Summary

A cross-sectional survey of non-Catholic Christian religious leaders was conducted in order to determine the awareness, practice and attitude to family planning amongst Christian religious leaders in Enugu, Eastern Nigeria. 303 respondents were recruited through a stratified random sampling technique. The mean age of respondents was 44±4 years. Every respondent was aware of at least one family planning method. Knowledge of the methods were: calendar method (45.9%), withdrawal (40.3%), condom (39.6%), (IUCD) (36.6%) and periodic sexual abstinence (28.7%). The main sources of information on family planning were health workers (46.9%), mass media (29.0%) and friends (12.5%). All respondents at risk of unwanted pregnancy were practicing some forms of family planning. The methods commonly practiced were withdrawal (28.7%), IUCD (26.2%), calendar (25.6%), condom (11.6%) and Billing’s method (7.3%). 124 (41%) respondents had ever recommended family planning to members of their congregations or groups; none ever discouraged its practice. The high rates of awareness, practice and favourable attitude to family planning existing amongst the Christian religious leaders in Enugu, offer opportunities for a partnership between family planning service providers and the religious leaders such that contraceptive information could be disseminated through the churches.

Introduction

The low contraceptive prevalence in Nigeria has been attributed to a number of factors including religious belief^1-9 as well as opposition from religious organizations^10-12. The Roman Catholic Church officially forbids artificial methods of family planning but encourages the natural methods^12-14. On the other hand, the Anglican Church officially permits all forms of family planning including the artificial methods^13-15. The official positions of the other churches in Nigeria are less clear.

The attitude of religious leaders to family planning, and particularly their practice or non-practice of it, has some influence on the overall prevalence of family planning practices in a community^16-18. Because the Church is an important organ of social mobilization, the attitude of her leaders to family planning could have significant effects on the attitude to, and practice of family planning by her members. Therefore, in a predominantly Christian society such as Enugu, the attitude of the Christian religious leadership to family planning could have a profound influence on the overall prevalence of family planning practice as well as on the particular family planning methods practiced. If the leadership is favourably disposed to family planning, the Church could also serve as an effective forum for the dissemination of family planning information. This study was carried out to investigate the awareness, practice and attitude to family planning amongst Christian religious leaders in Enugu so as to determine whether they constitute barriers or facilitators of family planning practice in the community. Information from the study will be useful in designing appropriate church-sensitive family planning interventions to improve the contraceptive prevalence in Enugu and its environs.

Materials and Method

Study setting

Study subjects

Sampling technique and interview method

Data management

Results

A total of 303 respondents participated in the study. The age of respondents ranged from 30 to 66 years with a mean of 44.3±1.7 years. They comprised of 171(56.4%) males and 132 (43.6%) females of whom 267(88.1%) were married, 33(10.9%) were single and 2(0.6%) were widows (total =303). One hundred and sixteen (38.3%) respondents had secondary education while 187(61.7) had tertiary education (theology training or university education) (total=303). There were 24 (7.9%) respondents from the orthodox protestant churches (Anglican, Presbyterian, Methodist, Baptist and Evangelical Church of West Africa) and 279 (92.1%) from the Pentecostal and spiritual (independent African churches) denominations (total=303). Their sources of information on family planning are shown in Table 1(a) which revealed that health care workers and the mass media were their main sources of information on family planning. Table 1(b) shows their awareness of family planning methods. They were most aware of calendar, withdrawal, condom and intrauterine contraceptive device (IUCD) in decreasing order. Every respondent was aware of at least one family planning method. Although women knew more family planning methods than the men, there was no significant difference in the awareness and knowledge of the two groups (p=0.085). Table 1(c) and 1(d) show their practices and recommendations of family planning methods. Of the 267 married respondents, 164 (61.4%) were practicing family planning, 72(27%) were menopausal (or had menopausal wives), 13(4.9%) were pregnant or had pregnant wives and 18(6.7%) were trying to conceive at the time of the study. Therefore all those who were at risk of unwanted pregnancy were practicing some form of family planning. Eighty-six point five percent (86.5%) of the respondents encouraged members of their congregations/groups to practice family planning and none discouraged its practice. Calendar method, withdrawal, condom, IUCD and Billing’s method were the most commonly practiced and recommended family planning methods.

Figure 1

Table 1: Sources of information, awareness, practice and recommendation of family planning amongst Christian church leaders in Enugu

Discussion

This study revealed that 100% of the respondents were aware of one or more family planning methods. This result is similar to the findings of Orji and Onwudiegwu¹⁶ from Ile-Ife but higher than Nigerian national average of 79% (amongst women aged 15 to 45 years)¹. Unlike previous studies^{1, 10, 11, 19}, all married respondents in this study at risk of unwanted pregnancy were practicing some form of family planning. The characteristics of the study population namely; being Christians, married, monogamous relationships, age greater than 30 years and being educated, are all associated with high prevalence of contraceptive practice in Nigeria²⁰ and may explain the high prevalence of family planning recorded. Similar reasons may explain the high rate of approval and recommendation of family planning to members of their congregations and groups.

It is however, disturbing that despite a positive attitude to family planning, majority of the respondents practiced and recommended the less effective methods of withdrawal, calendar and Billing’s method (which constitute 61.6% of their practices and 81.5% of their recommendations) in preference to the more effective methods of condom, intra-uterine contraceptive device (IUCD), bilateral tubal ligation (BTL) and other modern contraceptive methods (34.6 of their practices and 18.5 of their recommendations respectively). The recorded practices and recommendations followed a pattern similar to their awareness and revealed important defects in their sources of information and gaps in their knowledge. The defective contraceptive communication resulted to an unmet need for effective contraceptive practice ²¹. Targeted advocacy and orientation of religious leaders on modern family planning methods were found to be effective interventions in a similar situation elsewhere^19. The identified positive disposition to family planning amongst the church leaders in this study is a window of great opportunity for promoters of family planning to exploit and work in partnership with the church leaders to promote effective contraceptive practice in the community. Family planning advocacy and sensitization meetings as well as periodic trainings could be organized for the church leaders and adult groups in the churches. This promises to have a positive multiplier effect especially in the Igbo communities. It is customary for married Igbo women who live in the cities go to their various local communities every year in the month of August to meet with other married women in their communities in order to discuss developmental and health-related issues. This has become generally referred to as the ‘August General Return’. This ‘August meetings’ are increasingly being targeted for sensitization, education and trainings in gender-related matters, economic empowerment and health related issues. Trained female church leaders from Enugu could use this forum to reach their peers in the hinterlands on effective contraceptive practices.

It is concluded that the non-Catholic church leaders in Enugu have a high awareness and positive attitude to family planning. A knowledge gap was revealed by their preference for the less effective methods. Targeted advocacy, sensitization and periodic training of the church leaders on modern contraceptive methods would improve their own practices of contraception as well as the overall prevalence of effective contraception in the community. The favourable attitude of the church leaders to family planning is also an opportunity for a partnership between family planning service providers and the churches to promote effective contraception. This opportunity to partner with the church needs to be exploited to facilitate the dissemination of contraceptive information in the community.