Highlights:
What is current knowledge?
Knowledge about contraceptive use is often high but the practice is often impeded by different factors
What is new here?
Healthcare interventions that promote translation of knowledge into healthy sexual and reproductive health practices should be adopted on matters relating to family planning. Religious backgrounds play active role in choosing contraceptive method.
Introduction
 Family planning allows individuals and couples to achieve their desired number of children and determine the spacing of pregnancies through the use of contraceptives and infertility treatment (1). Increased access to contraceptives is key in improving maternal health outcomes. Therefore, contraception is an excellent method for reducing maternal mortality and morbidity (2).
Despite the benefits of contraception, women of reproductive age in Nigeria still have a limited range of methods to choose from and this has forestalled the ability to meet the reproductive health rights of women (3) Nigeria remains as one of the most populous countries in the Sub-Saharan Africa with a high total fertility rate of 5.5-5.7 for women of reproductive age (15–49 years). Meanwhile, 16% of the women in the country reported of unmet need for family planning service (4). A low rate of contraceptive use (17%) has also been recorded among married women (aged 15 to 49 years) in Nigeria. In addition, only 12% of women were reported to use modern contraceptive methods (5).
As in other parts of the world, the modern methods of contraception used in Nigeria include male and female condoms, oral pills, injectable contraceptives, intrauterine contraceptive device (IUCD), implants and male and female sterilization methods (3,6,7). However, the preferred method of contraception may vary depending on the level of the healthcare facility, education level, geopolitical zone and place of residence (8,9) Healthcare facilities in Nigeria are still not able to offer all types of contraceptives,6 which implies that clients have a limited range to choose from. This in turn decreases the likelihood for individuals to choose the method they truly desire (10).
Previous studies reported that choosing the method of contraception relies on availability, affordability and accessibility of the methods as well as couples’ education level, traditions, religion, culture, health status, number of children and socio-economic status (11-15) In Nigeria, women’s choice of contraceptives is hindered by traditional and cultural beliefs (16). A study conducted in the Niger Republic also stated that cultural norms directly impact contraceptive choice among women (17).
Given the significant effect of method of contraception on fertility and national health (9,18) this study aimed to identify factors affecting contraceptive decision-making among Nigerian women. The results of this study could help determine appropriate interventions for helping women in contraceptive decision-making, which in turn would contribute to reaching the target 3.7 of the sustainable development goals, which is to ensure universal access to sexual and reproductive health-care services (19).
Methods
This descriptive cross-sectional study was carried out among women of reproductive age (15-45 years) who visited the family planning clinic at the Lagos State University Teaching Hospital between December, 2019 and March, 2021. Inclusion criteria included age of 15-45 years and willingness to participate in the study. Overall, 200 eligible women were recruited through convenience sampling. The sample size was calculated using the Taro Yamane formula (20) where n, N and e represent sample size, population size and sampling error, respectively.
Data were collected using a demographic information form and a self-structured questionnaire consisting of 32 closed-ended questions related to knowledge about family planning methods (n=9), the choice of contraceptives (n=8) and factors influencing the choice of family planning (n=15). A score of ≥16, 8-15 and ≤7 indicated good, moderate and limited level of knowledge. Content and face validity of the instrument were verified by the researchers and experts in the field. Reliability of the instrument (internal consistency) was tested on 20 (10% of the sample size) women of reproductive age at the Babcock University Teaching Hospital (BUTH). The instrument was considered reliable with a Cronbach alpha values of 0.76, 0. 82 and 0.77 for each section of the questionnaire.
Data were analyzed using descriptive and inferential statistics. Correlation between study variables was evaluated using the Pearson correlation coefficient. All statistical analyses were carried out in SPSS (version 23) and at statistical significance level of 0.05.
Results
 The majority of subjects belonged to the Yoruba tribe (51.7%), had tertiary education (46.1%) and were married (44.4%) (Table 1) As shown in table 2, most women (82.8%) had good knowledge about contraceptives. The most commonly used methods of contraception were birth control pills (38.3%) and implants (36.1%), while the least commonly used methods were tubal ligation (29.4%) and withdrawal (29.4%) (Table 3).
Most respondents believed that cultural factors, level of education and religion affected the type of contraceptives used for family planning. Moreover, 84.4% of the subjects indicated that fear of injury incurred from contraceptive usage would influence their choice of contraceptives (Table 4).

DISCUSSION
The choice of contraceptives was significantly correlated with level of knowledge (r=-0.564, p=0.001) and religion (r=-0.173, p=0.020) of the subjects.
In our study, the majority (32.8%) of the respondents were 26-35 years old. In line with this finding, a previous study reported that most women seeking contraception were in the 24-34 years age group (21). Most of the participants in our study had good knowledge about contraceptives, which could be related to the high level of education among subjects. Similarly, a previous study revealed that 89.2% of women had good knowledge of contraceptives (22). However, only 12.5% women of reproductive age in the Abia State, Nigeria had good knowledge about contraceptives, which was found to also affect the use of contraceptives (23). According to our subjects, parity, cultural or tribal beliefs, cost of the method, the distance of the clinic from place of residence and side effects of the methods were factors associated with contraceptive choice, which is in line with the results of a previous study (25) In some studies, cultural beliefs, social traditions, costs, accessibility and support from the husband were reported as the factors influencing contraceptive choice (11,26).
We found that choice of contraceptives was significantly correlated with the subjects’ religion and level of knowledge, which is in line with results of previous studies (3,8). Adeyemi et al. also found a significant association between women’s education level and the likelihood of choosing IUCD as the preferred method of contraception (3). A previous study also showed that cultural/religious beliefs may affect the contraceptive use and choice (25). It has been also shown that Catholics and Muslims are more likely to buy contraception methods from patent medicine shops and less likely to use modern contraceptives (27).
Limitations
This study was conducted in the urban area of Lagos State in Nigeria and may not completely reflect the opinions of the general population. Moreover, the truthfulness of the respondents’ opinions could not be fully ascertained. However, efforts were made by the researchers to present the topic and questionnaire as understandable as possible.
Conclusion
    Based on the results, factors such as religion, level of education and level of knowledge about of contraceptives and their side effects may affect the choice of contraceptives among women of reproductive age in Lagos State, Nigeria. Therefore, it is recommended to take necessary measures in order to educate women on the importance of family planning and mechanism of action of each method of contraception. Furthermore, counseling sessions should be offered at healthcare facilities to assist women in contraceptive decision making. Healthcare interventions that promote translation of knowledge into healthy sexual and reproductive health practices should be adopted. Finally, it is suggested to consider religious backgrounds when providing prenatal care.
Acknowledgements
  We will like to extend our gratitude to  all participants for their cooperation in this research.

Funding source
There are no conflicts of interest to declare

Ethical statement
Ethical approval was obtained from the Babcock University Health Research Ethics Committee (BUHREC) with approval/certificate number: BUHREC794/19. The respondents were informed, and their consent was obtained before the copies of the questionnaire were administered. Written ethical permission was sought from each respondent, the same was granted before filling the questionnaire. The confidentiality of the respondents were maintained throughout and after the study.

Conflict of interest
The authors declare that there is no conflict of interest.

Author contributions
 All authors have contributed significantly to this study and the preparation of this manuscript and we agreed with its contents. The specific contributions include: Julius Maitanmi, Ogechukwu Okondu, and Simeon Olubiyi were involved in writing the background, literature review and the discussion of findings while Mary Tanimowo, Bukola Maitanmi, Yetunde Tola, Rafiat Akinokun, and Oluwadamilare Akingbade did the data collection and analysis. All the Authors contributed meaningfully to the writing and editing of the manuscript.