Determinants of Family Planning Method Mix in Rural Sub-Saharan Africa: Understanding Barriers, Preferences, and Drivers of Choice

Background 

Family Planning (FP) was a central component of global reproductive health, enabling individuals and couples to anticipate and achieve their desired family size, protect maternal and child health, and contribute to broader social and economic development. The global evidence-base consistently showed that access to a comprehensive method mix, high-quality counseling, confidentiality, affordability, and youth-friendly services were fundamental to increasing contraceptive use and reducing unintended pregnancies, which, in turn, were associated with improved maternal and child outcomes, reduced infant mortality, and expanded educational and economic opportunities for women. The demand for FP was shaped by a constellation of factors at the individual, relational, community, and structural levels. Individual knowledge, attitudes toward contraception, perceived risks and benefits, and levels of autonomy in decision-making influenced whether people sought information, initiated use, and sustained their chosen method. Partner dynamics, including communication, negotiation power, and male involvement, could either facilitate or hinder contraceptive uptake, depending on how couples navigated gender norms and their reproductive goals. Social and cultural contexts, such as religious beliefs, community expectations, and broader sociocultural norms around sexuality and fertility, strongly modulated acceptability and use, particularly for adolescents and unmarried individuals who often faced heightened stigma [1-3]. On the supply side, the availability of a full method mix, quality of counseling, confidentiality protections, geographic accessibility, and cost of services collectively determined not only whether people started using contraception but also whether they would continue to use it over time. Stockouts of commodities, stockouts of trained personnel, and supply chain weaknesses undermined trust in services and contributed to discontinuation or inconsistent use [4]. High-quality FP services were often characterized by respectful, non-coercive counseling that supported informed choice, provided accurate information about side effects and method characteristics, and offered follow-up and management of adverse events. Youth-friendly approaches-ensuring privacy, appropriate clinic hours, confidentiality, and information that was relevant to adolescents’ lives-were particularly important for engaging young people who faced unique barriers and risks, including higher rates of unintended pregnancies in many settings. Financing and policy environments profoundly influenced FP uptake. Policy coherence across sectors-health, education, social protection, and gender equality-supported comprehensive strategies that addressed not only access to contraception but also the broader determinants of reproductive health, including empowerment and education. Evidence consistently indicated that demand-generation efforts, when combined with reliable supply and quality care, yielded more substantial and durable increases in modern contraceptive use than isolated components. Programs that emphasized Long-Acting Reversible Contraceptives (LARC) alongside short-acting methods tended to expand choice and reduce discontinuation due to dissatisfaction. However, the distribution of methods had to reflect user preferences and be supported by competent counseling regarding effectiveness, side effects, and suitability for different life stages. Digital health innovations-ranging from mobile information campaigns and appointment reminders to telemedicine-based counseling and e-tools for method selection-offered opportunities to expand reach, particularly for remote populations and adolescents [5]. These technologies could reduce barriers related to distance, stigma, and privacy but required careful attention to digital literacy, data security, and equitable access to avoid widening existing gaps. The global policy landscape emphasized the alignment of FP with universal health coverage and sexual and reproductive health and rights, including the provision of a broad method mix, access to safe abortion where it was legal, and age-appropriate education. Additionally, the global FP conversation supported a holistic, rights-based, and equity-focused approach that combined access to a full method mix, high-quality client-centred care, gender-responsive programming, and health system strengthening to expand reach and sustain improvements. Translating these insights into practice required context-sensitive adaptation, ongoing community engagement, reliable supply chains, and robust data systems to monitor progress and adjust strategies in response to changing population needs. Bayelsa State, Nigeria, offered a subnational lens through which global FP principles could be contextualized. It’s environmental, sociocultural, and health system landscapes presented both opportunities and challenges for expanding FP. Bayelsa’s population was youthful, with fertility pressures that necessitated accessible services and a broad mix of methods. Geographic dispersion and limited health infrastructure in some local government areas introduced access barriers, making decentralized service delivery and mobile outreach particularly relevant. Supply chain fragility and occasional stockouts highlighted the need for strengthened procurement, inventory management, and predictable funding to ensure the consistent availability of contraception, including LARC. Sociocultural norms surrounding family size, gender roles, and fertility timing influenced client demand and uptake, underscoring the importance of culturally sensitive counseling, community engagement with faith-based and traditional leaders, and strategies that respected local values while promoting voluntary informed choice. Adolescent and youth FP required tailored approaches that addressed privacy, confidentiality, and safety in environments that had heightened stigma while ensuring that education on sexual and reproductive health was age-appropriate and culturally aligned. Data gaps at the state level, such as up-to-date prevalence, method mix by locality, and qualitative insights into decision-making processes, limited precise policy tailoring and program design, emphasizing the need for subnational surveillance, routine data collection, and mixed-methods research to capture the heterogeneity across Bayelsa’s urban and rural communities. Furthermore, unintended pregnancies were widely recognized as a crucial indicator of reproductive health and a key outcome affected by the availability, quality, and social context of Family Planning (FP) services; in summation, the global evidence base consistently linked higher levels of FP access, a broad method mix, and high-quality, rights-based counseling with reductions in unintended pregnancies, improved maternal and child health, and broader social and economic gains, while gaps in coverage, affordability, stigma, and sociocultural barriers maintained substantial unmet need across many settings [6]. At the core of this conversation was the recognition that FP was not simply about providing contraception but about enabling voluntary, informed, and sustained reproductive choices within a supportive health system and sociocultural environment. Studies repeatedly showed that when individuals and couples had knowledge of a wide range of methods, clear information about effectiveness and side effects, and access to confidential, youth-friendly, affordable services, contraceptive uptake increased and the likelihood of unintended pregnancies declined, although disparities persisted by age, education, wealth, urbanicity, and geographic location. The demand for FP was shaped by an interplay of individual knowledge, beliefs about fertility and contraception, partner communication, gender norms, and perceived autonomy. Women and adolescents often faced barriers related to stigma, fear of side effects, or anticipated disapproval from partners or family, all of which could influence initiation, continuation, and method switching. These dynamics were frequently reinforced or mitigated by broader sociocultural and religious contexts that either supported or constrained reproductive choices. On the supply side, the availability of a full method mix, quality of counseling, confidentiality of services, and overall user experience-along with practical factors such as costs, wait times, and geographic accessibility-played crucial roles in whether individuals could act on their intentions. Stockouts and supply chain weaknesses undermined trust in FP programs and contributed to unintended pregnancies when feasible options were temporarily unavailable, while well-managed supply chains and client-centered care promoted sustained use and planning. The integration of FP with other health services-most notably maternal and child health, HIV prevention and treatment, and general primary care-emerged as a central strategy to improve access, reduce fragmentation of care, and create multiple touchpoints for counseling and method provision; such integration could normalize FP as part of routine health maintenance rather than a standalone intervention, though it required coordinated governance, compatible data systems, and cross-training of providers to ensure consistent messaging and quality [7]. Equity considerations were central to the conversation, with persistent disparities observed among adolescents, unmarried individuals, people with lower socioeconomic status, rural residents, people with disabilities, and those living in humanitarian or fragile settings. Addressing these inequities often demanded targeted outreach, culturally competent communication, privacy protections, and services that respected rights and autonomy while accommodating diverse needs and life stages. The evidence base also emphasized the importance of addressing gender norms and power dynamics through gender-transformative approaches that involved both women and men in dialogues about shared decision-making and respectful partnerships, as coercive or inequitable norms could severely curtail voluntary FP use and elevate the risk of unintended pregnancies; programs that successfully engaged men and fostered supportive environments for women tended to show enhanced uptake and continuity when these strategies were implemented in ways that preserved autonomy and avoided coercion [8]. Adolescent and youth programming remained a critical frontier, with research indicating that comprehensive sexuality education, supportive school and community environments, and confidential clinic access could delay first pregnancies and increase the likelihood of using modern contraception among young people, provided that interventions were developmentally appropriate, evidence-based, and respectful of family and cultural contexts. Policy environments and financing schemes shaped both the supply and demand for FP and thereby influenced unintended pregnancy outcomes; notably, public funding and affordable services were associated with higher contraceptive use and lower unintended pregnancy, whereas user fees, supply interruptions, or restrictive policies could impede access and worsen inequities; accountability mechanisms, performance incentives, and transparent governance for FP programs were critical to sustaining gains and ensuring that services met the needs of marginalized populations [9]. From a methodological standpoint, a growing portion of the conversation advocated for multilevel approaches that considered individual, interpersonal, community, and health system factors, recognizing that decisions about contraception were not made in a vacuum but were embedded within social networks and structural constraints; accordingly, interventions that combined high-quality counseling, a diverse method mix, supportive community norms, and resilient health systems tended to yield the largest and most durable reductions in unintended pregnancy [10]. In synthesizing global insights with local relevance, it was essential to acknowledge that context mattered: subnational variation in culture, governance, health infrastructure, and population dynamics meant that successful FP and unintended pregnancy reduction strategies required tailoring to local realities, including alignment with cultural values, engagement with trusted community leaders, and investment in data systems that could monitor disparities and guide adaptive management. Ultimately, the conversation converged on the conclusion that unintended pregnancies were largely preventable through comprehensive, rights-based, equity-focused FP programs that ensured universal access to a complete method mix, high-quality counseling, respectful and confidential care, and integrated service delivery within strong health systems, with sustained political commitment, predictable financing, and participatory, evidence-informed planning required to translate global lessons into tangible improvements for individuals, families and communities. Unmet need for family planning remained a persistent challenge across diverse settings, representing a gap between individuals’ reproductive intentions and their actual contraceptive use. Global evidence consistently showed that unmet need was shaped by a complex interplay of demand-side factors, supply-side barriers, and broader sociopolitical contexts, with far-reaching implications for maternal health, child outcomes, and gender equity. On the demand side, gaps in knowledge about contraception, misperceptions about fertility, fear of side effects, and concerns about privacy or stigma suppressed contraceptive demand even among individuals who wished to space or limit births. These cognitive and perceptual barriers were often intensified by low health literacy, limited exposure to comprehensive sexuality education, and cultural or religious beliefs that valorized larger families or discouraged the use of modern methods. In addition, partner dynamics and gender norms frequently restricted autonomous decision-making, as women depended on male approval or experienced coercive practices that discouraged the facilitation of contraception. Adolescents and unmarried individuals faced heightened barriers due to stigma, family surveillance, or concerns about community judgment, leading to higher unmet needs in these groups. On the supply side, access barriers such as stockouts of commodities, inconvenient clinic hours, geographic inaccessibility, and long wait times impeded the ability to translate intention into use. Quality-related factors-including perceived provider bias, insufficient counseling on method effectiveness and side effects, and lack of youth-friendly, confidential services-contributed to discontinuation or reluctance to initiate contraception, thereby sustaining unmet need. Financial barriers, including user fees or indirect costs (transport, time away from work or school), disproportionately affected rural, low-income, and marginalized populations, compounding existing inequities and limiting equitable access to a full method mix, including Long-Acting Reversible Contraceptives (LARCs), which often had higher upfront costs but lower long-term costs per pregnancy averted [9]. Health system constraints, such as weak supply chains, underdeveloped data systems, and limited integration of family planning with other health services, hampered continuity of care and the ability to reach those with unmet needs through multiple touchpoints. Integrated service delivery, when well-implemented, could reduce barriers by offering family planning within obstetric and postnatal care, HIV services, and primary health care, thereby normalizing use and expanding reach. However, it required coordinated governance, interoperable data, and workforce capacity to maintain quality across settings. Contextual factors, including urban-rural disparities, conflict and displacement, humanitarian crises, and migration patterns, influenced unmet needs by altering access, demand, and priority-setting within health systems, with crises often compounding vulnerabilities and disrupting supply chains while elevating the importance of adaptable, community-based strategies and resilience planning. Equity considerations were central to understanding unmet need, as marginalized groups-adolescents, unmarried women, people with disabilities, those living in poverty, and ethnic or religious minorities-often experienced higher levels of unmet need due to compounded barriers across demand and supply dimensions. Research emphasized the importance of rights-based, non-coercive approaches, community engagement, and targeted outreach to identify and address specific constraints faced by these populations [8]. Policies and financing played crucial roles; when governments committed to family planning as part of universal health coverage, provided subsidized or free services, and implemented supportive procurement and pricing strategies, unmet need tended to decline. In contrast, user fees, restrictive policies, or inconsistent funding perpetuated gaps in access and equity. Behavioural and social science perspectives contributed to understanding unmet need by highlighting how intentions interacted with social networks, cultural norms, and perceived behavioural control, which influenced both the desire to use contraception and the perceived feasibility of doing so. Thus, interventions that aligned with local norms while promoting autonomous choice-such as community mobilization, peer education, and mass media campaigns tailored to language and culture-were more likely to translate demand into sustained use. The role of adolescents and youth was particularly salient, given that early sexual initiation, limited access to confidential services, and school- or work-related constraints elevated unmet needs in younger populations. Comprehensive sexuality education, youth-friendly clinics, and non-judgmental counseling were critical components of strategies designed to reduce unmet needs among this group. Finally, the translation of evidence into action required robust monitoring and evaluation, participatory planning with communities, and accountability mechanisms to ensure that family planning programs responded to evolving needs, tracked progress toward reducing unmet needs, and addressed persistent inequities. Synthesizing these strands suggested that reducing unmet needs hinged on delivering a full method mix through affordable, accessible, high-quality, rights-based services; integrating family planning with related health and development sectors; implementing culturally sensitive, equity-focused outreach to marginalized populations; and maintaining resilient health systems supported by transparent financing and data-driven, participatory planning-an approach that held promise for minimizing unmet needs and advancing reproductive health and rights globally. Method mix and user preferences in family planning were central to understanding how individuals and couples translated reproductive intentions into actual use. Evidence consistently showed that a broad, well-matched method mix paired with informed, non-coercive counseling enhanced satisfaction, continuation, and overall reproductive health outcomes across diverse settings. At the global level, expanded access to a range of contraceptive options-from Long-Acting Reversible Contraceptives (LARCs) such as intrauterine devices and implants to short-acting methods like pills, injectables, patches, rings, condoms, and fertility-awareness-based approaches-enabled individuals to select methods that aligned with their life stage, health considerations, partner dynamics, and personal preferences, while reducing discontinuation driven by side effects or dissatisfaction [11,12]. Preferences for specific methods were shaped by a constellation of factors including effectiveness, convenience, cost, accessibility, side effect profiles, reversibility, and compatibility with sexual and reproductive life plans. Client-centred counseling that presented unbiased information about benefits, risks, and failure rates supported informed choice, but the quality and depth of counseling significantly influenced perceived and actual method satisfaction, continuation, and eventual switching when circumstances or preferences changed. Demographic and psychosocial factors, such as age, parity, prior contraception experience, education level, cultural norms, and gender dynamics, influenced method preference and uptake, with younger or nulliparous individuals sometimes favouring methods perceived as more discreet or controllable, while older individuals or those with children preferred longer-acting, maintenance-free options. However, preferences were not static and could evolve with life events, relationship changes, and shifts in health status, necessitating ongoing counseling and routine opportunities for method reassessment. The role of health systems in shaping method mix was multifaceted: procurement policies, supply chain reliability, and the affordability of different methods determined what options were realistically available to clients, while provider biases, knowledge gaps, and workload influenced which methods were emphasized during counseling, potentially limiting choice if certain methods were undersold or not offered due to personal beliefs or logistic constraints [13]. Equity considerations were critical when examining method mix; marginalized groups-such as adolescents, unmarried individuals, rural residents, and people with disabilities-faced barriers to accessing a full method mix, either because of cost, stigma, or provider reluctance to discuss certain options in culturally sensitive ways. This underscored the need for youth-friendly services, community outreach, and policies that ensured universal access to a complete range of contraceptives regardless of age, marital status, or geographic location. The conversation also highlighted the importance of method satisfaction and user experience; successful programs reported that when clients were engaged in shared decision-making, received personalized information, and had access to follow-up support for managing side effects or method failures, continuation rates improved and the likelihood of method switching in response to changing needs increased, contributing to more effective fertility planning and better health outcomes. In addition, the integration of family planning with other health services-such as antenatal and postnatal care, HIV services, and primary care-could influence method mix by normalizing contraception within routine care, reducing stigma associated with seeking family planning, and expanding opportunities for provider-initiated counseling and method provision at multiple touchpoints. This integrated approach supported the alignment of method choice with broader health goals and life-course needs. The available literature also recognized the potential and challenges of expanding method mix through innovations like self-care and user-controlled options, digital decision aids, and telehealth-based counseling, which could empower users to explore various methods privately and at their own pace. However, these innovations needed to address concerns about digital literacy, privacy, data security, and equitable access to avoid deepening disparities. Policy and financing structures played a pivotal role in shaping method mix availability; publicly funded procurement, subsidies, and removal of user fees generally correlated with broader method portfolios in use, while restrictive policies, inconsistent funding, or supply interruptions constrained the repertoire offered to clients, limiting autonomy and choice. Method preference increasingly emphasized patient-centered outcomes, including method satisfaction, perceived control, and alignment with life goals, recognizing that preferences were dynamic and culturally contextual. Thus, health services needed to implement routine preference elicitation, offer decision aids, and ensure that providers presented balanced information free from coercive insinuations or gendered expectations. Globally, the trend toward a complete, rights-based, and user-informed method mix aligned with the broader objectives of universal health coverage and reproductive autonomy, suggesting that programs yielding the strongest results were those that coupled a diverse method range with high-quality counseling, affordable access, and systems that supported ongoing client engagement, monitoring, and adaptation to evolving needs. Within subnational contexts, such as Bayelsa State in Nigeria, these principles translated into practical imperatives: ensuring equitable access to a full spectrum of methods across urban and rural facilities, addressing supply chain fragility to prevent stockouts of popular and low-cost options, training providers to competently counsel on all method options with attention to local cultural considerations, and actively engaging communities, youth, and men in conversations about preferences and autonomy to reduce barriers and stigma. The success of such efforts hinged on reliable funding, governance that prioritized reproductive health, and data-driven feedback loops that captured variation in method uptake and satisfaction across different populations, enabling targeted improvements while preserving informed choice. Sociocultural, economic, and logistical barriers and drivers of choices in family planning operated within an interconnected ecosystem, where individuals’ reproductive decisions were shaped by beliefs, resources, and access, yielding diverse patterns of uptake, continuation, and satisfaction with services across settings. On the sociocultural front, deeply held norms about fertility, gender roles, and motherhood influenced which contraceptive options were considered acceptable, who made decisions about timing and method choice, and how openly couples discussed family planning; in many contexts, expectations surrounding childbearing, family honor, religious prescriptions, and community surveillance could either constrain autonomy or motivate uptake when family planning was framed as compatible with social values and provided through trusted community channels. Stigma surrounding adolescent sexuality or unmarried pregnancy often suppressed knowledge-seeking and access to confidential services, while supportive cultural narratives that valued women’s health, maternal autonomy, and male involvement in joint decision-making enhanced demand and sustained use [14-16]; social networks, including peers, partners, parents, and religious leaders, frequently served as information conduits and legitimacy sources, shaping perceptions of method safety, reliability, and appropriateness for different life stages. Economic conditions profoundly affected affordability and choices; direct costs such as user fees, transport, and time away from work or caregiving responsibilities interacted with indirect costs to create real or perceived financial barriers, especially for low-income individuals and those in rural or informal sectors; conversely, programs that reduced out-of-pocket expenses, provided subsidies, or integrated family planning with broader social protection or maternal health services expanded access and enabled long-term planning; economic constraints also influenced method preference, as some individuals opted for low-cost, readily available options while others prioritized longer-acting methods that reduced ongoing costs and time commitments, provided they had credible information about efficacy, side effects, and reversibility [17]. Logistical barriers-such as stockouts, supply chain disruptions, clinic hours that did not align with work or school schedules, long travel distances, and wait times-directly impeded the ability to translate intention into action; these constraints were often more acute in rural, conflict-affected, or underserved urban areas, where health facility density was low and transportation infrastructure was weak; health system fragmentation, including lack of integration between family planning and other services, could create cumbersome patient pathways that deterred continued use and diminished opportunities for method switching when needs changed [18,19]. Conversely, drivers of choice emerged from improvements in service delivery quality, accessibility, and relevance; client-centered counseling that presented a full method mix, discussed side effects honestly, and supported shared decision-making enhanced satisfaction, persistence, and alignment with personal life plans; confidentiality and youth-friendly services reduced fears about stigma and inspection, encouraging adolescents and unmarried individuals to seek information and consider contraception discreetly; when family planning was offered through integrated platforms-such as maternal, newborn, and child health services, HIV services, or primary care-clients experienced fewer barriers to access, more touchpoints for information, and a more normalized view of contraception as part of routine health maintenance. The role of information and literacy was pivotal; accurate, comprehensible, and culturally tailored messaging about available methods, effectiveness, and potential adverse effects empowered choices and could counter misinformation, whereas misinformation and myths about fertility, hormonal risks, and long-term health consequences could entrench fears and deter utilization. Digital information channels, mobile reminders, and telehealth counseling held promise for expanding reach and supporting informed choices, although they had to be designed to avoid excluding those with limited digital access or low health literacy. Gender dynamics and power relations consistently appeared as central determinants; women’s autonomy to seek, select, and continue contraception was shaped by partner involvement, negotiation capacity, and potential coercive pressures, underscoring the need for gender-transformative approaches that promoted equitable decision-making while safeguarding voluntariness and informed consent; engaging men as supportive partners, promoting shared decision-making within couples, and addressing intimate partner violence proved potent strategies when implemented with sensitivity to context and without reinforcing gender hierarchies. Adolescents and young people constituted a particularly salient subgroup; their needs intersected with legal frameworks, education systems, and family norms, so programs that combined comprehensive sexuality education, confidential youth-friendly services, and safe environments for service utilization tended to improve knowledge, reduce delays in uptake, and support healthier reproductive trajectories, provided adolescents’ rights to privacy and informed choice were respected. The social determinants of health-education, employment, housing, and social capital-also shaped family planning choices; higher educational attainment often correlated with greater knowledge and empowerment to negotiate contraception, while precarious employment or unstable housing could constrain consistent access and adherence, highlighting the importance of multi-sectoral policies that integrated family planning with education, economic opportunity, and social protection [1,2,20]. Cultural adaptation proved essential for program effectiveness; interventions that resonated with local beliefs, used credible messengers, and involved community leaders could reduce resistance and build trust, whereas misaligned messaging risked backlash and perceived normative intrusion; thus, participatory planning and ongoing community feedback were critical to align family planning services with values while preserving rights-based principles. Supply-side innovations, including task-shifting, provider training, and commodity security improvements, could expand the feasible method mix and improve counseling quality, particularly in resource-constrained settings; however, sustainable impact required stable funding, accountability, and capacity development to maintain quality and equity over time. Finally, monitoring and evaluation played a crucial role in understanding barriers and drivers across populations; disaggregated data by age, gender, residence, education, and socioeconomic status, along with qualitative investigations into local beliefs and experiences, illuminated how sociocultural, economic, and logistical factors interacted to shape choices and outcomes, enabling policymakers and practitioners to tailor interventions that were respectful, effective, and scalable. In summation, decisions about family planning were seldom determined by several factors; they emerged from the dynamic interplay of sociocultural norms, economic realities, and logistical capabilities, requiring holistic, rights-based, and context-responsive approaches that addressed all three dimensions simultaneously to expand informed choice, reduce unmet need, and strengthen reproductive health and equity across diverse populations [21]. 

Statement of Problem 

In Bayelsa State, the determinants of family planning method mix were marked by a complex interplay of barriers, preferences, and drivers that influenced individuals' and couples' reproductive choices. Despite the acknowledged importance of family planning in improving maternal and child health outcomes, significant challenges persisted. Access to a diverse range of contraceptive methods was hindered by sociocultural norms, economic constraints, and logistical barriers, which collectively contributed to a high level of unmet need for family planning services. Historically, sociocultural factors such as deeply ingrained beliefs about gender roles and family size, as well as stigma surrounding contraceptive use, particularly among adolescents and unmarried individuals, restricted open discussions about family planning. These norms often dictated who had the agency to make decisions regarding reproductive health, thereby limiting women's autonomy and perpetuating gender inequalities. Economically, many residents faced financial barriers that impeded access to family planning services. User fees, transportation costs, and the indirect expenses associated with seeking care created significant obstacles, particularly for those in rural and underserved areas. The lack of affordable, high-quality family planning services further exacerbated these issues, leaving many individuals unable to act on their reproductive intentions. Logistical challenges, including stockouts of contraceptive supplies, inconvenient clinic hours, and geographic inaccessibility, compounded the difficulties in obtaining desired methods of contraception. The fragmentation of health services and the inadequate integration of family planning into broader health programs further limited opportunities for individuals to access comprehensive care. As a result of these intertwined barriers, preferences for specific family planning methods often remained unfulfilled, leading to inconsistent contraceptive use and ultimately contributing to higher rates of unintended pregnancies in the region. Consequently, understanding the determinants of family planning method mix in Bayelsa State was crucial for developing effective, context-sensitive strategies that could enhance access, satisfaction, and overall reproductive health outcomes for the population.

General Objective 

To investigate the determinants of family planning method mix in Bayelsa State, with a focus on understanding the barriers, preferences, and drivers of choices among individuals and couples regarding family planning services.

Specific Objectives 

1. To identify and analyze the sociocultural, economic, and logistical barriers that inhibit access to a comprehensive family planning method mix in Bayelsa State.
2. To examine preferences for different family planning methods among diverse demographic groups, including adolescents, married couples, and unmarried individuals, and how these preferences influence their contraceptive choices.
3. To determine the key drivers that influence the decision-making process regarding family planning methods, including individual knowledge, partner dynamics, and community norms.
4. To evaluate the impact of counseling quality, confidentiality, and service accessibility on the uptake and continuation of various family planning methods.
5. To assess the level of knowledge and awareness of family planning methods among different populations and identify gaps that might hinder informed decision-making.
6. To propose evidence-based recommendations for improving family planning service delivery, addressing identified barriers, and enhancing users’ satisfaction with the available methods in Bayelsa State.

Significance of the Study 

The significance of this study laid in its potential to address critical gaps in knowledge and practice related to family planning within the unique sociocultural and economic context of Bayelsa State. With a youthful and rapidly growing population, Bayelsa faced pressing challenges associated with high fertility rates and unintended pregnancies that could adversely affect maternal and child health outcomes, educational attainment, and economic development. By investigating the specific barriers that individuals and couples encountered when seeking family planning services, as well as their preferences and the factors that drove their choices, this study aimed to provide a nuanced understanding of the local dynamics influencing contraceptive uptake and method satisfaction. Given Bayelsa's diverse cultural landscape, where traditional beliefs and gender norms often intersected with modern family planning practices, this study would significantly contributed to the body of knowledge in the state. The study offered insights into how sociocultural attitudes, economic constraints, and logistical barriers shaped reproductive choices, thereby informing the development of targeted, culturally sensitive interventions that enhanced access to a comprehensive method mix. Furthermore, the findings were instrumental for policymakers, healthcare providers, and community leaders in designing effective family planning programs that responded to the specific needs of Bayelsa's diverse populations, particularly marginalized groups such as adolescents and unmarried individuals, who frequently faced heightened stigma and access challenges. Ultimately, this research advanced academic discourse on family planning in Nigeria and served as a valuable resource for fostering informed decision-making, enhancing service delivery, and promoting reproductive health equity in Bayelsa State.

Scope and Limitation of the Study 

Scope of Study: The scope of this study focused on the determinants of the family planning method mix in Bayelsa State, Nigeria. Specifically, it aimed to explore the barriers, preferences, and drivers of choice that influenced contraceptive method selection among women of reproductive age. This study encompassed the following: 

Target Population: The research involved current users of family planning methods, including various demographic groups such as adolescents, married, and unmarried women in Bayelsa State. 

Data Collection Methods: This study employed a mixed-methods approach, utilizing cross-sectional surveys to gather qualitative data on family planning practices. 

Focus Areas 

• The current distribution and prevalence of various family planning methods utilized in the state, including long-acting reversible contraceptives (LARCs), short-acting methods, and permanent solutions, were examined.
• Sociodemographic factors that influenced contraceptive choices included age, education level, marital status, and socioeconomic status.
• Identification of barriers to accessing family planning services, including cultural beliefs, stigma, economic challenges, and logistical issues.
• Exploration of personal preferences regarding family planning methods, including perceptions of effectiveness, safety, and convenience.

The role of healthcare providers and community attitudes in shaping the method mix of family planning options available in Bayelsa State.

Limitations of the Study

While this study aimed to provide valuable insights into the family planning method mix in Bayelsa State, certain limitations affected the outcomes. 

Sample Size and Representativeness: The findings were limited by the sample size and participants selection. If the sample was not representative of the broader population, the results might not have accurately reflected the contraceptive preferences and barriers experienced by all women in the state. 

Self-Reported Data: The reliance on self-reported data might have introduced biases, as participants might have underreported or overreported their use of family planning methods due to social desirability or stigma associated with certain methods. 

Cultural Sensitivity: Given the cultural context of Bayelsa State, sensitive topics such as family planning might have led to reluctance among participants to share their true opinions or experiences, potentially affecting the depth and authenticity of the qualitative data collected. 

Temporal Context: Changes in political, economic, or health system dynamics over time might have influenced family planning practices. Therefore, the study's findings might have been limited to the specific time frame of data collection and might not have accounted for future developments or shifts in attitudes. 

Healthcare Infrastructure Variability: The availability and accessibility of family planning services might have varied significantly across different locations in Bayelsa State. This variability might have impacted the generalizability of the findings to the entire state. 

Focus on Women: While the study primarily targeted women of reproductive age, it might have overlooked the perspectives of male partners and other stakeholders who played a crucial role in family planning decisions. 

Resource Constraints: Limited funding and resources might have restricted the breadth of data collection methods or the geographical coverage of the study, potentially affecting the comprehensiveness of the findings.

By acknowledging these limitations, this study aimed to provide a nuanced understanding of the family planning method mix in Bayelsa State while recognizing the contextual factors that might have influenced the results.

Study Design 

The study on the determinants of family planning method mix in Bayelsa State employed a cross-sectional design, utilizing quantitative research methods to gather comprehensive data on the barriers, preferences, and drivers of contraceptive choices among women of reproductive age. This approach allowed for a thorough exploration of the factors influencing family planning behaviours within the unique sociocultural context of Bayelsa State. 

Cross-Sectional Survey 

Target Population: The primary target population comprised women of reproductive age (15-49 years), including current users of family planning methods. The sample was stratified based on key demographic factors, such as age, marital status, education level, and socioeconomic status, to ensure representation across diverse subgroups. 

Sample Size: A statistically significant sample size was determined using power analysis, considering the prevalence of contraceptive use and the desired level of precision for the study. 

Data Collection Tools: Structured questionnaires were developed, incorporating validated instruments to measure. 

• Current contraceptive methods used and the distribution of these methods among current users.
• Sociodemographic factors influencing the method choice.
• Barriers to accessing family planning services, including economic, cultural, and logistical impediments.
• Personal preferences regarding the effectiveness, safety, and convenience of different methods.
• Perceptions of method switching. 

Data Analysis: Quantitative data were analyzed using statistical software such as SPSS version 23 and Microsoft Excel XLMiner Analysis ToolPak to perform descriptive and inferential analyses of the data. Frequencies, means, and chi-square tests were conducted to identify significant associations between demographic factors and contraceptive method preferences. Logistic regression was used as predictors of key FP methods outcomes. 

Study Area 

Bayelsa State, located in the southern region of Nigeria, was characterized by its unique geographical, cultural, and socio-economic landscape, which played a significant role in shaping the family planning method mix of its residents. Established in 1996, Bayelsa was predominantly inhabited by the Ijaw ethnic group, alongside other ethnic communities, contributing to a rich cultural tapestry that influenced social norms and reproductive health behaviours. Bayelsa State was situated in the Niger Delta region, bordered by the Atlantic Ocean to the south, and was characterized by a network of rivers and wetlands. This geographical setting presented both opportunities and challenges for healthcare delivery, particularly in accessing family planning services. The state's extensive riverine areas often hindered transportation and logistics, complicating the distribution of contraceptive methods and access to health facilities. Consequently, residents, especially in rural areas, faced significant barriers in obtaining family planning services, which led to a reliance on traditional methods and a skewed method mix. The population of Bayelsa State was diverse, with a significant proportion of young people and women of reproductive age. According to recent demographic data, a considerable number of women in this age group expressed a desire to prevent unintended pregnancies, yet many remained underserved due to a lack of access to modern contraceptive options. The demographic characteristics in Bayelsa, including age, education level, marital status, and socioeconomic status, played a crucial role in influencing family planning preferences and choices. Cultural beliefs and practices were deeply entrenched in the social fabric of Bayelsa State. Traditional views regarding family size often equated larger families with status and wealth, which discouraged the acceptance of modern contraceptive methods. Furthermore, gender roles restricted women’s autonomy in making decisions about their reproductive health, as societal norms often prioritized male authority in family planning discussions. Stigma associated with contraceptive use, particularly for methods perceived as invasive, such as Long-Acting Reversible Contraceptives (LARCs), further complicated the acceptance and uptake of family planning services. Economically, Bayelsa State faced challenges typical of many regions in Nigeria, including high poverty rates and limited financial resources. Economic constraints significantly impacted individuals' ability to access family planning services, as the cost of contraceptives, transportation to health facilities, and hidden fees deterred usage. Additionally, in times of economic hardship, families often prioritized immediate survival needs over long-term family planning goals, leading to increased rates of unintended pregnancies. The healthcare infrastructure in Bayelsa State, while improving, presented ongoing challenges for family planning service delivery. Primary healthcare centres served as the main points of access for contraceptive services. However, inconsistencies in the availability of contraceptive supplies, inadequate healthcare provider training, and logistical barriers severely limited the effectiveness of family planning programs. In crisis-affected eras such as the perennial flooding or during periods of social instability, these challenges became even more pronounced, further exacerbating the unmet need for contraception. Understanding the dynamics of Bayelsa State was essential for investigating the determinants of family planning method mix. The interplay of geographical, demographic, socio-cultural, economic, and healthcare infrastructure factors shaped the reproductive health landscape, influencing individuals' choices and access to family planning services. By exploring these dimensions, the study aimed to provide insights that could inform targeted interventions and policies to enhance family planning services, improve contraceptive uptake, and ultimately empower individuals to make informed reproductive choices in Bayelsa State. 

Study Population 

The study population for this research on the determinants of family planning method mix in Bayelsa State, Nigeria, encompassed a diverse group of individuals, primarily focusing on women of reproductive age, as well as key influencers within the community. Understanding the characteristics and dynamics of this population was essential for capturing a comprehensive view of family planning behaviours, preferences, barriers, and drivers of choice. 

Women of Reproductive Age: The primary focus was on women aged 15-49 years, as this group was most directly affected by family planning policies and practices. Within this demographic, the study further segmented participants based on. 

Age: Young adults (15-24), adults (25-34), and older women (35-49) to analyze differences in contraceptive preferences and behaviours. 

Marital Status: Including single, married, separated, divorced, and widowed women to understand how relationship status influenced family planning choices. 

Educational Level: Assessing women with varying levels of education-from no formal education to higher education-to explore how education impacted knowledge, attitudes, and access to family planning methods. 

Youth: Young individuals, particularly those aged 15-24, were included as a distinct group to understand their unique perspectives on family planning. This group often had different needs and challenges compared to older demographics, making their input vital for developing targeted interventions. 

Healthcare Providers: The study involved healthcare providers, including those working in primary health centres. Their insights into the availability of contraceptive methods, counseling practices, and barriers faced in providing family planning services were essential for understanding the health system's role in shaping the method mix. 

Community Leaders: Engaging influential community leaders and local stakeholders was important, as they could influence cultural attitudes and perceptions surrounding family planning. Their involvement provided valuable insights into the social fabric of the community and how it shaped reproductive health behaviours. 

Current Users and Non-Users of Family Planning Methods: The study differentiated between individuals who were currently using family planning methods and those who were not. This distinction was crucial for identifying barriers to access and understanding the motivations behind method choices. 

The study population for this research was characterized by its diversity, encompassing women of reproductive age, youth, healthcare providers, and community leaders in Bayelsa State. By understanding the unique perspectives and experiences of these groups, the study aimed to provide comprehensive insights into the determinants of family planning method mix, ultimately contributing to more effective family planning interventions tailored to the local context. 

Sample Size Determination 

To ensure the study on the determinants of family planning method mix in Bayelsa State was adequately powered and representative of the target population, a systematic approach for sample size determination was employed. The following factors were considered in calculating the sample size. 

Prevalence Rate: Previous studies in similar contexts indicated varying contraceptive prevalence rates ranging from 4% to 36.8% [22-24]. For the purpose of this calculation, a conservative estimate of a 36.8% prevalence rate was used. 

Confidence Level: A confidence level of 95% was commonly used. This corresponds to a Z-value of 1.96.

Margin of Error: A margin of error of 5% was chosen to balance precision with practical considerations of resource availability.

Using the sample size formula for proportions:

n= Z² x p(1-p) /E²

Where:

 n = required sample size

 Z = Z-value (1.96 for 95% confidence)

p = estimated prevalence (0.30)

E = margin of error (0.05)

Substituting the values into the formula:

n =          (1.96)² x 0.368 (1-0.368) / (0.05)²

n =          (3.842) x (0.368) x (0.632) / 0.0025

n =          0.894/ 0.0025 = 357.6

n =          357.6 ≈ 358

Rounding up the figures, the minimum sample size required was approximately 358 women of reproductive age. To account for potential non-responses and to ensure adequate representation across different demographic segments, a 20% increase was added to the sample size. 

Additional sample = 358 + (0.2 x 358) = 358 + 71.6 = 429.6 ≈ 430 

Thus, a total sample size of approximately 430 women of reproductive age was targeted for the study.

Sampling Technique 

Stratified Sampling: To ensure representation across various demographic groups, stratified sampling was utilized. The population was divided into strata based on age, marital status, education level, and geographic location. This approach allowed for a more nuanced analysis of the factors influencing family planning method mix.

Selection Criteria

Inclusion Criteria 

1. Women aged 15-49 years who resided in Bayelsa State during the study period were included in the study.
2. Participants who were current users of family planning methods, including long-acting reversible contraceptives (LARCs), short-acting methods, and permanent solutions, were included.
3. Women who expressed a willingness to provide informed consent to participate in the study were included.
4. Healthcare providers working in primary health centres or family planning services in Bayelsa State who consented to participate were included.
5. Community leaders and local stakeholders who had a significant influence on reproductive health attitudes and practices in the community and were willing to participate were included.
6. Young individuals aged 15-24 years who were willing to share their perspectives on family planning were included. 

Exclusion Criteria 

1. Women outside the age range of 15-49 years were excluded from the study.
2. Individuals who did not reside in Bayelsa State during the study period were excluded.
3. Participants who were not willing to provide informed consent were excluded.
4. Healthcare providers not actively involved in family planning services or who did not consent to participate were excluded.
5. Community leaders and local stakeholders who were unwilling to share their insights or participate in discussions were excluded.
6. Individuals who had previously participated in pilot studies or preparatory phases for the research were excluded to avoid overlap and bias.

Method of Data Collection

Quantitative Data Collection 

Structured Questionnaires: Trained data collectors administered structured questionnaires to participants in the selected strata. The questionnaires encompassed questions on demographic information, contraceptive methods currently in use, barriers to access, and preferences regarding family planning.

Pre-Testing 

Validity Test: The validity of the research instrument was assessed prior to its deployment in Bayelsa State. This involved conducting a pre-testing phase in selected communities that were not included in the main study. During this phase, a panel of experts in reproductive health and family planning reviewed the questionnaire to ensure that the items accurately represented the constructs of interest. The experts provided feedback on the clarity, relevance, and comprehensiveness of the questions. Subsequently, the instrument was administered to a small sample of participants from these selected communities to evaluate its content validity. Participants were asked to provide feedback on their understanding of the questions and the relevance of the items to their experiences regarding family planning. The responses were analyzed to identify any ambiguities or inconsistencies in the questions. Adjustments were made based on the feedback received, enhancing the instrument's ability to capture the intended data accurately and effectively.

Reliability Test: To assess the reliability of the instrument, a pilot study was conducted within the same selected communities prior to the main data collection phase. The instrument was administered to a sample of respondents, and the consistency of their responses was evaluated using Cronbach's alpha coefficient. This statistical measure was employed to determine the internal consistency of the items within the questionnaire. The results from the pilot study indicated a Cronbach's alpha value above the acceptable threshold of 0.7, suggesting a high level of reliability for the instrument. To further ensure reliability, the questionnaire was re-administered to the same participants after a two-week interval to test for test-retest reliability. The correlation between the two sets of responses was calculated, confirming that the instrument produced stable and consistent results over time.

Based on the findings from both the validity and reliability tests, the instrument was deemed appropriate for use in the main study in Bayelsa State, ensuring that it effectively captured the determinants of family planning method mix in the target population.

Data Management and Analysis 

The data analysis for the study on the determinants of family planning method mix in Bayelsa State employed a mixed-methods approach, integrating quantitative data analyses across different FP users to provide a comprehensive understanding of the barriers, preferences, and drivers of contraceptive choices. The following sections outline the specific methodologies for each component of the analysis:

Quantitative Data Analysis 

Descriptive Statistics: Descriptive statistics were calculated to summarize the demographic information of the participants, including age, marital status, education level, and socioeconomic status. Frequencies, means, medians, and standard deviations will be reported as appropriate. 

Contraceptive Method Usage: The distribution of various family planning methods utilized by participants were analyzed, including long-acting reversible contraceptives (LARCs), short-acting methods, and permanent solutions. 

Inferential Statistics: Chi-square tests were conducted to examine associations between demographic factors (e.g., age, marital status, education) and contraceptive method preferences. This helped in identifying significant relationships that influenced the choices of family planning methods. 

T-tests/ANOVA: T-tests or ANOVA were used to compare means between groups (e.g., between users and non-users of specific contraceptive methods) in terms of knowledge, attitudes, and perceived barriers to access. 

Logistic Regression Analysis: Logistic regression was deployed to assess the influence of multiple independent variables (sociocultural, economic, and logistical factors) on the likelihood of getting satisfaction on specific family planning methods users. This analysis helped in identifying key predictors of contraceptive usage and preferences. 

Timeline for the study 

Research Planning and Proposal: The research planning and proposal phase commenced in June 2025. During this period, the study objectives, methodology, and research instruments were developed and finalized. By the end of June, the proposal was prepared for submission. 

Ethical Approval: In July 2025, the team submitted the proposal to the relevant ethics committee for approval. Following the submission, the research team addressed any feedback and queries from the committee. Ethical approval was successfully obtained by mid-July. 

Data Collection Preparation: In August 2025, preparations for data collection were undertaken. This involved training data collectors, finalizing data collection tools, and establishing partnerships with local healthcare providers and community leaders to facilitate access to participants. 

Data Collection: The actual data collection phase took place from September to October 2025. During this period, surveys and interviews were conducted across various demographic groups in Bayelsa State, ensuring comprehensive coverage of the target population. 

Report Writing and Publication: In November 2025, the research team focused on report writing. The analysis of the collected data was completed, and the findings were compiled into a comprehensive report. The final report was prepared for publication by the end of November. 

Ethical Considerations 

Institutional Consent: Ethical approval for the study was obtained from the Ethics Committee, Bayelsa State Primary Healthcare Board with the approval number "PHCB/AD/126/Vol.1/p.34." This ensured that the research adhered to ethical standards and guidelines for conducting studies involving human participants. 

Community Consent: Before commencing the research, community consent was sought through engagement with local leaders and stakeholders. Informational sessions were held to discuss the study's objectives, significance, and potential benefits to the community. This approach fostered trust and transparency, allowing community members to voice their concerns and opinions regarding the research. The community's endorsement was essential to ensure cultural sensitivity and appropriateness in the implementation of the study. 

Individual Consent: Individual consent was obtained from all participants prior to their involvement in the study. Participants were provided with comprehensive information about the purpose of the research, the nature of their participation, and their rights, including the right to withdraw at any time without consequence. Consent forms were distributed, and participants confirmed their understanding of the study's implications before signing. This process respected participants' autonomy and ensured that their involvement was entirely voluntary.  

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