*2.2.2.1 Barrier method*

In addition to its roles in birth control, barrier methods like male condoms are an effective means of preventing sexually transmitted infections such as HIV/AIDs and other ills. They act by creating a barrier between the male spermatozoa and the female ova and therefore prevent fertilization. During sexual intercourse, barrier methods reduce the exposure of both individuals to sexually transmitted infection [4]. Examples of this method include the male and female condom, cervical caps, and diaphragm.

## *2.2.2.2 Hormonal methods*

Hormonal contraception (HC), also known as "the pill", are currently made up of either estrogen-progestin combinations or progestins alone. Ongoing research to add to this group of contraceptives have focused on the "antiprogestins", more precisely called selective progesterone receptor modulators (SPRM) [7]. This group of contraceptives were originally administered in the form of daily pills, but in recent times, seven different routes of administration have been developed which include: intramuscularly, intranasally, intrauterus, intravaginally, orally, subcutaneously, and transdermally [7]. Common example of this group of contraception are: oral pills, implant, IUD with progestin, injectables like depo-provera, vaginal rings, and skin patch [8].

#### *2.2.2.3 Emergency post-coital contraceptives*

This form of contraceptives is not recommended to be the first line of contraceptives for any user. This form of contraception refers to the use of a drug or device to prevent pregnancy after unprotected sexual intercourse. Estimate reveals that the expected risk of pregnancy after unprotected intercourse without emergency contraceptive use is 5.6% [9]. Examples of this form of contraceptives include emergency contraceptive pills (combined and progesterone-only), Copper T380 IUD, Levonorgestrel (Plan B), and ulipristal acetate (Ella).

#### *2.2.2.4 Long-acting reversible contraceptives*

Long-acting reversely contraceptives are a group anti-fertility that provide effective contraception that provides extended period without requiring user action. They include injections, intrauterine devices, and subdermal contraceptive implants. They are the most effective reversible methods of contraception because their efficacy is not reliant on patient compliance. Long-acting reversible contraceptives include IUDs and the subdermal implant such as:


### *2.2.2.5 Permanent method of contraception*

Sterilization is considered an elective permanent method of contraception. Although both female and male sterilization procedures can be reversed surgically, the surgery is technically more difficult than the original procedure and the success rate is often low. Vasectomy (male sterilization) and tubectomy (female sterilization) are the two common forms of permanent methods of contraception. Hysterectomy is a form of the permanent method of contraceptive which is not commonly practiced among women.

#### **2.3 Trends in contraceptive use**

Trends in contraceptive use have been shown to vary between developed and developing nations, across nations, and within nations. The United Nations (2015) report on trends in contraceptive use showed that contraceptives are used by majority of women of reproductive age group in almost all regions of the world [10]. In 2015, 64% of women of reproductive age worldwide who are either married or in a union were using some form of contraception. However, the report showed that contraceptive use was much lower in the least developed countries with an estimate of 40.0% with the Africa continent having the lowest estimated at 33.0%. Among the other major geographic areas, contraceptive use was much higher, ranging from 59% in Oceania to 75% in Northern America [10]. Furthermore, the report revealed that globally, an estimated 12.0% of married or in-union women have an unmet need for contraceptives [10]. This implies that they wanted to stop or delay childbearing but was not using any method of contraception with the highest figure (22.0%) recorded among the least developed countries [10]. Most of the countries with high unmet needs for contraceptives are in sub-Saharan Africa estimated at 24.0% which doubles the global average in 2015 [10]. In Nigeria, estimates from the National Population Commission revealed that only 14.5% of women use modern contraceptive methods [11]. Paul [12] noted that over 83% of women were not using any form of contraceptives in 2018 with a geographical variation within the country. Yobe State in North East Nigeria has the highest number of women (98.1%) who do not use contraceptives while Lagos State in South West Nigeria had the least number of women (50.6%) who do not use contraceptives [12].

## **2.4 Benefits of contraception**

Contraception is one of the most effective public health interventions of the twenty-first century which is highly needed more than before, especially with the ever-increasing human population and the increase in crime rates. A well-planned pregnancy often enables couples to be able to give the best to their children for them to be productive to the family and the society at large. Thus, contraceptives help in the prevention of unwanted pregnancies among couples and therefore promote planned family size and time of birth for improved reproductive wellbeing of the women. Some contraceptives such as the make condom in addition to prevention of pregnancy are also beneficial in the reduction of sexually transmitted infections such as HIV/AIDs and syphilis. They indirectly reduce the burden of infertility through the prevention of infertility secondary to complications of sexually transmitted infections and abortions conducted with crude instruments in clandestine places by unskilled

*Scaling up Contraception through Social and Behavior Change Intervention in Low… DOI: http://dx.doi.org/10.5772/intechopen.104207*

personnel. Voluntary family planning practices include the promotion of maternal and child health, human right, population and development, and environmental sustainability and development of a nation. These benefits are clearly exemplified in the developed nations unlike in most low and middle-income countries which are yet to maximize the benefits of contraceptives in their society.

#### **2.5 Factors influencing contraceptive use in low and middle-income countries**

Despite efforts and availability of contraceptives in low and middle-income countries, uptake continues to be low as a result of several barriers. These barriers can be grouped into client and health services related.

Akamike et al. [13] in their systematic review of literature observed that clientrelated include the desire for more children, partner disapproval of contraceptive use, religious and culture bias, educational qualification of women, lack of knowledge on contraceptives, and wealth index [13]. Health service-related factors are poor access to contraceptive services, inability to procure modern contraceptive methods and stockouts of modern contraceptives methods [14].

### *2.5.1 Client related factors*

## *2.5.1.1 Desire for more children*

The desire for large family size is often one of the reasons for refusal of contraceptive use. Couples often ensure continuous procreation and avoid the use of contraceptives until they attain the purported family size they want to actualize [15]. This trend has accounted for high family size of up to 7 above in some regions of low and middleincome countries like Nigeria. This is unlike in regions that prefer a small family size. Despite the need for large family size, couples tend to desire or use contraceptive methods [16].

#### *2.5.1.2 Partner disapproval*

Despite the willingness of some women to use contraceptives, partner disapproval and abuse of the right of women continue to negate against the use of contraceptives in low and middle-income countries like Nigeria. Women who desire to delay or limit births often experience strong disapproval and warning from their spouses against the use of contraceptives [17]. They may experience abuse following the discovery of their use of contraceptives without knowledge and approval by their partner.
