AN EVALUATION OF THE ACCESSIBILITY AND UTILIZATION OF COMBINED ORAL CONTRACEPTIVES AMONG WOMEN OF REPRODUCTIVE AGE IN GWARINPA, ABUJA

CHAPTER ONE INTRODUCTION 1.1 Background to the Study Significant developments have occurred in the global reproductive health landscape, with increasing emphasis placed on women’s autonomy and decision-making capacity regarding contraceptive use. Contemporary contraceptive methods have become instrumental in empowering women to make informed decisions about their reproductive health, leading to improved maternal and child health outcomes and promoting overall societal well-being. For women of reproductive age, the use of modern contraception is recognized as a critical strategy to reduce maternal and infant morbidity and mortality, enhance quality of life, and prevent unintended pregnancies. According to the World Health Organization (WHO, 2019), individual or joint decisions by couples to regulate fertility through modern contraceptives substantially influence the health and welfare of women during their reproductive years. Despite advancements, many developing countries, including Nigeria, continue to struggle with elevated rates of maternal and child mortality. As stated by the United Nations Population Fund (UNPF, 2018), an estimated 287,000 women of reproductive age die annually from pregnancy and childbirth-related complications—predominantly in low-income nations. Many of these deaths are preventable through the proper application of modern contraceptive methods. The use of modern family planning techniques has proven instrumental in the pursuit of Millennium Development Goals (MDGs) 4 and 5 by reducing maternal and child deaths (Eliason et al., 2018). Additionally, these methods play a crucial role in reducing the financial burdens associated with achieving broader sustainable development goals (Lozano et al., 2020). In recognition of these benefits, the WHO (2018) underscores family planning as a global public health priority that fosters improved health, economic stability, and social advancement for individuals, families, and communities. Modern contraceptive options include implants, injectables, intrauterine devices, barrier methods, spermicides, sterilization procedures, and both progesterone-only and combined oral contraceptives (Adekunle, 2023). Combined oral contraceptives (COCs), introduced in the 1960s, remain one of the most widely used contraceptive options for women aged 15 to 34, especially in industrialized countries (Okpani & Okpani, 2020). COCs contain both estrogen and progestin hormones—typically ethinyloestradiol or mestranol as the estrogen component—both of which are synthetically derived and orally active (Thorogood & Villard-Mackintosh, 2023). Over the years, efforts have been made to reduce the estrogen content in these pills to lower associated risks such as thromboembolism, which is a known adverse effect. COCs are classified based on estrogen content into low-dose, medium-dose, and high-dose formulations (Adekunle, 2023). Despite reductions in estrogen levels, the efficacy of the pills remains intact. COCs are available in monophasic and phasic forms, and although highly effective, their success is heavily dependent on consistent and correct daily use. Failure rates can range from less than 1 per 100 women-years to over 15 per 100 women-years. These contraceptives offer various health benefits, including reduced menstrual bleeding, improved iron levels, predictable menstrual cycles, relief from dysmenorrhea, and management of abnormal uterine bleeding and rheumatoid arthritis (Milsom, Sundell & Andersch, 2020). Furthermore, they have been shown to protect against pelvic inflammatory disease, ectopic pregnancies, and endometriosis, while reducing the risk of ovarian and endometrial cancers. They also help prevent benign breast conditions like fibroadenoma and fibrocystic disease. Nonetheless, long-term use is associated with slight risks, such as hepatic adenomas and, in susceptible individuals, breast or cervical cancers. Given these implications, it becomes crucial to explore the accessibility and utilization of combined oral contraceptives, particularly in specific communities. Thus, this study aims to investigate the accessibility and usage of combined oral contraceptives among women of childbearing age in Gwarinpa, Abuja. 1.2 Statement of the Problem In many traditional African societies, contraception remains a sensitive and often controversial issue due to prevailing socio-cultural barriers. Various factors hinder contraceptive adoption, including limited knowledge, poor accessibility, cultural norms, religious beliefs, opposition from partners or family, and concerns about side effects (Otoide, Oronsaye & Okonofua, 2021; Carr & Khan, 2019). In Nigeria, governmental attitudes toward contraception have evolved from indifference to proactive support, resulting in the integration of family planning into the primary healthcare system as early as 1988 (Abiodun & Balogun, 2019). This shift has contributed to increased awareness and use of contraceptive methods among Nigerian women. Despite these efforts, contraceptive prevalence remains relatively low in developing countries—especially across Africa—largely due to inadequate information and socio-religious resistance. Multiple Nigerian studies report usage rates between 5.3% and 20% (Odujinrin, 2021). Makinwa (2022) notes that combined oral contraceptives are contraindicated in pregnant women, smokers, and women aged 35 and above. Women with a history of thromboembolism, cardiovascular disease, or liver disorders are also advised against using them. Although current literature highlights the health and reproductive benefits of oral contraceptives, region-specific research—particularly in Gwarinpa, Abuja—remains limited. Furthermore, most side effects of the pills are self-limiting and can be effectively managed with appropriate counselling before commencing treatment (van Vlijmen et al., 2019). It is in light of these considerations that this study seeks to examine the accessibility and usage of combined oral contraceptives among women of childbearing age in Gwarinpa, Abuja, thereby contributing to localized evidence on contraceptive use and informing relevant health policies.  1.3  Objectives of the Study The main purpose of this study is to evaluate the Accessibility and Utilization of Combined Oral Contraceptives Among Women of Reproductive Age in Gwarinpa, Abuja. Specifically, the study will; i.Determine the level of women accessibility to oral contraceptives in Gwarinpa ii.Determine the extent oral contraceptives are utilized among women of child bearing age in Gwarinpa iii.Assess the factors associated with utilization of oral contraceptives among women of child bearing age in Gwarinpa. iv.Investigate the implications of excessive use of oral contraceptive among women's health in Gwarinpa. 1.4 Research Questions The following questions have been prepared for the study: i.What is the level of women's accessibility to oral contraceptives in Gwarinpa? ii.To what extent are oral contraceptives utilized among women of childbearing age in Gwarinpa? iii.What are the factors associated with the utilization of oral contraceptives among women of childbearing age in Gwarinpa? iv.What are the implications of excessive use of oral contraceptives on women's health in Gwarinpa? 1.5 Research Hypotheses H0: Accessibility and usage of combined oral contraceptives among women of childbearing age are not significant. Ha: Accessibility and usage of combined oral contraceptives among women of childbearing age are significant.  1.6 Significance of the Study This research will be useful to media house to disseminate information to a large population regarding safe sex, increase their knowledge of modern contraceptives and  encourage the use. Furthermore, the findings of this study will inform policy decisions related to family planning and reproductive health. Additionally, subsequent researchers will use it as a literature review. This means that other students who may decide to conduct studies in this area will have the opportunity to use this study as available literature that can be subjected to critical review. Invariably, the result of the study contributes immensely to the body of academic knowledge with regard to the accessibility and usage of combined oral contraceptive among women of child bearing age in Gwarinpa, Abuja. 1.7 Scope of the study The scope of this study is boarded on the Accessibility and Utilization of Combined Oral Contraceptives Among Women of Reproductive Age in Gwarinpa, Abuja. Empirically, this study will determine the level of women accessibility to oral contraceptives, the extent oral contraceptives are utilized among women of child bearing age, assess the factors associated with utilization of oral contraceptives among women of child bearing age and investigate the implications of excessive use of oral contraceptive among women's health. Geographically, the study will be delimited to women in Gwarinpa, Abuja. 1.8 Limitation of the study In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. In addition, there was the element of researcher bias. Here, the researcher possessed some biases that may have been reflected in the way the data was collected, the type of people interviewed or sampled, and how the data gathered was interpreted thereafter. The potential for all this to influence the findings and conclusions could not be downplayed.  More so, the findings of this study are limited to the sample population in the study area, hence they may not be suitable for use in comparison to other schools, local governments, states, and other countries in the world.  1.9 Definition of Terms Contraceptives: also known as birth control or family planning methods, refer to various devices, medications, or procedures designed to prevent pregnancy by inhibiting the fertilization of an egg by sperm or interfering with the implantation of a fertilized egg. Family planning:the practice of birth control, child spacing and contraceptive use. Combined oral contraceptives (COCs): are a type of birth control pill that contains two hormones: estrogen and progestin.