Barriers to Reproductive Autonomy: Understanding Family Planning Access and Choice Among Women of Reproductive Age in Osun State, Nigeria

Barriers to Reproductive Autonomy: Understanding Family Planning Access and Choice Among Women of Reproductive Age in Osun State, Nigeria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Barriers to Reproductive Autonomy: Understanding Family Planning Access and Choice Among Women of Reproductive Age in Osun State, Nigeria Iyanu Adufe, Cassandra Akinde, Samson Olagoke Oladoye This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8473968/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Despite significant efforts to expand access to family planning services, women still encounter obstacles to practicing reproductive autonomy in Nigeria. The achievement of universal access to reproductive health care requires recognition and comprehensive understanding of the multifaceted factors that undermine women’s ability to make informed reproductive decisions. Methods This qualitative research investigated the experiences, perceptions and issues of family planning access and choice by the women in Osun state, Nigeria. Focus group discussions and in-depth interviews (IDIs) were used in this study. A sample of 25 women in the reproductive age was chosen in Osogbo, Olorunda and Egbedore Local Government Areas. Audio tapes were made of interviews, transcribed, translated thematically and analyzed. Themes and subthemes were created and they were supplemented with illustrative quotes. Results There were five themes, which included - Knowledge of family planning and Autonomy; Attitudes towards family planning; Reproductive Autonomy; Barriers to family planning; and Recommendations for Improving Reproductive Autonomy. Results indicated that the level of awareness regarding family planning was high, but misconceptions and sociocultural constraints were limiting adoption. Dominance by partners, religious and cultural values, and other health system issues also limited the reproductive options. Women realized that they needed community education to be inclusive, spouse support, and quality services. Conclusion Intersecting individual, socio-cultural, and systemic factors influence women to have reproductive autonomy in Osun State. The interventions should be aimed at education, male participation, and health system empowerment to make sure that there is an equal access to family planning and reproductive rights. Reproductive autonomy Family planning Women’s health Contraceptive use Nigeria Gender norms INTRODUCTION Reproductive autonomy refers to the ability of individuals to make informed and voluntary choices about their reproductive health; an essential human right and one of the pillars of women's empowerment ( 1 ). It covers the right to make responsible decisions about the number, timing, and spacing of their children, to obtain information and means of implementing their choices without being forced, discriminated, or subjected to violence ( 2 ). Reproductive autonomy is necessary to ensure gender equality and better maternal and child health outcomes, but in most low and middle-income countries, it remains largely a facade ( 3 – 4 ). The issues of reproductive autonomy are even more acute in Nigeria, as the high fertility level, low prevalence rate of contraceptives, and one of the highest maternal mortality ratios in the world of 512 maternal deaths in 100,000 live births. This is still a challenge as the Nigeria Demographic and Health Survey (NDHS) also confirms its existence among the population ( 5 – 6 ). Although the level of awareness of family planning (FP) methods is high among sexually active unmarried [98%] and married [94%] women, contemporary contraceptive use is dismally low [19%] ( 7 ). This gap between theory and practice highlights a more profound structural and cultural issue, indicating that these impediments go beyond awareness to actions, social norms, and access. Despite government initiatives to enhance the maternal and reproductive health outcomes, the adoption of modern FP services is suboptimal ( 8 ). Lack of reproductive autonomy, gender inequality, socio-cultural, and economic deprivation are some of the issues that render females unable to gain control over their fertility ( 9 ). Sociocultural environment of Nigerian societies is mostly inclined towards the elucidation of the masculine supremacy of the reproductive options, thus, making contraception either morally controversial or unnecessary, particularly in marriage ( 10 ). Women have more challenges in their reproductive choices due to cultural and religious pressures. Religious explanations can influence the position of contraception in most societies, where it is occasionally viewed as tampering with the will of God ( 11 ). Similarly, the tradition of having a big family size or emphasis on kids (male) continues to exacerbate the pressure against contraceptive use. These are the forces that limit women in their activities, particularly in patriarchal families where decision-making concerning reproduction is normally dominated by the male partners or significant others. All these are made more difficult by the economic factors where poverty is known to limit access to contraceptives or traveling to healthcare facilities, as well as the healthcare service delivery system constraining access ( 12 ). FP and reproductive autonomy have a high level of interrelation. FP is a public health intervention that is vital and also a significant practice of autonomy and reproductive rights ( 12 ). By making reproductive choices, women have a higher chance to pursue education, participate actively in strengthening the economy and national development ( 13 ). Evidence indicates that enhanced reproductive autonomy results in a decline in unwanted pregnancies, unsafe abortion, and maternal deaths ( 14 ). On the other hand, when women are limited in their autonomy, they may become vulnerable to reproductive coercion, high-risk pregnancy, and poverty cycles. FP in the world is among the most cost-effective strategies of public health in reducing maternal and infant mortality ( 15 ). However, in sub-Saharan Africa, Nigeria, being no exception, the gender norms and structural injustices still inhibit the reproductive freedom of women ( 16 ). The prevailing common themes in the literature have always been socio-cultural resistance, religious constraints, insufficient participation of men, fear of side effects, inaccessible quality services, and bias by the health care providing personnel as some of the major factors that discourage the use of birth control ( 17 – 18 ). All these combine to bring about a scenario where knowledge fails to translate to action, and decision fails to mean independence. Nigeria has many barriers to reproductive autonomy; these cut across individual, household, community, and institutional levels. On an individual level, the adverse factors to uptake include myths and misconceptions about contraception, fear of infertility, and absence of spousal support. The problem of contraception and fertility has been preconditioned on the community level by patriarchal norms and religious conservatism. At the institutional level, lack of trained staff, inconsistent supply of goods and services, and inadequate counseling services undermine the quality of care ( 17 – 18 ). These intersecting challenges underscore the need to have a local and contextualized research that would unveil how structural and sociocultural determinants affect the reproductive practices of women in specific situations within Nigerian contexts. This study is therefore located in the broader area of discourse of reproductive rights and gender equality. It argues that improvement of female access and control to family planning services should be one of the priority areas, not only in health outcomes but in the objective of achieving the Sustainable Development Goals (SDGs), in this instance, Goal 3 (Good Health and Well-Being) and Goal 5 (Gender Equality). The objective of the study was to determine reproductive autonomy and explore the FP barriers that hinder women of reproductive age in Osun State, a setting representative of Nigeria’s diverse ethnic and socio-economic landscape. METHODS Study Design The study employed a qualitative research design to examine barriers to reproductive autonomy and other factors shaping access to and choice of family planning among women of reproductive age in Osun State, Nigeria. The qualitative approach was appropriate because it allowed for an in-depth exploration and understanding of women’s reproductive experiences, perceptions, and the socio-cultural influences that inform reproductive decision-making. Data was collected through in-depth interviews (IDIs) and focus group discussions (FGDs), which provided rich narrative accounts of both individual and collective realities. A thematic analysis was subsequently conducted, offering an appropriate framework for the detailed exploration of participants lived experiences, perceptions, and processes of meaning-making. Study Setting The study was conducted within the geopolitical region of the south west in Nigeria known as Osun State. The state shares borders with Oyo State on the western, Ekiti, and Ondo States on the eastern, Ogun State on the southern and Kwara State on the northern sides. It has an estimated land area of 9251km2 and 30 Local Government Areas (LGAs), further divided into three senatorial districts. National Census in 2006 has shown that population of Osun State is 3.4 million, the population is predicted to grow to 4.7 million by 2016 with an annual growth rate of 3.3. The Yoruba ethnic group is the dominant and main religion is Christianity and Islam, both of which are very influential in determining cultural and reproductive norms. The study was conducted in two LGAs (Osogbo, Olorunda and Egbedore) chosen to represent the population that had different socio-cultural backgrounds, both in the urban and semi-urban settings. Study Population and Sampling The population of the study included 25 women of reproductive age (15–49 years) who live in the chosen LGAs. The selection of this group was due to the fact that they are the main users and the potential beneficiaries of the FP services ( 1 ). The non-probability convenience sampling was employed to recruit participants between 29th April and 4th June, 2024. This enabled women who were available, willing to join as well as met the inclusion criteria to be included. Inclusion criteria were: women between 15–49 years old, living in the target LGAs not less than one year and at least had one child. Participation was not permitted in the mentally unwell and women who did not provide consent. The concept of data saturation was the principle that was applied in the determination of the sample size, meaning that, the interviews conducted until such a time when no new themes or insights were acquired through the data. It was made rich and comprehensive with this strategy to capture the diversity of the views about reproductive autonomy and access to family planning. Data Collection Procedures and Instruments Data were collected using IDI and FGD guides. These tools were developed in line with research objectives. Some of the themes that were covered by the guides were the knowledge of women on reproductive autonomy, attitudes towards FP, perceived barriers to access and choice, and the influence of reproductive choices by religion, culture, and gender expectations. A pilot sample of the women in another LGA was used to test the relevance, validity, and clarity of the instruments, before the actual data collection. Feedback was used to revise and improve the language, structure, and flow of questions. The guides were validated through face and content validity assessments involving experts and independent qualitative researchers. Data collection was conducted through face-to-face interviews and focus group discussions. The FGDs included 6–8 people per group, and IDIs were conducted with separate women who valued individual sessions. The principal investigator would facilitate the discussions with the help of a trained note-taker. The interviews were conducted in English and Yoruba language, depending on the selection of participants so that they would comprehend and feel comfortable. The meetings lasted 15 to 50 minutes and were held in neutral and convenient locations that did not interfere with the privacy and comfort of the respondents. All the focus group discussions and individual sessions were audio-recorded with permission from participants, and nonverbal cues and contextual details were documented as field notes. Data Management and Analysis Audio-recordings were transcribed directly and translated into English when applicable before analysis. The transcripts were checked for completeness and accuracy and then analysed. The analysis of the data was conducted using an inductive approach in thematic analysis to reveal some of the common patterns, meanings, and relationships in the data. The analysis was performed in various phases, including reading of transcripts, coding of meaningful text units with descriptive codes, clustering the codes into larger themes and subthemes, which are based on the research objectives, and synthesizing the themes to obtain an insight into the barriers influencing reproductive autonomy and FP access. A synthesis was also made on the themes in order to gain an understanding of the obstacles affecting reproductive autonomy and FP access, in accordance with the thematic analysis framework, developed by Braun and Clarke ( 19 ). Illustrative quotes from participants were selected to support the interpretation of key findings, providing authenticity and grounding the analysis in participants’ voices. Ethical Considerations The Health Research Ethics Committee (HREC) of the College of Health Sciences, Osun State University granted the study ethical approval (Ref: HREC/2024/PBH/070). The appropriate local authorities also gave permission to carry out the study. The involvement of participants was all voluntary. Before the interviews and discussions, the participants were informed of the study’s objectives, the privacy conditions, and the ability to drop out of the process without any penalty. Verbal and written informed consent was received. In order to preserve confidentiality, transcripts lacked identifiers, and all the audio files and notes were stored in folders with passwords and could be accessed only by the research team. Trustworthiness and Study Limitations Triangulation of data sources (IDI and FGD) and peer debriefing were used to guarantee credibility during the analysis. Reliability was ensured through the preservation of an audit trail of procedures, decisions, as well as coding processes. Rich contextual descriptions were used to increase transferability, as it was possible to evaluate applicability to other settings by the reader. One of the weaknesses of this research is that the study was qualitative and, therefore, the results cannot be statistically generalized to the population as a whole. Nevertheless, it is a strong point as it gives the context and abundant information about the lived experiences of women in terms of reproductive autonomy and family planning decisions in the Osun State. RESULTS Thematic analysis revealed that five major themes and each one of them had sub-themes and categories (Table 1 ). These themes showed a dynamic nature of the interaction between knowledge and sociocultural interactions and institutional factors that construct reproductive autonomy in women in Osun State. Table 1 Extracted themes, sub-themes, and categories. Themes Sub-Themes Categories / Illustrative Ideas Knowledge of FP and Autonomy Awareness, Sources of Information Health center education, antenatal exposure, varying awareness levels Attitudes towards FP Positive and Negative Perceptions Benefits of spacing vs. fear of side effects, religious and cultural influence Reproductive Autonomy Personal vs. Joint Decision-Making norms Spousal influence, secrecy, peer, and elder pressure Barriers to FP Fear, Cultural and Spousal Opposition Misconceptions, religious stigma, misinformation Recommendations for Improving Reproductive Autonomy Education, Accessibility, Male Involvement Community sensitization, affordable services, non-judgmental care Socio-demographic characteristics/Reproductive profile of the participants 13 IDIs, 2 FGDs were done among women of reproductive age in Osogbo, Egbedore and Olorunda LGAs and 25 participants were sampled. The average age of the sample was 34.6 years old, most of them attended senior secondary school, 10 years and above living in the community, and had two or more children. A majority are Christians and are more than half. Virtually all respondents were married (Table 2 ). Table 2 Participants’ socio-demographic characteristics (n = 25) Variables Sub-variables Frequency(N) Percentage (%) Age 23–30 31–40 41–49 8 12 5 32.0 48.0 20.0 Educational status Primary Secondary Tertiary 4 14 7 16.0 56.0 28.0 Marital status Single Married Divorced 6 16 3 24.0 64.0 12.0 Occupation Unemployed Employed Self employed 4 10 11 16.0 40.0 44.0 Religion Christian Muslim 14 11 56.0 44.0 Number of years lived in the community ≤ 10 years 11–20 years > 20 years 8 10 7 32.0 40.0 28.0 Number of children 1 2–3 4 above 8 12 5 32.0 48.0 20.0 Theme 1: Knowledge of Family Planning and Reproductive Autonomy The majority of the respondents (94 per cent) were aware of family planning methods, but the knowledge level was quite different. Although the population was highly informed about the existence of the different forms of contraception like injectable, intrauterine devices (IUDs), implants, pills, and condoms, a considerable portion of the population was not aware of how to use these methods correctly, their effectiveness, and possible side effects. Participants noted that health centers, antenatal clinics and community outreach programs were also their key sources of information, although the quality and the depth of counseling were not always similar. Others knew about modern birth control techniques such as Copper T, injections, and condoms in maternity sessions, while most of them had little or no knowledge about reproductive autonomy. “I know about family planning methods such as pills and injections from the local health center.” – IDI_P2 ; “Health workers during antenatal visits talked about pills and injectables.” – IDI_P6 ; "Yes, I have heard about family planning methods such as pills, injections, and condoms..but not reproductive autonomy." – FGD_P1 ; "I know about pills, condoms, and injections as family planning methods." – FGD_P6 Awareness about condoms was largely attributed to informal peer discussions and outreach sessions. “I have heard about condoms as a family planning method from community outreach programs.” – IDI_P3 ; “Friends mentioned condoms during our discussions on family planning.” – IDI_P11 Knowledge of IUDs and implants was primarily derived from clinical and maternity centers. “I know about the Copper T and IUDs from my visits to the maternity center.” – IDI_P4 ; “Implants were discussed during health talks at the clinic.” – IDI_P1 ; "We were informed about the use of implants and IUDs during our women's group meetings." – FGD_P8 A few participants recognized natural methods, such as the rhythm and breastfeeding methods: "I know that there are natural methods like the rhythm method and withdrawal." – FGD_P3 ; "I am aware of natural methods like breastfeeding and the rhythm method." – FGD_P9 Regardless of this knowledge, there was low use of modern methods as most of the participants used traditional or natural approaches because they were afraid of complications and distrusted modern decisions.. Theme 2: Attitudes towards Family Planning The attitudes of participants towards FP were mixed, which were predetermined by their personal experiences, cultural and religious beliefs, and perceived side effects. On one hand, family planning was appreciated by women as one of the ways to space children and have better maternal health, but on the other hand, some believed in it because of a lack of information and culture. "I believe family planning is important to control the number of children and space pregnancies." – FGD_P2 ; "Using contraceptives helps me manage my health better and plan for my family's future." – FGD_P5 ; "I don’t like family planning methods because I’ve heard they have many side effects." – FGD_P4 ; "In my religion, using contraceptives is not allowed, so I don’t use them." – FGD_P3 Those participants who favored FP considered it as a family wellbeing and health management tool, whereas others linked it to infertility, marital stressfulness, or sin. "I think family planning is good because it helps in managing the number of children you can take care of." – FGD_P6 ; "I don’t use family planning because I’ve heard it can cause permanent health issues." – FGD_P8 ; These differing attitudes highlight the influence of cultural and religious norms, particularly among women in conservative communities. Theme 3: Reproductive Autonomy and Decision-Making The theme of reproductive autonomy was also significant, showing certain degrees of autonomy of women in terms of FP decisions. Some of interviewees mentioned that they had full reproductive autonomy; however, others said that spousal or communal pressure was among the key factors. "My own decision is prioritized when it comes to my reproductive health now because I know what I want, and you cannot decide for me." – FGD_P2 ; "I started using family planning secretly because my husband does not support it." – FGD_P7 ; "My husband and I decided together not to use family planning because he wants more children." – FGD_P6 Other respondents even revealed that their husbands or extended families were the decisive factors in using contraceptives or not. "My husband decided that we should not use family planning because he wants more children." – FGD_P10 ; "Peer pressure also affects decisions about family planning, as many of my friends do not use it." – FGD_P9 ; "The opinions of elders in my community make it difficult for women to openly use family planning methods." – FGD_P8 Some participants mentioned that they prefer natural approaches, which is related to their safety and acceptance of cultural aspects. “I prefer natural methods like breastfeeding and the rhythm method.” – IDI_P1 ; “Modern contraceptives don’t appeal to me; I believe in natural family planning methods.” – IDI_P6 Along with the fear of side effects and cultural beliefs, reproductive autonomy was limited further: “Fear of side effects and health risks make me hesitant to use modern contraceptives.” – IDI_P7 ; “Due to my faith, I don’t consider using any family planning methods.” – IDI_P5 All in all, the results have shown that spousal control, peer pressures, and religious doctrines are significant obstacles to free reproductive choices amongst women. Theme 4: Barriers to Family Planning The participants cited various obstacles that prevent them accessing and using FP methods. These were individual likes and dislikes, fear of side effects, cultural and religious resistance, spouse rejection and poor education. Personal Preferences “I prefer natural methods and don’t feel the need for modern contraceptives.” – IDI_P1 ; “I haven’t used any family planning methods because I don’t feel the need for it.” – IDI_P2 Fear of Side Effects "Some people think that contraceptives cause infertility, which scares them away from using these methods." – FGD_P3 ; "I have heard that using family planning methods can lead to cancer." – FGD_P5 ; "I am afraid of the side effects like weight gain and irregular periods." – FGD_P1 Negative Personal Experience "I used the injection once, and it caused me to bleed excessively." – FGD_P4 ; "I once used the pills, and it caused me severe headaches and nausea." – FGD_P9 Cultural and Religious Opposition "There are beliefs that it’s a sin. Even some ‘teblik’ Muslims believe it is a sin. Some Christians don’t believe in it too." – FGD_P4 ; "In my community, using family planning is seen as something bad, and people talk negatively about those who use it." – FGD_P5 Spousal Opposition "My husband does not support family planning because he believes it is against our culture." – FGD_P4 Lack of Detailed Knowledge “I need more information before deciding to use family planning methods.” – IDI_P12 ; "I heard about family planning at the maternity center but have no interest in it because I don’t trust it." – FGD_P7 All these obstacles indicate that the greatest impediments to contraceptive uptake are misinformation, fear, social opposition and poor reproductive literacy. Theme 5: Suggestions for Improving Family Planning Services The participants suggested some measures that can be taken to increase FP awareness and autonomy. Education and sensitization programs, male involvement, engagement of the community leaders, and affordable and non-judgmental services were the most repeated recommendations. Education and Awareness Programs “The government should provide more education and awareness programs about family planning.” – IDI_P1 ; "Sensitization and awareness are key to enabling reproductive autonomy among women." – FGD_P5 ; "Health workers need to provide detailed information and counseling about family planning options." – FGD_P2 Involvement of Community and Religious Leaders “Community leaders should be involved in sensitizing people about the benefits of family planning.” – IDI_P3 ; "Involving religious and community leaders in these programs can help in gaining acceptance." – FGD_P4 Accessible and Affordable Services “Family planning services should be made more accessible and affordable.” – IDI_P8 ; "Family planning services should be more accessible and affordable for all women." – FGD_P7 Inclusion of Men in Reproductive Health Education “Men should be included in reproductive health education to support family planning.” – IDI_P5 ; "When men are educated, they will support their wives in using family planning methods." – FGD_P6 Non-Judgmental and Supportive Counseling “Healthcare providers should offer family planning services without judgment or stigma.” – IDI_P10 ; "There should be no judgment or stigma from healthcare providers when women come for family planning services." – FGD_P8 The viewpoints highlight the importance of multilevel interventions to encourage informed and independent reproductive decisions in women. DISCUSSION This study examined the barriers of women in making decisions regarding their FP in Osun State, Nigeria. The results indicate that the general awareness of FP methods is high, but there are still significant gaps in the level of knowledge, attitudes, and autonomy all of which impact on reproductive choices of women. Socio-Demographic Characteristics The socio-demographic characteristics of the sample represent a cross-section of the female population being of reproductive age with the majority of them being 26–35 years of age which is a time frame when most women make active decisions regarding childbearing and FP. This holds true with national results by Ajaero et al. ( 20 ), which showed that there was the same pattern of age among Nigerian women within the reproductive age. The level of education was also fairly good at 56 percent of the respondents attended secondary school. It is not a new realization that education is a determinant of reproductive health awareness that affects the ability of women to make informed choices regarding contraception ( 21 ). The fact that the majority of women were married (64) emphasizes the importance of the role of spouses and relatives in the reproductive autonomy that is in line with previous results by Feyisetan and Casterline ( 22 ). Working conditions among the majority participants also indicate the necessity of workplace-based reproductive health services because economic autonomy can influence the contraceptive preferences and availability. Knowledge of Family Planning and Reproductive Autonomy Most of the respondents (94 percent) were familiar with the use of modern methods of contraceptives including pills, injectables, implants and IUD. This is relative to the 72.4% awareness of OlaOlorun and Hindin ( 23 ) in Ibadan meaning that there is gradual increase in the awareness levels in southwestern Nigeria. The study did not reveal in-depth knowledge about long-acting reversible contraceptives and the misunderstanding of side effects, however, the trend has been reported by Blackstone and Iwelunmor ( 24 ), who detected the same gap in the knowledge of Nigerian women. The health facilities and antenatal sessions were mentioned as the main sources of information by the majority of participants, which highlights the core of the health system in the FP communication. However, asymmetrical information sharing and inconsistent counselling were also noted, which is why there is a necessity to improve the community outreach and unify the content of FP education. Whereas other people were conversant with the concept of reproductive autonomy, some people had never heard of this term, which points to the fact that autonomy is a poorly discussed facet of reproductive health on a grassroots level. Attitudes towards Family Planning The perceptions of FP were ambivalent as they depended on the subjective experience, perceived health risk, cultural expectations and religious doctrines. A majority of the interviewees were positive since they recognized the role of FP in enhancing maternal and child health and family well-being - the same as Okigbo et al. ( 25 ). But still negative perceptions were present especially the fear of infertility, hormonal imbalance, and long-term health complication. Such misunderstandings still play roles of creating reluctance, as also cited by Oye-Adeniran et al. ( 26 ). The repetitive influences were the culture and religious beliefs. In societies where using contraceptives was viewed as defiant of religion, women would either shun FP altogether or find the secret usage method. This is congruent with the documented findings of Feyisetan and Casterline ( 22 ) who wrote that religious opposition has been a consistent hindrance to the acceptance of contraceptives in Nigeria. Reproductive Autonomy and Decision-Making The result states that reproduction choices made by women depend on various social strata such as husbands, peers, elders in community, and religious authorities. Even though some ladies made their own choices about the use of FP, many of them reported low autonomy because of patriarchal expectations. The spousal authority in decisions on contraceptives is corroborated with the findings of OlaOlorun and Hindin ( 23 ) who assert that the decisions about reproduction in southwestern Nigeria are controllable by men. Women with supportive partners responded better to contraceptives with confidence and those in restrictive relationships would either resort to secrecy or shun FP altogether. The power of the community norm and elder judgment was also high especially in rural or religion-based context. These results support the point that advocating reproductive freedom in Nigeria needs to empower women, as well as involve men, families and communities in more social transformation. Barriers to Family Planning According to the participants, the primary obstacles to the uptake of FP were the fear of side effects, misinformation, and sociocultural opposition. Previous studies have reported fear of side effects, including fear of weight gain, menstrual irregularities, or infertility to be one of the biggest deterrents to using contraceptives in Nigeria ( 7 , 18 , 28 ). Popular myths and misconceptions such as the erroneous assumptions about the safety and efficacy of contraceptives have also been cited as a major obstacle hindering the uptake of family planning strategies by women ( 2 , 7 , 18 ). It has been demonstrated that sociocultural resistance, such as disapproval of partners, societal standards, and beliefs, are very potent in affecting reproductive autonomy and restricting the uptake of FP among women in such environments ( 3 , 10 , 17 ). The myths regarding infertility, cancer, and moral wrongdoing are quite popular, which is also reported by Oye-Adeniran et al. ( 26 ) and Afolabi et al. ( 27 ). In addition, the challenges in access such as cost of transport, fluctuating supply of commodities, and bias by the provider were indicated as hindrances. All of these are factors that limit women in their capacity to make free informed choices concerning reproductive matters. The view that FP violates cultural or religious beliefs highlights the good role of contextual health communication techniques. According to Okonkwo et al. ( 28 ), it can be observed that myths can be effectively busted as faith-based and community-sensitive education bring more acceptance. Suggestions for Improving Family Planning Services They highlighted five important interventions as a result of the discussions, which included lifelong learning and sensitisation, incorporation of community and religious leaders, men inclusion in reproductive health dialogues, better access and affordability of services, and absence of judgmental provider attitudes. These recommendations are consistent with those provided by Sedgh et al. ( 29 ), who emphasized the need to have culturally sensitive FP education and involvement. The importance of male involvement was especially highlighted, which confirms the results by Moronkola and Fakeye ( 30 ), who attributed the positive attitudes of the partners towards increased contraceptive use. Another theme resonating the motive expressed by the participants is the call to have the approachable and respectful service delivery that Izugbara et al. ( 31 ) observed to be a significant benefit in terms of reproductive autonomy. In general, the findings are indicative of a community that is conscious but bound, educated but restricted by the social cultural reality. Awareness coupled with willingness and prevailing systemic barriers offer a challenge and an opportunity to interventions on reproductive health in Osun State. CONCLUSIONS The research is helpful in understanding the knowledge, attitudes, and independence of women in Osun State, Nigeria on FP. The results indicate that there is good awareness and overall positive attitudes towards using contraceptives, but there are still barriers that persist in the form of misinformation, cultural and religious resistance, dominance of spouses, and limited accessibility of services that prevent successful use. Marital status and educational attainment proved to be crucial factors, and it implies that the intervention should be gender-sensitive and socio-culturally oriented. Women who had higher education were more autonomous and accurate in their knowledge, whereas married women frequently had to bargain FP decisions in patriarchal frames. The evidence points to the need of multilevel approaches that are focused on individual, relational, and systemic factors at the same time. Enhancement of health learning, promotion of male participation, availability of uniform service delivery and incorporation of community-based advocacy may all enhance reproductive autonomy. Abbreviations • FP Family Planning • FGD Focused Group Discussions • IDI In-Depth Interviews • LGA Local Government Areas Declarations Ethics Approval and Consent to Participate The ethical guidelines of the Declaration of Helsinki, when conducting research with human subjects, were to be observed in the study. The Health Research Ethics Committee (HREC) of the College of Health Sciences, Osun State University, gave the ethical approval (Ref: HREC/2024/PBH/070). Proper authorization was also acquired before data collection to the concerned local authorities. Consent for Publication Not applicable Availability of Data and Materials The datasets (all transcripts) analyzed during the current study are available from the corresponding author on request. Competing Interests No competing interest Funding Not applicable Author Contributions IA conceptualized the research and wrote the first draft of the manuscript, while all authors (IA, CA & SOO) reviewed, edited, and approved the manuscript. Acknowledgement The authors would like to sincerely acknowledge the contributions of Ogundare Bolawale Marvellous for her invaluable assistance in data collection, transcription, and preliminary analysis. Her dedication and support were instrumental to the successful completion of this study. References United Nations Population Fund (UNFPA). State of World Population 2019: Unfinished business—the pursuit of rights and choices for all. New York: UNFPA; 2019. 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The cultural context of fertility control in Africa. Stud Fam Plann. 2014;45(2):105–21. Upadhyay UD, et al. Development and validation of a reproductive autonomy scale. Stud Fam Plann. 2014;45(1):19–41. Sen A. Gender and cooperative conflicts. In: Persistent inequalities. Oxford: Clarendon Press; 2019. World Bank. Investing in women’s reproductive health. Washington DC: World Bank; 2018. Guttmacher Institute. Adding it up: Investing in sexual and reproductive health 2020. New York: Guttmacher Institute; 2020. Wambua SM, et al. Determinants of family planning use in sub-Saharan Africa: A systematic review. Glob Health Sci Pract. 2018;6(4):748–59. Singh S, Darroch JE. Adding it up: The costs and benefits of contraceptive services. Guttmacher Institute and UNFPA. 2014. Blanc AK, et al. The role of gender norms in shaping reproductive health behaviors in Africa. Glob Public Health. 2018;13(4):505–19. Woulibijnen J, et al. Barriers to family planning in Nigeria: a systematic review. Afr J Reprod Health. 2018;22(3):123–34. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psych . 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa Ajaero CK, Odimegwu CO, Ajaero ID, Nwachukwu CA. Access to mass media messages, and use of family planning in Nigeria: a spatio-demographic analysis from the 2013 DHS. BMC Public Health. 2016;16(1):1–10. Onwujekwe O, Uguru N, Etiaba E, Chikezie I, Uzochukwu B, Adjagba A. The economic burden of abortion in Nigeria: A cost–effectiveness analysis of unsafe abortion prevention. BMC Health Serv Res. 2019;19(1):1–12. Feyisetan B, Casterline JB. Fertility preferences and contraceptive change in developing countries. Int Fam Plan Perspect. 2019;45(2):67–77. OlaOlorun F, Hindin MJ. Having a say matters: Influence of decision-making power on contraceptive use among Nigerian women ages 35–49 years. PLoS One. 2014;9(6):e98702. Blackstone SR, Iwelunmor J. Determinants of contraceptive use among Nigerian couples: evidence from the 2013 Demographic and Health Survey. Contracept Reprod Med. 2017;2(1):9. Okigbo CC, Speizer IS, Corroon M, Gueye A. Exposure to family planning messages and modern contraceptive use among men in urban Kenya, Nigeria, and Senegal: a cross-sectional study. Reprod Health. 2015;12(1):63. Oye-Adeniran BA, Adewole IF, Umoh AV, Oladokun A, Gbadegesin A, Ekanem EE, et al. Community-based study of contraceptive behaviour in Nigeria. Afr J Reprod Health. 2016;20(2):75–85. Afolabi BM, Ezedinachi EN, Wagbatsoma VA, Eze S, Ezeanolue EE. Influence of spousal communication on family planning practices among couples in Nigeria. J Biosoc Sci. 2015;47(6):702–716. Okechukwu EF, Akinola OI, Balogun MR, Afolabi OT. Access and barriers to contraceptive use among rural women in Nigeria. Afr J Prim Health Care Fam Med. 2017;9(1):e1–e6. Sedgh G, Ashford LS, Hussain R. Unmet need for contraception in developing countries: examining women’s reasons for not using a method. Guttmacher Institute Report. 2016;1–36. Moronkola OA, Fakeye OO. Male involvement in family planning decisions and practices among married men in Ibadan, Nigeria. Afr J Reprod Health. 2018;22(4):44–54. Izugbara CO, Egesa CP, Kabiru CW. Service availability and readiness for family planning in Nigeria: implications for the Sustainable Development Goals. BMC Health Serv Res. 2016;16(1):1–9. Additional Declarations No competing interests reported. Supplementary Files INTERVIEWIDIFGDGUIDES.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 15 Mar, 2026 Reviewers agreed at journal 11 Mar, 2026 Reviewers invited by journal 05 Mar, 2026 Editor assigned by journal 04 Mar, 2026 Editor invited by journal 06 Feb, 2026 Submission checks completed at journal 04 Feb, 2026 First submitted to journal 04 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8473968","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":603964067,"identity":"c66188e7-4c9d-40a6-804f-0366cdb3d6b7","order_by":0,"name":"Iyanu Adufe","email":"data:image/png;base64,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","orcid":"","institution":"Osun State University","correspondingAuthor":true,"prefix":"","firstName":"Iyanu","middleName":"","lastName":"Adufe","suffix":""},{"id":603964068,"identity":"ecaebac3-d194-41f9-ac8d-1b283dbc141f","order_by":1,"name":"Cassandra Akinde","email":"","orcid":"","institution":"Women in Global Health","correspondingAuthor":false,"prefix":"","firstName":"Cassandra","middleName":"","lastName":"Akinde","suffix":""},{"id":603964069,"identity":"0a4d232c-b07a-4aea-9127-d3f0eafd4edd","order_by":2,"name":"Samson Olagoke Oladoye","email":"","orcid":"","institution":"Kings University","correspondingAuthor":false,"prefix":"","firstName":"Samson","middleName":"Olagoke","lastName":"Oladoye","suffix":""}],"badges":[],"createdAt":"2025-12-29 14:38:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8473968/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8473968/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104405917,"identity":"1dd0023e-5b4d-4710-a30c-06a34fdc864e","added_by":"auto","created_at":"2026-03-11 12:24:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1308335,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8473968/v1/ce353777-5c83-4d04-860f-15a642be478d.pdf"},{"id":104374280,"identity":"365a91e5-d487-462a-9112-ae1c181598b4","added_by":"auto","created_at":"2026-03-11 06:07:42","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":18383,"visible":true,"origin":"","legend":"","description":"","filename":"INTERVIEWIDIFGDGUIDES.docx","url":"https://assets-eu.researchsquare.com/files/rs-8473968/v1/dbc08e7122f117e6a030d68c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eBarriers to Reproductive Autonomy: Understanding Family Planning Access and Choice Among Women of Reproductive Age in Osun State, Nigeria\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eReproductive autonomy refers to the ability of individuals to make informed and voluntary choices about their reproductive health; an essential human right and one of the pillars of women's empowerment (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It covers the right to make responsible decisions about the number, timing, and spacing of their children, to obtain information and means of implementing their choices without being forced, discriminated, or subjected to violence (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Reproductive autonomy is necessary to ensure gender equality and better maternal and child health outcomes, but in most low and middle-income countries, it remains largely a facade (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe issues of reproductive autonomy are even more acute in Nigeria, as the high fertility level, low prevalence rate of contraceptives, and one of the highest maternal mortality ratios in the world of 512 maternal deaths in 100,000 live births. This is still a challenge as the Nigeria Demographic and Health Survey (NDHS) also confirms its existence among the population (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Although the level of awareness of family planning (FP) methods is high among sexually active unmarried [98%] and married [94%] women, contemporary contraceptive use is dismally low [19%] (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This gap between theory and practice highlights a more profound structural and cultural issue, indicating that these impediments go beyond awareness to actions, social norms, and access.\u003c/p\u003e \u003cp\u003eDespite government initiatives to enhance the maternal and reproductive health outcomes, the adoption of modern FP services is suboptimal (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Lack of reproductive autonomy, gender inequality, socio-cultural, and economic deprivation are some of the issues that render females unable to gain control over their fertility (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Sociocultural environment of Nigerian societies is mostly inclined towards the elucidation of the masculine supremacy of the reproductive options, thus, making contraception either morally controversial or unnecessary, particularly in marriage (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWomen have more challenges in their reproductive choices due to cultural and religious pressures. Religious explanations can influence the position of contraception in most societies, where it is occasionally viewed as tampering with the will of God (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Similarly, the tradition of having a big family size or emphasis on kids (male) continues to exacerbate the pressure against contraceptive use. These are the forces that limit women in their activities, particularly in patriarchal families where decision-making concerning reproduction is normally dominated by the male partners or significant others. All these are made more difficult by the economic factors where poverty is known to limit access to contraceptives or traveling to healthcare facilities, as well as the healthcare service delivery system constraining access (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFP and reproductive autonomy have a high level of interrelation. FP is a public health intervention that is vital and also a significant practice of autonomy and reproductive rights (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). By making reproductive choices, women have a higher chance to pursue education, participate actively in strengthening the economy and national development (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Evidence indicates that enhanced reproductive autonomy results in a decline in unwanted pregnancies, unsafe abortion, and maternal deaths (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). On the other hand, when women are limited in their autonomy, they may become vulnerable to reproductive coercion, high-risk pregnancy, and poverty cycles.\u003c/p\u003e \u003cp\u003eFP in the world is among the most cost-effective strategies of public health in reducing maternal and infant mortality (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, in sub-Saharan Africa, Nigeria, being no exception, the gender norms and structural injustices still inhibit the reproductive freedom of women (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The prevailing common themes in the literature have always been socio-cultural resistance, religious constraints, insufficient participation of men, fear of side effects, inaccessible quality services, and bias by the health care providing personnel as some of the major factors that discourage the use of birth control (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). All these combine to bring about a scenario where knowledge fails to translate to action, and decision fails to mean independence.\u003c/p\u003e \u003cp\u003eNigeria has many barriers to reproductive autonomy; these cut across individual, household, community, and institutional levels. On an individual level, the adverse factors to uptake include myths and misconceptions about contraception, fear of infertility, and absence of spousal support. The problem of contraception and fertility has been preconditioned on the community level by patriarchal norms and religious conservatism. At the institutional level, lack of trained staff, inconsistent supply of goods and services, and inadequate counseling services undermine the quality of care (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). These intersecting challenges underscore the need to have a local and contextualized research that would unveil how structural and sociocultural determinants affect the reproductive practices of women in specific situations within Nigerian contexts.\u003c/p\u003e \u003cp\u003eThis study is therefore located in the broader area of discourse of reproductive rights and gender equality. It argues that improvement of female access and control to family planning services should be one of the priority areas, not only in health outcomes but in the objective of achieving the Sustainable Development Goals (SDGs), in this instance, Goal 3 (Good Health and Well-Being) and Goal 5 (Gender Equality). The objective of the study was to determine reproductive autonomy and explore the FP barriers that hinder women of reproductive age in Osun State, a setting representative of Nigeria\u0026rsquo;s diverse ethnic and socio-economic landscape.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThe study employed a qualitative research design to examine barriers to reproductive autonomy and other factors shaping access to and choice of family planning among women of reproductive age in Osun State, Nigeria. The qualitative approach was appropriate because it allowed for an in-depth exploration and understanding of women\u0026rsquo;s reproductive experiences, perceptions, and the socio-cultural influences that inform reproductive decision-making. Data was collected through in-depth interviews (IDIs) and focus group discussions (FGDs), which provided rich narrative accounts of both individual and collective realities. A thematic analysis was subsequently conducted, offering an appropriate framework for the detailed exploration of participants lived experiences, perceptions, and processes of meaning-making.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Setting\u003c/h3\u003e\n\u003cp\u003eThe study was conducted within the geopolitical region of the south west in Nigeria known as Osun State. The state shares borders with Oyo State on the western, Ekiti, and Ondo States on the eastern, Ogun State on the southern and Kwara State on the northern sides. It has an estimated land area of 9251km2 and 30 Local Government Areas (LGAs), further divided into three senatorial districts. National Census in 2006 has shown that population of Osun State is 3.4\u0026nbsp;million, the population is predicted to grow to 4.7\u0026nbsp;million by 2016 with an annual growth rate of 3.3. The Yoruba ethnic group is the dominant and main religion is Christianity and Islam, both of which are very influential in determining cultural and reproductive norms. The study was conducted in two LGAs (Osogbo, Olorunda and Egbedore) chosen to represent the population that had different socio-cultural backgrounds, both in the urban and semi-urban settings.\u003c/p\u003e\n\u003ch3\u003eStudy Population and Sampling\u003c/h3\u003e\n\u003cp\u003eThe population of the study included 25 women of reproductive age (15\u0026ndash;49 years) who live in the chosen LGAs. The selection of this group was due to the fact that they are the main users and the potential beneficiaries of the FP services (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The non-probability convenience sampling was employed to recruit participants between 29th April and 4th June, 2024. This enabled women who were available, willing to join as well as met the inclusion criteria to be included. Inclusion criteria were: women between 15\u0026ndash;49 years old, living in the target LGAs not less than one year and at least had one child. Participation was not permitted in the mentally unwell and women who did not provide consent.\u003c/p\u003e \u003cp\u003eThe concept of data saturation was the principle that was applied in the determination of the sample size, meaning that, the interviews conducted until such a time when no new themes or insights were acquired through the data. It was made rich and comprehensive with this strategy to capture the diversity of the views about reproductive autonomy and access to family planning.\u003c/p\u003e\n\u003ch3\u003eData Collection Procedures and Instruments\u003c/h3\u003e\n\u003cp\u003eData were collected using IDI and FGD guides. These tools were developed in line with research objectives. Some of the themes that were covered by the guides were the knowledge of women on reproductive autonomy, attitudes towards FP, perceived barriers to access and choice, and the influence of reproductive choices by religion, culture, and gender expectations. A pilot sample of the women in another LGA was used to test the relevance, validity, and clarity of the instruments, before the actual data collection. Feedback was used to revise and improve the language, structure, and flow of questions. The guides were validated through face and content validity assessments involving experts and independent qualitative researchers.\u003c/p\u003e \u003cp\u003eData collection was conducted through face-to-face interviews and focus group discussions. The FGDs included 6\u0026ndash;8 people per group, and IDIs were conducted with separate women who valued individual sessions. The principal investigator would facilitate the discussions with the help of a trained note-taker. The interviews were conducted in English and Yoruba language, depending on the selection of participants so that they would comprehend and feel comfortable. The meetings lasted 15 to 50 minutes and were held in neutral and convenient locations that did not interfere with the privacy and comfort of the respondents. All the focus group discussions and individual sessions were audio-recorded with permission from participants, and nonverbal cues and contextual details were documented as field notes.\u003c/p\u003e\n\u003ch3\u003eData Management and Analysis\u003c/h3\u003e\n\u003cp\u003eAudio-recordings were transcribed directly and translated into English when applicable before analysis. The transcripts were checked for completeness and accuracy and then analysed. The analysis of the data was conducted using an inductive approach in thematic analysis to reveal some of the common patterns, meanings, and relationships in the data. The analysis was performed in various phases, including reading of transcripts, coding of meaningful text units with descriptive codes, clustering the codes into larger themes and subthemes, which are based on the research objectives, and synthesizing the themes to obtain an insight into the barriers influencing reproductive autonomy and FP access. A synthesis was also made on the themes in order to gain an understanding of the obstacles affecting reproductive autonomy and FP access, in accordance with the thematic analysis framework, developed by Braun and Clarke (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Illustrative quotes from participants were selected to support the interpretation of key findings, providing authenticity and grounding the analysis in participants\u0026rsquo; voices.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003eThe Health Research Ethics Committee (HREC) of the College of Health Sciences, Osun State University granted the study ethical approval (Ref: HREC/2024/PBH/070). The appropriate local authorities also gave permission to carry out the study. The involvement of participants was all voluntary. Before the interviews and discussions, the participants were informed of the study\u0026rsquo;s objectives, the privacy conditions, and the ability to drop out of the process without any penalty. Verbal and written informed consent was received. In order to preserve confidentiality, transcripts lacked identifiers, and all the audio files and notes were stored in folders with passwords and could be accessed only by the research team.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTrustworthiness and Study Limitations\u003c/h3\u003e\n\u003cp\u003eTriangulation of data sources (IDI and FGD) and peer debriefing were used to guarantee credibility during the analysis. Reliability was ensured through the preservation of an audit trail of procedures, decisions, as well as coding processes. Rich contextual descriptions were used to increase transferability, as it was possible to evaluate applicability to other settings by the reader. One of the weaknesses of this research is that the study was qualitative and, therefore, the results cannot be statistically generalized to the population as a whole. Nevertheless, it is a strong point as it gives the context and abundant information about the lived experiences of women in terms of reproductive autonomy and family planning decisions in the Osun State.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThematic analysis revealed that five major themes and each one of them had sub-themes and categories (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). These themes showed a dynamic nature of the interaction between knowledge and sociocultural interactions and institutional factors that construct reproductive autonomy in women in Osun State.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExtracted themes, sub-themes, and categories.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-Themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCategories / Illustrative Ideas\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKnowledge of FP and Autonomy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAwareness, Sources of Information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHealth center education, antenatal exposure, varying awareness levels\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAttitudes towards FP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive and Negative Perceptions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBenefits of spacing vs. fear of side effects, religious and cultural influence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReproductive Autonomy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePersonal vs. Joint Decision-Making norms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpousal influence, secrecy, peer, and elder pressure\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBarriers to FP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFear, Cultural and Spousal Opposition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMisconceptions, religious stigma, misinformation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRecommendations for Improving Reproductive Autonomy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEducation, Accessibility, Male Involvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCommunity sensitization, affordable services, non-judgmental care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSocio-demographic characteristics/Reproductive profile of the participants\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e13 IDIs, 2 FGDs were done among women of reproductive age in Osogbo, Egbedore and Olorunda LGAs and 25 participants were sampled. The average age of the sample was 34.6 years old, most of them attended senior secondary school, 10 years and above living in the community, and had two or more children. A majority are Christians and are more than half. Virtually all respondents were married (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants\u0026rsquo; socio-demographic characteristics (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency(N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u0026ndash;30\u003c/p\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003cp\u003e41\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003cp\u003e12\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003cp\u003e48.0\u003c/p\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e14\u003c/p\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003cp\u003e56.0\u003c/p\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003cp\u003eMarried\u003c/p\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e16\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.0\u003c/p\u003e \u003cp\u003e64.0\u003c/p\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003cp\u003eSelf employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003cp\u003e40.0\u003c/p\u003e \u003cp\u003e44.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.0\u003c/p\u003e \u003cp\u003e44.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of years lived in the community\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;10 years\u003c/p\u003e \u003cp\u003e11\u0026ndash;20 years\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003cp\u003e40.0\u003c/p\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003cp\u003e4 above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003cp\u003e12\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003cp\u003e48.0\u003c/p\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: Knowledge of Family Planning and Reproductive Autonomy\u003c/h2\u003e \u003cp\u003eThe majority of the respondents (94 per cent) were aware of family planning methods, but the knowledge level was quite different. Although the population was highly informed about the existence of the different forms of contraception like injectable, intrauterine devices (IUDs), implants, pills, and condoms, a considerable portion of the population was not aware of how to use these methods correctly, their effectiveness, and possible side effects. Participants noted that health centers, antenatal clinics and community outreach programs were also their key sources of information, although the quality and the depth of counseling were not always similar. Others knew about modern birth control techniques such as Copper T, injections, and condoms in maternity sessions, while most of them had little or no knowledge about reproductive autonomy.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I know about family planning methods such as pills and injections from the local health center.\u0026rdquo; \u0026ndash;\u003c/em\u003e \u003cb\u003eIDI_P2\u003c/b\u003e; \u003cem\u003e\u0026ldquo;Health workers during antenatal visits talked about pills and injectables.\u0026rdquo; \u0026ndash;\u003c/em\u003e \u003cb\u003eIDI_P6\u003c/b\u003e; \u003cem\u003e\"Yes, I have heard about family planning methods such as pills, injections, and condoms..but not reproductive autonomy.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P1\u003c/b\u003e; \u003cem\u003e\"I know about pills, condoms, and injections as family planning methods.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P6\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAwareness about condoms was largely attributed to informal peer discussions and outreach sessions.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I have heard about condoms as a family planning method from community outreach programs.\u0026rdquo; \u0026ndash;\u003c/em\u003e \u003cb\u003eIDI_P3\u003c/b\u003e; \u003cem\u003e\u0026ldquo;Friends mentioned condoms during our discussions on family planning.\u0026rdquo; \u0026ndash;\u003c/em\u003e \u003cb\u003eIDI_P11\u003c/b\u003e\u003c/p\u003e \u003cp\u003eKnowledge of IUDs and implants was primarily derived from clinical and maternity centers.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I know about the Copper T and IUDs from my visits to the maternity center.\u0026rdquo; \u0026ndash;\u003c/em\u003e \u003cb\u003eIDI_P4\u003c/b\u003e; \u003cem\u003e\u0026ldquo;Implants were discussed during health talks at the clinic.\u0026rdquo; \u0026ndash;\u003c/em\u003e \u003cb\u003eIDI_P1\u003c/b\u003e; \u003cem\u003e\"We were informed about the use of implants and IUDs during our women's group meetings.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P8\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA few participants recognized natural methods, such as the rhythm and breastfeeding methods:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I know that there are natural methods like the rhythm method and withdrawal.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P3\u003c/b\u003e; \u003cem\u003e\"I am aware of natural methods like breastfeeding and the rhythm method.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P9\u003c/b\u003e\u003c/p\u003e \u003cp\u003eRegardless of this knowledge, there was low use of modern methods as most of the participants used traditional or natural approaches because they were afraid of complications and distrusted modern decisions..\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Attitudes towards Family Planning\u003c/h2\u003e \u003cp\u003eThe attitudes of participants towards FP were mixed, which were predetermined by their personal experiences, cultural and religious beliefs, and perceived side effects. On one hand, family planning was appreciated by women as one of the ways to space children and have better maternal health, but on the other hand, some believed in it because of a lack of information and culture.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I believe family planning is important to control the number of children and space pregnancies.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P2\u003c/b\u003e; \u003cem\u003e\"Using contraceptives helps me manage my health better and plan for my family's future.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P5\u003c/b\u003e; \u003cem\u003e\"I don\u0026rsquo;t like family planning methods because I\u0026rsquo;ve heard they have many side effects.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P4\u003c/b\u003e; \u003cem\u003e\"In my religion, using contraceptives is not allowed, so I don\u0026rsquo;t use them.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P3\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThose participants who favored FP considered it as a family wellbeing and health management tool, whereas others linked it to infertility, marital stressfulness, or sin.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I think family planning is good because it helps in managing the number of children you can take care of.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P6\u003c/b\u003e; \u003cem\u003e\"I don\u0026rsquo;t use family planning because I\u0026rsquo;ve heard it can cause permanent health issues.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P8\u003c/b\u003e; \u003cem\u003eThese differing attitudes highlight the influence of cultural and religious norms, particularly among women in conservative communities.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Reproductive Autonomy and Decision-Making\u003c/h2\u003e \u003cp\u003eThe theme of reproductive autonomy was also significant, showing certain degrees of autonomy of women in terms of FP decisions. Some of interviewees mentioned that they had full reproductive autonomy; however, others said that spousal or communal pressure was among the key factors.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"My own decision is prioritized when it comes to my reproductive health now because I know what I want, and you cannot decide for me.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P2\u003c/b\u003e; \u003cem\u003e\"I started using family planning secretly because my husband does not support it.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P7\u003c/b\u003e; \u003cem\u003e\"My husband and I decided together not to use family planning because he wants more children.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P6\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOther respondents even revealed that their husbands or extended families were the decisive factors in using contraceptives or not.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"My husband decided that we should not use family planning because he wants more children.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P10\u003c/b\u003e; \u003cem\u003e\"Peer pressure also affects decisions about family planning, as many of my friends do not use it.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P9\u003c/b\u003e; \u003cem\u003e\"The opinions of elders in my community make it difficult for women to openly use family planning methods.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P8\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSome participants mentioned that they prefer natural approaches, which is related to their safety and acceptance of cultural aspects.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I prefer natural methods like breastfeeding and the rhythm method.\u0026rdquo; \u0026ndash;\u003c/em\u003e \u003cb\u003eIDI_P1\u003c/b\u003e; \u003cem\u003e\u0026ldquo;Modern contraceptives don\u0026rsquo;t appeal to me; I believe in natural family planning methods.\u0026rdquo; \u0026ndash;\u003c/em\u003e \u003cb\u003eIDI_P6\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAlong with the fear of side effects and cultural beliefs, reproductive autonomy was limited further:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Fear of side effects and health risks make me hesitant to use modern contraceptives.\u0026rdquo; \u0026ndash;\u003c/em\u003e \u003cb\u003eIDI_P7\u003c/b\u003e; \u003cem\u003e\u0026ldquo;Due to my faith, I don\u0026rsquo;t consider using any family planning methods.\u0026rdquo; \u0026ndash;\u003c/em\u003e \u003cb\u003eIDI_P5\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAll in all, the results have shown that spousal control, peer pressures, and religious doctrines are significant obstacles to free reproductive choices amongst women.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eTheme 4: Barriers to Family Planning\u003c/h2\u003e \u003cp\u003eThe participants cited various obstacles that prevent them accessing and using FP methods. These were individual likes and dislikes, fear of side effects, cultural and religious resistance, spouse rejection and poor education.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003ePersonal Preferences\u003c/h2\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I prefer natural methods and don\u0026rsquo;t feel the need for modern contraceptives.\u0026rdquo; \u0026ndash;\u003c/em\u003e \u003cb\u003eIDI_P1\u003c/b\u003e; \u003cem\u003e\u0026ldquo;I haven\u0026rsquo;t used any family planning methods because I don\u0026rsquo;t feel the need for it.\u0026rdquo; \u0026ndash;\u003c/em\u003e \u003cb\u003eIDI_P2\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eFear of Side Effects\u003c/h2\u003e \u003cp\u003e \u003cem\u003e\"Some people think that contraceptives cause infertility, which scares them away from using these methods.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P3\u003c/b\u003e; \u003cem\u003e\"I have heard that using family planning methods can lead to cancer.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P5\u003c/b\u003e; \u003cem\u003e\"I am afraid of the side effects like weight gain and irregular periods.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P1\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eNegative Personal Experience\u003c/h2\u003e \u003cp\u003e \u003cem\u003e\"I used the injection once, and it caused me to bleed excessively.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P4\u003c/b\u003e; \u003cem\u003e\"I once used the pills, and it caused me severe headaches and nausea.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P9\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eCultural and Religious Opposition\u003c/h2\u003e \u003cp\u003e \u003cem\u003e\"There are beliefs that it\u0026rsquo;s a sin. Even some \u0026lsquo;teblik\u0026rsquo; Muslims believe it is a sin. Some Christians don\u0026rsquo;t believe in it too.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P4\u003c/b\u003e; \u003cem\u003e\"In my community, using family planning is seen as something bad, and people talk negatively about those who use it.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P5\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eSpousal Opposition\u003c/h2\u003e \u003cp\u003e \u003cem\u003e\"My husband does not support family planning because he believes it is against our culture.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P4\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eLack of Detailed Knowledge\u003c/h2\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I need more information before deciding to use family planning methods.\u0026rdquo; \u0026ndash;\u003c/em\u003e \u003cb\u003eIDI_P12\u003c/b\u003e; \u003cem\u003e\"I heard about family planning at the maternity center but have no interest in it because I don\u0026rsquo;t trust it.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P7\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAll these obstacles indicate that the greatest impediments to contraceptive uptake are misinformation, fear, social opposition and poor reproductive literacy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eTheme 5: Suggestions for Improving Family Planning Services\u003c/h2\u003e \u003cp\u003eThe participants suggested some measures that can be taken to increase FP awareness and autonomy. Education and sensitization programs, male involvement, engagement of the community leaders, and affordable and non-judgmental services were the most repeated recommendations.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eEducation and Awareness Programs\u003c/h2\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The government should provide more education and awareness programs about family planning.\u0026rdquo; \u0026ndash;\u003c/em\u003e \u003cb\u003eIDI_P1\u003c/b\u003e; \u003cem\u003e\"Sensitization and awareness are key to enabling reproductive autonomy among women.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P5\u003c/b\u003e; \u003cem\u003e\"Health workers need to provide detailed information and counseling about family planning options.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P2\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eInvolvement of Community and Religious Leaders\u003c/h2\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Community leaders should be involved in sensitizing people about the benefits of family planning.\u0026rdquo; \u0026ndash;\u003c/em\u003e \u003cb\u003eIDI_P3\u003c/b\u003e; \u003cem\u003e\"Involving religious and community leaders in these programs can help in gaining acceptance.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P4\u003c/b\u003e\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eAccessible and Affordable Services\u003c/h2\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Family planning services should be made more accessible and affordable.\u0026rdquo; \u0026ndash;\u003c/em\u003e \u003cb\u003eIDI_P8\u003c/b\u003e; \u003cem\u003e\"Family planning services should be more accessible and affordable for all women.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P7\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eInclusion of Men in Reproductive Health Education\u003c/h2\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Men should be included in reproductive health education to support family planning.\u0026rdquo; \u0026ndash;\u003c/em\u003e \u003cb\u003eIDI_P5\u003c/b\u003e; \u003cem\u003e\"When men are educated, they will support their wives in using family planning methods.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P6\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eNon-Judgmental and Supportive Counseling\u003c/h2\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Healthcare providers should offer family planning services without judgment or stigma.\u0026rdquo; \u0026ndash;\u003c/em\u003e \u003cb\u003eIDI_P10\u003c/b\u003e; \u003cem\u003e\"There should be no judgment or stigma from healthcare providers when women come for family planning services.\" \u0026ndash;\u003c/em\u003e \u003cb\u003eFGD_P8\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe viewpoints highlight the importance of multilevel interventions to encourage informed and independent reproductive decisions in women.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study examined the barriers of women in making decisions regarding their FP in Osun State, Nigeria. The results indicate that the general awareness of FP methods is high, but there are still significant gaps in the level of knowledge, attitudes, and autonomy all of which impact on reproductive choices of women.\u003c/p\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eSocio-Demographic Characteristics\u003c/h2\u003e \u003cp\u003eThe socio-demographic characteristics of the sample represent a cross-section of the female population being of reproductive age with the majority of them being 26\u0026ndash;35 years of age which is a time frame when most women make active decisions regarding childbearing and FP. This holds true with national results by Ajaero et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), which showed that there was the same pattern of age among Nigerian women within the reproductive age. The level of education was also fairly good at 56 percent of the respondents attended secondary school. It is not a new realization that education is a determinant of reproductive health awareness that affects the ability of women to make informed choices regarding contraception (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The fact that the majority of women were married (64) emphasizes the importance of the role of spouses and relatives in the reproductive autonomy that is in line with previous results by Feyisetan and Casterline (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Working conditions among the majority participants also indicate the necessity of workplace-based reproductive health services because economic autonomy can influence the contraceptive preferences and availability.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eKnowledge of Family Planning and Reproductive Autonomy\u003c/h3\u003e\n\u003cp\u003eMost of the respondents (94 percent) were familiar with the use of modern methods of contraceptives including pills, injectables, implants and IUD. This is relative to the 72.4% awareness of OlaOlorun and Hindin (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) in Ibadan meaning that there is gradual increase in the awareness levels in southwestern Nigeria. The study did not reveal in-depth knowledge about long-acting reversible contraceptives and the misunderstanding of side effects, however, the trend has been reported by Blackstone and Iwelunmor (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), who detected the same gap in the knowledge of Nigerian women. The health facilities and antenatal sessions were mentioned as the main sources of information by the majority of participants, which highlights the core of the health system in the FP communication. However, asymmetrical information sharing and inconsistent counselling were also noted, which is why there is a necessity to improve the community outreach and unify the content of FP education. Whereas other people were conversant with the concept of reproductive autonomy, some people had never heard of this term, which points to the fact that autonomy is a poorly discussed facet of reproductive health on a grassroots level.\u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003eAttitudes towards Family Planning\u003c/h2\u003e \u003cp\u003eThe perceptions of FP were ambivalent as they depended on the subjective experience, perceived health risk, cultural expectations and religious doctrines. A majority of the interviewees were positive since they recognized the role of FP in enhancing maternal and child health and family well-being - the same as Okigbo et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). But still negative perceptions were present especially the fear of infertility, hormonal imbalance, and long-term health complication. Such misunderstandings still play roles of creating reluctance, as also cited by Oye-Adeniran et al. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The repetitive influences were the culture and religious beliefs. In societies where using contraceptives was viewed as defiant of religion, women would either shun FP altogether or find the secret usage method. This is congruent with the documented findings of Feyisetan and Casterline (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) who wrote that religious opposition has been a consistent hindrance to the acceptance of contraceptives in Nigeria.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eReproductive Autonomy and Decision-Making\u003c/h2\u003e \u003cp\u003eThe result states that reproduction choices made by women depend on various social strata such as husbands, peers, elders in community, and religious authorities. Even though some ladies made their own choices about the use of FP, many of them reported low autonomy because of patriarchal expectations. The spousal authority in decisions on contraceptives is corroborated with the findings of OlaOlorun and Hindin (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) who assert that the decisions about reproduction in southwestern Nigeria are controllable by men. Women with supportive partners responded better to contraceptives with confidence and those in restrictive relationships would either resort to secrecy or shun FP altogether. The power of the community norm and elder judgment was also high especially in rural or religion-based context. These results support the point that advocating reproductive freedom in Nigeria needs to empower women, as well as involve men, families and communities in more social transformation.\u003c/p\u003e \u003cdiv id=\"Sec33\" class=\"Section3\"\u003e \u003ch2\u003eBarriers to Family Planning\u003c/h2\u003e \u003cp\u003eAccording to the participants, the primary obstacles to the uptake of FP were the fear of side effects, misinformation, and sociocultural opposition. Previous studies have reported fear of side effects, including fear of weight gain, menstrual irregularities, or infertility to be one of the biggest deterrents to using contraceptives in Nigeria (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Popular myths and misconceptions such as the erroneous assumptions about the safety and efficacy of contraceptives have also been cited as a major obstacle hindering the uptake of family planning strategies by women (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). It has been demonstrated that sociocultural resistance, such as disapproval of partners, societal standards, and beliefs, are very potent in affecting reproductive autonomy and restricting the uptake of FP among women in such environments (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe myths regarding infertility, cancer, and moral wrongdoing are quite popular, which is also reported by Oye-Adeniran et al. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) and Afolabi et al. (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). In addition, the challenges in access such as cost of transport, fluctuating supply of commodities, and bias by the provider were indicated as hindrances. All of these are factors that limit women in their capacity to make free informed choices concerning reproductive matters. The view that FP violates cultural or religious beliefs highlights the good role of contextual health communication techniques. According to Okonkwo et al. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), it can be observed that myths can be effectively busted as faith-based and community-sensitive education bring more acceptance.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section3\"\u003e \u003ch2\u003eSuggestions for Improving Family Planning Services\u003c/h2\u003e \u003cp\u003eThey highlighted five important interventions as a result of the discussions, which included lifelong learning and sensitisation, incorporation of community and religious leaders, men inclusion in reproductive health dialogues, better access and affordability of services, and absence of judgmental provider attitudes. These recommendations are consistent with those provided by Sedgh et al. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), who emphasized the need to have culturally sensitive FP education and involvement. The importance of male involvement was especially highlighted, which confirms the results by Moronkola and Fakeye (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), who attributed the positive attitudes of the partners towards increased contraceptive use. Another theme resonating the motive expressed by the participants is the call to have the approachable and respectful service delivery that Izugbara et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) observed to be a significant benefit in terms of reproductive autonomy. In general, the findings are indicative of a community that is conscious but bound, educated but restricted by the social cultural reality. Awareness coupled with willingness and prevailing systemic barriers offer a challenge and an opportunity to interventions on reproductive health in Osun State.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThe research is helpful in understanding the knowledge, attitudes, and independence of women in Osun State, Nigeria on FP. The results indicate that there is good awareness and overall positive attitudes towards using contraceptives, but there are still barriers that persist in the form of misinformation, cultural and religious resistance, dominance of spouses, and limited accessibility of services that prevent successful use. Marital status and educational attainment proved to be crucial factors, and it implies that the intervention should be gender-sensitive and socio-culturally oriented. Women who had higher education were more autonomous and accurate in their knowledge, whereas married women frequently had to bargain FP decisions in patriarchal frames. The evidence points to the need of multilevel approaches that are focused on individual, relational, and systemic factors at the same time. Enhancement of health learning, promotion of male participation, availability of uniform service delivery and incorporation of community-based advocacy may all enhance reproductive autonomy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; FP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFamily Planning\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; FGD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFocused Group Discussions\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; IDI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIn-Depth Interviews\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; LGA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLocal Government Areas\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ethical guidelines of the Declaration of Helsinki, when conducting research with human subjects, were to be observed in the study. The Health Research Ethics Committee (HREC) of the College of Health Sciences, Osun State University, gave the ethical approval (Ref: HREC/2024/PBH/070). Proper authorization was also acquired before data collection to the concerned local authorities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets (all transcripts) analyzed during the current study are available from the corresponding author on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo competing interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIA conceptualized the research and wrote the first draft of the manuscript, while all authors (IA, CA \u0026amp; SOO) reviewed, edited, and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to sincerely acknowledge the contributions of Ogundare Bolawale Marvellous for her invaluable assistance in data collection, transcription, and preliminary analysis. Her dedication and support were instrumental to the successful completion of this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eUnited Nations Population Fund (UNFPA). State of World Population 2019: Unfinished business\u0026mdash;the pursuit of rights and choices for all. New York: UNFPA; 2019.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization (WHO). Family planning/Contraception. Geneva: WHO; 2023.\u003c/li\u003e\n\u003cli\u003eIzugbara CO. Socio-cultural barriers to women\u0026rsquo;s reproductive autonomy in sub-Saharan Africa. Reprod Health Matters. 2015;23(45):155\u0026ndash;62.\u003c/li\u003e\n\u003cli\u003eUNICEF. Adolescent fertility and reproductive health in sub-Saharan Africa. New York: UNICEF; 2022.\u003c/li\u003e\n\u003cli\u003eNational Bureau of Statistics (NBS). Demographic and Health Survey 2021. Abuja: NBS; 2021.\u003c/li\u003e\n\u003cli\u003eNational Population Commission (Nigeria), ICF. \u003cstrong\u003eNigeria Demographic and Health Survey 2023\u0026ndash;24: Key indicators report\u003c/strong\u003e. Abuja: National Population Commission; 2025. Available from: https://www.dhsprogram.com/pubs/pdf/PR157/PR157.pdf\u003c/li\u003e\n\u003cli\u003eAgbana BE, et al. Modern contraceptive use among women in Nigeria: Determinants and regional variations. BMC Public Health. 2023;23:1110.\u003c/li\u003e\n\u003cli\u003eNational Population Commission (NPC). Nigeria Demographic and Health Survey 2018. Abuja: NPC; 2019.\u003c/li\u003e\n\u003cli\u003eWHO. Family planning and reproductive rights in sub-Saharan Africa. Geneva: WHO; 2020.\u003c/li\u003e\n\u003cli\u003eCleland J, Bastin S. The cultural context of fertility control in Africa. Stud Fam Plann. 2014;45(2):105\u0026ndash;21.\u003c/li\u003e\n\u003cli\u003eUpadhyay UD, et al. Development and validation of a reproductive autonomy scale. Stud Fam Plann. 2014;45(1):19\u0026ndash;41.\u003c/li\u003e\n\u003cli\u003eSen A. Gender and cooperative conflicts. In: Persistent inequalities. Oxford: Clarendon Press; 2019.\u003c/li\u003e\n\u003cli\u003eWorld Bank. Investing in women\u0026rsquo;s reproductive health. Washington DC: World Bank; 2018.\u003c/li\u003e\n\u003cli\u003eGuttmacher Institute. Adding it up: Investing in sexual and reproductive health 2020. New York: Guttmacher Institute; 2020.\u003c/li\u003e\n\u003cli\u003eWambua SM, et al. Determinants of family planning use in sub-Saharan Africa: A systematic review. Glob Health Sci Pract. 2018;6(4):748\u0026ndash;59.\u003c/li\u003e\n\u003cli\u003eSingh S, Darroch JE. Adding it up: The costs and benefits of contraceptive services. Guttmacher Institute and UNFPA. 2014.\u003c/li\u003e\n\u003cli\u003eBlanc AK, et al. The role of gender norms in shaping reproductive health behaviors in Africa. Glob Public Health. 2018;13(4):505\u0026ndash;19.\u003c/li\u003e\n\u003cli\u003eWoulibijnen J, et al. Barriers to family planning in Nigeria: a systematic review. Afr J Reprod Health. 2018;22(3):123\u0026ndash;34.\u003c/li\u003e\n\u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. \u003cem\u003eQual Res Psych\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e 2006;3(2):77\u0026ndash;101. https://doi.org/10.1191/1478088706qp063oa\u003c/li\u003e\n\u003cli\u003eAjaero CK, Odimegwu CO, Ajaero ID, Nwachukwu CA. Access to mass media messages, and use of family planning in Nigeria: a spatio-demographic analysis from the 2013 DHS. \u003cem\u003eBMC Public Health.\u003c/em\u003e 2016;16(1):1\u0026ndash;10.\u003c/li\u003e\n\u003cli\u003eOnwujekwe O, Uguru N, Etiaba E, Chikezie I, Uzochukwu B, Adjagba A. The economic burden of abortion in Nigeria: A cost\u0026ndash;effectiveness analysis of unsafe abortion prevention. \u003cem\u003eBMC Health Serv Res.\u003c/em\u003e 2019;19(1):1\u0026ndash;12.\u003c/li\u003e\n\u003cli\u003eFeyisetan B, Casterline JB. Fertility preferences and contraceptive change in developing countries. \u003cem\u003eInt Fam Plan Perspect.\u003c/em\u003e 2019;45(2):67\u0026ndash;77.\u003c/li\u003e\n\u003cli\u003eOlaOlorun F, Hindin MJ. Having a say matters: Influence of decision-making power on contraceptive use among Nigerian women ages 35\u0026ndash;49 years. \u003cem\u003ePLoS One.\u003c/em\u003e 2014;9(6):e98702.\u003c/li\u003e\n\u003cli\u003eBlackstone SR, Iwelunmor J. Determinants of contraceptive use among Nigerian couples: evidence from the 2013 Demographic and Health Survey. \u003cem\u003eContracept Reprod Med.\u003c/em\u003e 2017;2(1):9.\u003c/li\u003e\n\u003cli\u003eOkigbo CC, Speizer IS, Corroon M, Gueye A. Exposure to family planning messages and modern contraceptive use among men in urban Kenya, Nigeria, and Senegal: a cross-sectional study. \u003cem\u003eReprod Health.\u003c/em\u003e 2015;12(1):63.\u003c/li\u003e\n\u003cli\u003eOye-Adeniran BA, Adewole IF, Umoh AV, Oladokun A, Gbadegesin A, Ekanem EE, et al. Community-based study of contraceptive behaviour in Nigeria. \u003cem\u003eAfr J Reprod Health.\u003c/em\u003e 2016;20(2):75\u0026ndash;85.\u003c/li\u003e\n\u003cli\u003eAfolabi BM, Ezedinachi EN, Wagbatsoma VA, Eze S, Ezeanolue EE. Influence of spousal communication on family planning practices among couples in Nigeria. \u003cem\u003eJ Biosoc Sci.\u003c/em\u003e 2015;47(6):702\u0026ndash;716.\u003c/li\u003e\n\u003cli\u003eOkechukwu EF, Akinola OI, Balogun MR, Afolabi OT. Access and barriers to contraceptive use among rural women in Nigeria. \u003cem\u003eAfr J Prim Health Care Fam Med.\u003c/em\u003e 2017;9(1):e1\u0026ndash;e6.\u003c/li\u003e\n\u003cli\u003eSedgh G, Ashford LS, Hussain R. Unmet need for contraception in developing countries: examining women\u0026rsquo;s reasons for not using a method. \u003cem\u003eGuttmacher Institute Report.\u003c/em\u003e 2016;1\u0026ndash;36.\u003c/li\u003e\n\u003cli\u003eMoronkola OA, Fakeye OO. Male involvement in family planning decisions and practices among married men in Ibadan, Nigeria. \u003cem\u003eAfr J Reprod Health.\u003c/em\u003e 2018;22(4):44\u0026ndash;54.\u003c/li\u003e\n\u003cli\u003eIzugbara CO, Egesa CP, Kabiru CW. Service availability and readiness for family planning in Nigeria: implications for the Sustainable Development Goals. \u003cem\u003eBMC Health Serv Res.\u003c/em\u003e 2016;16(1):1\u0026ndash;9.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Reproductive autonomy, Family planning, Women’s health, Contraceptive use, Nigeria, Gender norms","lastPublishedDoi":"10.21203/rs.3.rs-8473968/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8473968/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDespite significant efforts to expand access to family planning services, women still encounter obstacles to practicing reproductive autonomy in Nigeria. The achievement of universal access to reproductive health care requires recognition and comprehensive understanding of the multifaceted factors that undermine women\u0026rsquo;s ability to make informed reproductive decisions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis qualitative research investigated the experiences, perceptions and issues of family planning access and choice by the women in Osun state, Nigeria. Focus group discussions and in-depth interviews (IDIs) were used in this study. A sample of 25 women in the reproductive age was chosen in Osogbo, Olorunda and Egbedore Local Government Areas. Audio tapes were made of interviews, transcribed, translated thematically and analyzed. Themes and subthemes were created and they were supplemented with illustrative quotes.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere were five themes, which included - Knowledge of family planning and Autonomy; Attitudes towards family planning; Reproductive Autonomy; Barriers to family planning; and Recommendations for Improving Reproductive Autonomy. Results indicated that the level of awareness regarding family planning was high, but misconceptions and sociocultural constraints were limiting adoption. Dominance by partners, religious and cultural values, and other health system issues also limited the reproductive options. Women realized that they needed community education to be inclusive, spouse support, and quality services.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIntersecting individual, socio-cultural, and systemic factors influence women to have reproductive autonomy in Osun State. The interventions should be aimed at education, male participation, and health system empowerment to make sure that there is an equal access to family planning and reproductive rights.\u003c/p\u003e","manuscriptTitle":"Barriers to Reproductive Autonomy: Understanding Family Planning Access and Choice Among Women of Reproductive Age in Osun State, Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-11 06:07:37","doi":"10.21203/rs.3.rs-8473968/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-03-15T23:04:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"135581468569938867047585429374692155213","date":"2026-03-11T21:08:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-05T16:10:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-04T12:38:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-06T10:49:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-04T11:49:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2026-02-04T11:29:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1d173a15-c06f-4d47-acd0-e2c0eb17ce1a","owner":[],"postedDate":"March 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-11T06:07:37+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-11 06:07:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8473968","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8473968","identity":"rs-8473968","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}