interviewing those legibleclients for the study, training was given for the data collectors about

data collection and questionnaire were pretested . The English version questionnaire wastranslated 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


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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.

Thecollected 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 aclient 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.


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

having poor practice.

CHAPTER FIVE:

RESULTS


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A total of 371 study subjects were interviewed and that gave aresponse 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 accounts99 (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 No %

Age

(in Years)

1519 63 16.982024 87 23.45

2529 119 32.08

3034 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 12.40Widowed 51 13.75

Total 371 100

Ethnicity Oromo 136 36.66

Amahra 112 30.19


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Gurage 71 19.14

Others (yem, Dawero, Sidama) 52 14.01

Total 371 100

Monthly Income(in birr)

< 300 birr70 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 45.28Student 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


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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 practiceout 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 allowedby 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


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26

Fear of developing side effects 43 14.53

Total 296 100

Reason of

discontinuation of

implant

Developing other side effects 9 12.02Desire 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


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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 causesterility

114

52.77 16 7.41

86 39.81

2 Implants causespontaneous abortion.

114

52.77 18 8.33

84 38.89

3 The available implantsare effective to preventpregnancy.

96 44.44 6 2.78

114

52.77

4 Implants cause lowbirth weight babies infuture pregnancy.

114

52.77 11 5.09

91 42.13


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28

5 Insertion and removalof implant causespain

114

52.78 2 0.93

100

46.38

6 Implants do not causeusers thin.

97 44.91 5 2.31

114

52.78

7 Implants do notnegatively affectbreast Milk.

97 44.91 5 2.31

113

52.31

8 Implant help a motherregain strength beforeher next baby.

99 45.83 3 1.39

113

52.32

9 Using implant causesirregular bleeding.

114

52.77 7 3.24

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


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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.

Variable

s

Charac

teristicNo %

PositiveAttitude

NegativeAttitude

X2P=V

alueNo % No %

Age

(inYear

s)

1519202425293034

>34

Total

63871195745

371

16.9823.4532.0815.3612.13

100

1722301813

100

26.9825.2825.2131.5728.88

26.95

4665893932

271

73.02

74.7274.79

68.4371.12

73.05

1.170.88

4

Relig

ion

MuslimOrthodoxProtestantOthers(Chatolic)Total

1769378

24

371

47.4425.0621.03

6.47

100

412719

996

23.2929.0324.35

3.7525.87

1356659

15275

76.7170.9775.65

96.2574.13

2.88 0.411

MaritalSt

atus

MarriedSingle

Divorced

Widowed

Total

19679

4650

371

52.8521.23

12.4313.49

100

40

2213

2398

20.4

28.228.26

45.0926.41

156

5733

27273

79.6

71.871.74

54.9173.59

13.70.00

3

Ethn

icity

Oromo

AmharaGurageOthers

Total

136

11270

53

371

36.65

30.1918.87

14.29

100

31

311820

100

22.79

27.6725.7137.73

26.95

105

825232

271

77.21

72.3374.2962.27

73.05

4.760.19

0

MonthlyIncom

e(inbi

rr)

< 300birr300-500501-10001001-

1500>1500

70

105122

4628

18.87

28.3132.88

12.377.55

221739138

31.4216.1931.9628.2628.57

4888833320

68.5883.8168.0471.7471.43

8.570.07

3

Total 371 100 99 26.68 272 73.32


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30

Educationalstatus

Canreadand

writeIlliterat

eGrade

1-6Grade7-12

College

/University

Total

99

144465428371

26.6838.81

12.3914.567.54

100

18

3810

2311

99

18.1826.3821.73

42.5939.28

26 68

80

1063632

18

272

81.8273.6278.27

57.4160.72

73 32

11.30.01

5

O

ccupationStat

us

Housewife

StudentGovernment

employMercha

ntFarmer

Other

Total

1684451

4352

13

371

45.2811.8513.7511.5914.022.51

100

5410151395

1 6

32.1422.7229.4130.2317.3

38.46

27.43

114323631

448

265

67.8677.2870.5969.7782.761.54

72.57

5.670.34

0

Parity


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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.

Variables

Characteristic

No %

Goodpractice

Poorpractice X2

P=Value

No % No %

Age

(inYears)

151920242529

3034>34

Total

6387

119

5745

371

16.9823.4532.08

15.3612.13

100

172230

1813

100

26.98

25.2825.21

31.5728.8826.95

466589

3932

271

73.02

74.7274.79

68.4371.12

73.05

1.17 0.884

Religion

Muslim

OrthodoxProtestant

Others

Total

17693

7824

371

47.4425.06

21.036.47

100

41

27199

96

23.29

29.0324.353.7525.87

135

665915

275

76.71

70.9775.6596.25

74.13

2.88 0.411

MaritalStatus

MarriedSingle

Divorced

Widowed

Total

19678

4651

371

52.8321.03

12.3913.75

100

402213

2398

20.428.228.26

45.0926.41

1565733

27273

79.671.871.74

54.9173.59

13.7 0.003


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32

Ethnici

ty

Oromo

Amhara

GurageOthers

Total

136

112

7053

371

36.65

30.19

18.8714.29

100

31

31

1820

100

22.7927.67

25.7137.7326.95

105

82

5232

271

77.21

72.33

74.2962.27

73.05

4.76 0.190

Monthly

Income(in

birr)

< 300 birr300-500501-1000

1001-1500>1500

Total

70

105

1224628

371

18.87

28.31

32.8812.377.55

100

22

173913

8

99

31.4216.1931.9628.26

28.5726.68

48

888333

20

272

68.58

83.8168.0471.74

71.43

73.32

8.57 0.073

Educational

status

Can readand write

Illiterate

Grade 1-6Grade 7-

12College/U

niversityTotal

99

14446

5428371

26.6838.81

12.3914.567.54

100

18

3810

231199

18.1826.3821.73

42.5939.2826.68

80

1063632

18272

81.82

73.6278.2757.4160.72

73.32

11.3 0.015

Occupation

Status

Housewife

Student

Government employMerchantFarmer

OtherTotal

168

4451

4352

13

371

45.2811.8513.75

11.5914.02

2.51

100

54

10151395

106

32.1422.7229.4130.2317.3

38.46

27.43

114

323631

448

265

67.8677.2870.5969.7782.761.54

72.57

5.67 0.340

Parity


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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 isrelatively 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 observedamong 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 ofimplant 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).


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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 useimplant 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 StudyNature of the study design has its own limitation.it does not show the cause and effects of

the study


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35

CHAPTER SEVEN7. CONCLUSION AND RECCOMENDATION

7.1. ConclusionIt 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.


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36

7.2. RecommendationsThe 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 followup 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 improvedthrough health education communication and integration with health

workers

3) Health workers effectiveness and efficiency with in health facility isrecommended to improve misconceptions toward the method.

4) Refresher course for health workers regarding implant contraceptionshould be given regularly regarding reproductive issues

5) Client counseling particularly about side effects of the method has to begiven regularly.

In general adequate implant service utilization can be achieved throughan 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.


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37

REFERENCE

1. Ram chand ran D and up adhyay UD. Implants the next generation.Population reports series k. No 7. Balti more johns Hopkins bloom berg

school of public health(2007).

2. Hoh man H. Examining the efficacy safety and patient acceptability ofthe etonogestrel Implantable contraceptive patient prefer adherence

(2009) Nov 33 205-11

3. Ishley mm, Edel man A. contraceptive implants an over view and update:obstet and Gynaeco. Notrh am. (2007). 341 (1).73-20

4.Gracsslin of implanon. A review of cilinilaltrals and marketing ofimplanon. A review of clinical trials and marketing experiences.

European journal of contraception and reproductive health care.(2008).

13 (supp 1): 4-12.

5.Jacobsitin (Rs, and pile, is). Hormonal implants service deliveryconsideration for and improved and increasing popular method. New

York Endanger-health (the respond projects. (2007). 16,(2) 341-349

6. Family health international: us agency for internal development Pharm.access Africa maries topes international. Endanger health (the

respondents project; (2010) comparison of contraceptive.7. Central statistical authority and ORC Macro Ethiopia demographic and

health surveys 2007, Addis Ababa, Ethiopia and Calverton, marry land,

USA, 2008

8. Central statistical authority. The family and fertility survey, Ababa,Ethiopia.2007,

9. Bhargara A, Desire of family size family planning and fertility in Ethiopia,journal of Bi o social, (2007), 39, 367-38.

10. WHO. International planned parenthood federation http/www.enwekiedia. org/wikj/ International planned parenthood federation.

11. ORC macro Calverton,. Evaluation of program options to meet un metneed for family in Ethiopia, Addis Ababa, marry land USA November

2006.


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38

12. Center of statistical authority. The family and fertility survey AddisAbaba, Ethiopia, (1993).

13. Power T, French, R, and Covoan, F, sub dermas implantablecontraceptives Versus other form of reversible contraceptive or other

implantable as effective methods of preventing pregnancy. Co charane

data base of systematic reviews (2007) 3(31 1-3)

14.Steven Clements, Angela Baschri. Explaining a real varation incontraceptive, use in east Africa letter presented at TJE UAPS

conference, thumb is December 2004.

15.Tannes WH. Existing demand for birth spacing in developing countriesperspectives from house surveys data. Int Gynaco -obstet 2005 8-9

suppl. 1.550-60.

16. Ishley mm, Edelman. Contraceptive implant an overview and updateddata obstet and Gynaeco North am. (2007) 341 (1). 73-40

17. Hubacher D. Lopez, L. Steiner M and Dorfinger L. menstrual patternchanges from levongestrelsubdermal implants and DMPA systematic

review and evidence based comparisons. (2009) Contraception (2). 113

118.

18. Lekine, J, Sin of Sky, F and Christ M, Assessment of implant insertionand removal contraception.(2008) 78 (15). 409-417.

19. Dancy PD, At nin son E, Tanners, et al. acceptance and perception ofimplants among users in san Francisco, USA study fam -plan .(2008)

21, 152,

20. Who making designs about contraceptive introduction A guide forconducting assessment to broader contraceptive choice and improve

quality of Broader contraceptive choice and improve quality of care. (The

strategic approach) world health organization, Jeneva .(2005).

21. Rivera R, Chem-mok m. analysis of a client characteristics that mayaffect early discontinuation of the TCU380, IUD contraception. (2003).

22.Tolly E, loza S, kafafi L, and Wmmings S, the impact of menstrual; sideeffects on contraceptive discontinuation, finding from a longitudinal


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39

study in Cairo Egypt internal national family planning perspective.

(2005) 31 (1):15-19.

23. Harrison wool rych M, and Hill R. unintended pregnancies with theetonogestrel implant. A case series from post marketing experiences in

Austria :(2005) contraception 71 (41; 306-308.

24. Bas nakake S. Thapas s. Balogh SA: e valuation of safety efficacy, andacceptability of implants in stilanka, stud farm plan: (2004) 19:39,

25.Johns B, caster line Zabar A. Sather and Ninghul has given obstacle tocontraceptive use in Pakistani, studies family planning USA, (2005), vol.

32 Nov pp25-209

26.Temesgen A. Assessment of factors affecting utilization of implantablecontracentive among married women in Jinka town, Omo zone SPPNS .

Ethiopia .2008 sub mitted to AAU.

27. Kebede y contraception prevalence and factors associated with usage ofcontraceptive around MEKELE town, Tigray north Ethiopia .2009. town.

Ethiopia journal of health dev.t August (2006) 14 (3) 327-334.

28.Tasfaye F. Assessment of factors influencing utilization of moderncontraceptive method among women ButtaJira town Guragezone

,national regional state (2010). MPH.

29. Kaba M: fertility regulation among women in rural communities aroundJimma, western Ethiopia. Journal of health development august (2003)

14 (2) 117-124.


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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 4thyear midwifery Student.

1. Do not leave any items of information without answer (for datacollectors).

2. You are kindly requested to run through each questions for (bothrespondents 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).


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41

PART I:Socio Demographic Characteristics.

1. Respondents age (in years)2. Noof children ever born to you a, m b, f _______3. What is your ethnicity?

a. Oromob. Amharac. Dawro

d. Guragee. Others specify

4. What is your educational status?a. Illiterateb. Can read and writec.

Elementary school (1-6)

d.Junior high school (7-12)e. College/University

5. Current marital statusa. Singleb. Marriedc. Divorced

d. Widowede. Other specify

6. If married what is your husbands educational status?a. Illiterateb. Can read and writec. Elementary school (1-6)

d.Junior high school (7-12)e. College/University

7.What is your main occupationa. House wifeb. Farmerc. Government employee

d. Studente. Merchant others specify

8. What is your religion?a. Muslimb. Orthodox

c. Protestantd. Others specify

e.9. What is your monthly income in Birr?


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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 pillsb. inject able

c. Implantabled. 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 noinfertility

b. Its short periodc. Less side effects

d. Other method isunavailable

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 Pillsb. Injectablec. Implant

d. IUSDe. Other specify

6. If used implant which type?a. Implanon used for three yearsb. Janelle effective for five years c. Sino implant (II) effectivefor four years

7. If ever used implant what was the main reason that you stopped using themethod?

a. Its expiry timeb. Desire to have more

children

c. Fear of infertility

d. Irregular or prolongeduterine bleeding

e. Rumors they are not goodf. 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 breastmilk

d. It causes user thin


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e. Un availability in the nearby, others specify_______.9. If you are currently using Implants which method are you using?

a. Implanon one rod systemb.Jadelle (two rod system)c. Sino implant (two rod system )

10.If yes you are using Implants who is your source of information to useit?

a. Health workersb. Husbandc. Friendsd. Others specify

11.Are you satisfied with this method?a. Yesb. No

12.If yes, what made you satisfied?a. Easy of useb. High effectivenessc. Prevent pregnancy for extended periodd. 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?____________________________________________________________________

_____________________________________________________________________


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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. Agree2. Neutral3. 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

Documents

teferi resalt