Using Theory of Planned Behaviour to Assess the Determinants of Uptake of Modern Family Planning among Women of Reproductive Age in Rural Settings of Morogoro, Tanzania; A Cross-Sectional Study.

Abstract

Background: Modern family planning is considered one of the most cost-effective health intervention to improve the well-being of women and newborns. Little is known about the influence of the theory of planned behaviour on the uptake of modern family planning. Therefore, the study aims to address the existing gap in using the theory of planned behaviour to explain the uptake of modern family planning in rural settings of Morogoro, Tanzania.

Methods: The community-based analytical cross-sectional study was conducted at Malinyi District in rural Morogoro, in June to July 2022. A multistage sampling technique was used to select 421 women of reproductive age. A structured questionnaire adapted from previous studies was used as the data collection tool. The determinants for the uptake of modern family planning were analyzed using bivariable and multivariable binary logistic regression model. The final results, which were statistically significant from the regression analysis model were presented using Adjusted Odd's Ratio (AOR), Confidence Interval (95% CI), and p-value <.05.

Results: The majority of women of reproductive age, 328 (78%), were using modern family planning methods, with more than half of respondents (54.1%) using implants. Depo Provera (29.1%) and the pill (14.4%) were the second and third most frequently used methods. Only 4.9% reported IUCD and 2.8% condom use. The majority of the women, 342 (81%), had a positive attitude, positive subjective norms 289 (68.6%), positive perceived behaviour control 388 (92%), and high intention on uptake of modern family planning 61 (85.7%). The women with a positive attitude on modern family planning uptake (AOR 2.307: 95% CI, 1.243 to 4.281) and positive perceived Behavioural control (AOR 6.015: 95% CI; 0.017 to 2.569) were more likely to be significantly associated with increased uptake of modern family planning. Those with high intention on uptake of modern family planning (AOR 0.038; 95% CI; 0.018 to 0.080) were less likely to be significantly associated with increased uptake of modern family planning.

Conclusion: Positive attitude and high perceived behavioural control have a direct positive effect on the uptake of modern family planning. The family planning education-based programs could be offered to the community, particularly in rural areas, to maximise the community awareness and uptake of modern family planning. The theory of planned behaviour could predict intention to use but not the actual utilisation of modern family planning. A combination of theoretical models may be required to understand additional external elements that may influence the utilisation of modern family planning.