Prevalence, Patterns, and Determinants of Family Planning Uptake Among Women Attending a General Outpatient Clinic in Southern Nigeria: A Hospital-Based Cross-Sectional Study

Study Area

The study was conducted at the General Outpatient Clinic (GOPC) of Delta State University Teaching Hospital (DELSUTH), Oghara, Delta State, Nigeria. DELSUTH is a tertiary healthcare institution that provides specialized, secondary, and primary healthcare services to residents of Delta State and neighbouring states in the South-South geopolitical zone of Nigeria. The General Outpatient Clinic serves as the first point of contact for adult patients seeking medical care and receives a large number of women of reproductive age with diverse socioeconomic and reproductive backgrounds. The clinic also provides health education, preventive healthcare services, and referral for specialized reproductive health services, including family planning.

Study Design

A hospital-based analytical cross-sectional study was conducted to determine the prevalence, patterns, and determinants of family planning uptake among women attending the General Outpatient Clinic of Delta State University Teaching Hospital.

Study Population

The study population comprised women of reproductive age (15–49 years) who attended the General Outpatient Clinic during the study period.

Inclusion Criteria

Women were eligible if they:

were aged 15–49 years;

attended the General Outpatient Clinic during the study period;

provided written informed consent to participate;

were mentally and physically capable of responding to the interview.

Exclusion Criteria

Women were excluded if they:

were critically ill or medically unstable;

had cognitive impairment that limited effective communication;

declined participation or withdrew consent at any stage of the study.

Sample Size Determination

The minimum sample size was calculated using the Cochran formula for single population proportion:

n = Z²P(1−P)/d²

where:

n = minimum required sample size;

Z = standard normal deviate corresponding to a 95% confidence level (1.96);

P = prevalence of family planning uptake obtained from a previous similar Nigerian study;

d = margin of error of 5% (0.05).

After adjusting for an anticipated non-response rate, a final sample size of 370 participants was obtained and recruited for the study.

Sampling Technique

A systematic random sampling technique was employed.

Based on the average monthly clinic attendance and estimated study duration, the sampling interval (k) was calculated by dividing the estimated number of eligible attendees by the required sample size. The first participant was selected by simple random sampling, after which every kth eligible woman was recruited until the desired sample size was achieved.

Women who declined participation were not replaced unless they were selected through the predetermined sampling interval, thereby minimizing selection bias.

Study Instrument and Data Collection

Data were collected using a pretested interviewer-administered structured questionnaire developed after an extensive review of relevant literature and previously validated instruments.

The questionnaire comprised five sections:

Section A Socio-demographic characteristics including age, marital status, educational level, occupation, ethnicity, religion, and monthly income.

Section B Obstetric and reproductive characteristics including parity, previous pregnancies, desired family size, and reproductive intentions.

Section C Family planning utilization, including awareness, current contraceptive use, type of contraceptive method used, duration of use, source of contraceptive services, reasons for utilization, and reasons for non-utilization.

Section D Socio-cultural determinants, including partner support, family influence, community norms, cultural beliefs, religious beliefs, and women's autonomy in reproductive decision-making.

Section E Clinical and health-system factors, including previous counselling on family planning, accessibility of services, availability of contraceptive commodities, previous adverse effects, and satisfaction with family planning services.

The questionnaire was pretested among women attending a comparable healthcare facility outside the study site. Necessary modifications were made to improve clarity, content validity, and comprehensibility before commencement of the main study.

Data collection was undertaken by trained research assistants under the direct supervision of the principal investigator to ensure uniformity and quality of data.

Definition of Outcome Variable

The primary outcome variable was family planning uptake, defined as the current use of any modern or traditional contraceptive method at the time of the survey.

Participants who reported currently using at least one contraceptive method were classified as current users, whereas those who reported not using any contraceptive method were classified as non-users.

Data Quality Assurance

Several measures were implemented to ensure data quality.

The questionnaire underwent expert review before pretesting. Research assistants received standardized training on interview techniques, questionnaire administration, ethical conduct, and confidentiality.

Completed questionnaires were checked daily for completeness and internal consistency before data entry. Double data entry and routine validation checks were performed to minimize transcription errors.

Data Management and Statistical Analysis

Data were entered into Microsoft Excel, cleaned, coded, and exported into IBM SPSS Statistics version 27.0 (IBM Corp., Armonk, NY, USA) for statistical analysis.

Descriptive statistics were used to summarize participants' characteristics. Continuous variables were presented as means and standard deviations (SD) or medians with interquartile ranges where appropriate, while categorical variables were summarized using frequencies and percentages.

Associations between independent variables and family planning uptake were assessed using the Pearson chi-square test or Fisher's exact test, where appropriate.

Variables with p < 0.05 during bivariate analysis and those considered biologically plausible were entered into a multivariable binary logistic regression model to identify independent predictors of family planning uptake.

Adjusted odds ratios (AORs) with 95% confidence intervals (95% CI) were reported, and statistical significance was established at p < 0.05.

The fitness of the final logistic regression model was assessed using the Hosmer–Lemeshow goodness-of-fit test, while multicollinearity among explanatory variables was evaluated using the Variance Inflation Factor (VIF). Variables with VIF values less than 5 were considered free of significant multicollinearity.

Ethical Considerations

Ethical approval was obtained from the Health Research Ethics Committee of Delta State University Teaching Hospital, Oghara, before commencement of the study (Approval Number: HREC/PAN/2024/007).

Permission to conduct the study was also obtained from the hospital management and the Head of the General Outpatient Clinic.

Written informed consent was obtained from all participants before enrolment. For participants younger than 18 years, assent and the required parental or guardian consent were obtained in accordance with institutional ethical guidelines.

Participation was entirely voluntary, and respondents were informed of their right to withdraw from the study at any stage without any consequences to their healthcare.

Confidentiality and anonymity were maintained throughout the study by assigning unique identification numbers instead of participants' names. All collected information was securely stored and used solely for research purposes.

Socio-demographic Characteristics and Their Implications

The study population was predominantly composed of women aged 31–40 years, with a mean age of 32.97 ± 7.39 years. This age distribution reflects women in their peak reproductive years, when the need for fertility regulation and birth spacing is greatest. Similar age distributions have been reported in studies conducted in Nigeria, Ghana, and Ethiopia, where women in their third and fourth decades constitute the largest users of reproductive health services. The predominance of married women in this study is expected because marriage is strongly associated with childbearing intentions and contraceptive demand in many African settings. Married women are more likely to seek contraception for birth spacing or limiting family size than unmarried women.

More than half of the respondents had tertiary education. Although educational attainment generally enhances health literacy and awareness of contraceptive methods, education did not independently predict contraceptive uptake in this study. This finding suggests that access to reproductive health services and counselling within a tertiary healthcare facility may reduce educational disparities in contraceptive use. It also indicates that socioeconomic and cultural factors may have a greater influence on contraceptive behaviour than educational status alone.

Prevalence of Family Planning Uptake

The prevalence of family planning uptake in this study was 55.1%, which is higher than the national contraceptive prevalence reported in the Nigeria Demographic and Health Survey but comparable to findings from other hospital-based studies in Nigeria and Ghana. The relatively higher prevalence may reflect improved access to healthcare providers, availability of contraceptive commodities, and opportunities for routine counselling within a tertiary healthcare setting. Women attending hospitals are more likely to receive reproductive health information and referrals than women in community settings.

Despite this encouraging level of uptake, nearly 45% of respondents were not using any family planning method, indicating that important barriers to contraceptive utilization persist. This finding emphasizes the need to strengthen counselling services, improve community awareness, and address misconceptions that continue to discourage contraceptive use.

Socio-demographic Predictors of Family Planning Uptake

Monthly income emerged as one of the strongest predictors of contraceptive uptake. Women earning between ₦31,000 and ₦60,000 were more than six times as likely to use family planning as women earning ₦30,000 or less, while women earning ₦61,000–₦90,000 were over three times more likely to utilize contraception. This finding suggests that financial empowerment enhances women's ability to access healthcare services, afford transportation and associated costs, and exercise greater autonomy in reproductive decision-making. Similar associations between higher income and contraceptive use have been reported in studies from Nigeria, Ethiopia, Uganda, and other low- and middle-income countries.

Ethnicity was significantly associated with contraceptive uptake at bivariate analysis but did not remain an independent predictor after multivariable adjustment. This suggests that cultural practices linked to ethnicity may influence contraceptive behaviour indirectly through education, income, religious beliefs, and community norms rather than acting as independent determinants.

Marital status was also significantly associated with uptake, with married women demonstrating greater contraceptive utilization than unmarried women. This observation agrees with previous studies showing that contraceptive use in sub-Saharan Africa is closely linked to fertility regulation within marriage.

Sociocultural Determinants

The study demonstrated that sociocultural factors continue to influence contraceptive decision-making. Community support and health education positively influenced family planning uptake, suggesting that community-based interventions remain effective strategies for improving contraceptive acceptance. In contrast, misconceptions regarding contraceptive safety particularly the belief that contraceptives cause cancer were associated with lower utilization. These misconceptions remain widespread across many African settings and continue to contribute to fear, method discontinuation, and unmet need for family planning.

Male partner involvement also emerged as an important issue. Although many respondents reported joint decision-making regarding family size, inadequate male support remained a barrier to contraceptive uptake. This finding highlights the need for interventions that actively engage men in reproductive health education and promote shared decision-making between partners.

Clinical Factors Associated with Family Planning Uptake

Parity was significantly associated with contraceptive use. Women who had previously given birth were more likely to use family planning than nulliparous women, reflecting increased motivation to space or limit subsequent pregnancies after childbirth. Primiparous women remained significantly more likely to use contraception even after adjustment for other factors, emphasizing the importance of postpartum family planning counselling following the first delivery.

Hypertension and body mass index were not significantly associated with family planning uptake. Although these clinical characteristics may influence the choice of contraceptive method because of medical eligibility considerations, they appeared to have limited influence on whether women adopted contraception in this population.

Independent Predictors of Family Planning Uptake

After adjusting for potential confounders, only monthly income and parity remained significant independent predictors. These findings indicate that economic empowerment and reproductive experience are stronger determinants of contraceptive use than many demographic and clinical characteristics. Financially empowered women are more likely to access reproductive healthcare services, while women with previous childbirth may have greater motivation to prevent unintended pregnancies and achieve optimal birth spacing.

Public Health and Policy Implications

The findings have important implications for reproductive health programmes in Nigeria. Although family planning uptake was moderate, substantial gaps remain. Efforts to improve contraceptive utilization should focus on strengthening community-based health education, dispelling misconceptions through evidence-based communication, promoting male involvement, and improving equitable access to affordable contraceptive services. Integrating comprehensive family planning counselling into routine outpatient care, antenatal services, postnatal clinics, and child welfare programmes would provide additional opportunities to increase contraceptive uptake and reduce unmet need.

Strengths of the Study

This study provides contemporary evidence on family planning uptake among women attending a tertiary healthcare facility in Southern Nigeria. The use of systematic random sampling, a relatively large sample size, standardized data collection procedures, and multivariable logistic regression strengthened the reliability of the findings. In addition, the study explored a broad range of socioeconomic, sociocultural, and clinical determinants, providing a comprehensive understanding of factors influencing contraceptive utilization.

Limitations of the Study

The cross-sectional design limits the ability to establish causal relationships between identified determinants and family planning uptake. The hospital-based nature of the study may also limit generalizability to women in community settings or those receiving care in primary healthcare facilities. Furthermore, contraceptive use was self-reported and may have been influenced by recall or social desirability bias. Nevertheless, the findings provide valuable evidence for improving reproductive health services in similar healthcare settings and can inform future multicentre studies.

Strengths of the Study

This study has several strengths. It employed a systematic random sampling technique, thereby minimizing selection bias and enhancing the representativeness of the study population. The relatively large sample size improved the statistical power of the study, while the use of a pretested structured questionnaire ensured standardized data collection. Furthermore, the application of multivariable logistic regression enabled adjustment for potential confounding variables and facilitated the identification of independent predictors of family planning uptake. The findings provide valuable contemporary evidence that can guide family planning programmes and reproductive health policies in similar tertiary healthcare settings.

Limitations of the Study

Despite its strengths, this study has some limitations. The cross-sectional design precludes the establishment of causal relationships between the identified determinants and family planning uptake. Being a hospital-based study conducted in a tertiary healthcare facility, the findings may not be fully generalizable to women in the community or those attending primary healthcare centres. In addition, contraceptive use was self-reported and may have been influenced by recall bias or social desirability bias. Nevertheless, the study provides important insights into the determinants of family planning uptake among women attending tertiary healthcare facilities in Southern Nigeria.