|Year : 2016 | Volume
| Issue : 3 | Page : 327-331
The social class and reasons for grand multiparity in Calabar, Nigeria
CI Emechebe, CO Njoku, EM Eyong, K Maduekwe, JT Ukaga
Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
|Date of Web Publication||8-Feb-2017|
C I Emechebe
Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Calabar, Cross River State
Source of Support: None, Conflict of Interest: None
Background: Grand multiparity is a high-risk pregnancy, and it is a common phenomenon in this part of the world, and when added to low socioeconomic status, it significantly increases obstetrics risk to mother and fetus.
Objective: To determine the social class and reasons for grand multiparity in Calabar.
Materials and Methods: This prospective cross-sectional study was carried out in the Department of Obstetrics and Gynaecology of the University of Calabar Teaching Hospital, Calabar. The study comprised 150 grand multiparous women who were admitted for delivery and consented to the study during the period. The social class, educational level, and reasons for grand multiparity were determined. The data obtained were collated and analyzed using SPSS version 18.
Results: The incidence of grand multiparity in this study is 8.7%, and most grand multiparous women belong to low social class 63 (42.0%). Grand multiparity was higher among women with primary education, polygamous marriage, and traders. Gender desirability (31.3%) was the most common reason for grand multiparity followed by desire for more offspring to maintain large family size (16.7%).
Conclusion: This study showed that the incidence of grand multiparity is still high in our environment, and the reasons were complex, multiple, interrelated but preventable. Health awareness on the dangers of grand multiparity, reorientation of our long-held culture of gender preference, female education, and economic empowerment will help women to discard wrong sociocultural and religious beliefs.
Keywords: Calabar; gender preference; grand multiparity; Nigeria; social class.
|How to cite this article:|
Emechebe C I, Njoku C O, Eyong E M, Maduekwe K, Ukaga J T. The social class and reasons for grand multiparity in Calabar, Nigeria. Trop J Obstet Gynaecol 2016;33:327-31
|How to cite this URL:|
Emechebe C I, Njoku C O, Eyong E M, Maduekwe K, Ukaga J T. The social class and reasons for grand multiparity in Calabar, Nigeria. Trop J Obstet Gynaecol [serial online] 2016 [cited 2020 Apr 5];33:327-31. Available from: http://www.tjogonline.com/text.asp?2016/33/3/327/199808
| Introduction|| |
Grand multiparity is a common feature of many African societies, and women have many children for various sociocultural and gender reasons.,, Much premium is placed on procreation as children are held as blessings from God and for maintaining family lineage. Marriage is usually for childbearing purposes, and a woman stabilizes her marriage by having many children.,,, This feature in African society is compounded by early marriage in some societies and poor acceptance of modern family planning methods., The prevalence of 10.2% was reported in Kano  and 6.1% was reported in Ibadan  in South-west Nigeria. In developed countries, grand multiparity is becoming rare and has a lower prevalence of 3%–4% of all births., Lower prevalence is usually found where there is a high level of education and increased uptake of family planning as well as promotion of gender equity.
In most African settings, the social status of a woman is bound to the number of children; she had particularly male children. Nassar et al. found that grand multiparity was associated with low socioeconomic status. Since high parities were found to be more common in the lower socioeconomic groups with low income, the nutritional and health status of these mothers will be compromised, and there is a limitation in their ability to contact health facility with attendant complications. Olusanya et al. classified social class into high (class I and II), medium (class III), and low (class IV and V) based on the husband's profession and the woman's educational status. Pregnancy outcome has been shown to be poorer among women of low social class, and these poor outcomes are worsened by complications of grand multiparity. Complications of pregnancy reported among grand multiparous women include hypertension in pregnancy, anemia, placenta previa, malpresentation, fetal macrosomia, postpartum hemorrhage, and operative deliveries with its consequent risk of maternal morbidity and mortality.
Several reasons have been given for grand multiparity in different regions, and the reasons vary., Obiechina et al. in their study showed that poor usage of family planning and desire for a male child were major reasons for grand multiparity. Furthermore, Kuti et al. revealed that the desire for large family size and loss of previous offspring were the main reasons for grand multiparity. Other reported reasons for grand multiparity which stem from the prevalent cultural or traditional beliefs are child replacement phenomenon (i.e. to replace unforeseen future childhood death), competitive childbearing (to outdo co-spouses in polygamous settings), attainment of perceived reproductive potentials, and misconception about the cause of pathologies of the female reproductive tract such as fibroid.
The reports on the reasons for grand multiparity are conflicting even in the same region, and this study in our center will make input on the subject. With the high rate of grand multiparity in developing countries and associated reported complications, it is important to determine the magnitude and reasons for grand multiparity in Calabar for the purpose of prevention and health planning. This study also offers an opportunity for contraceptive advice, counseling the women on the complication of grand multiparity, and suggests ways to reduce both its prevalence and complications.
| Materials and Methods|| |
This prospective cross-sectional study was carried out at the Obstetrics and Gynaecology Department of the University of Calabar Teaching Hospital (UCTH), Calabar, Cross River State. Calabar is comprised a heterogenous mix of diverse cultural, religious, and ethnic groups. UCTH is a tertiary health facility located in Calabar, South-south geopolitical area of Nigeria, and is also a referral center for both government and private hospitals within and outside the state.
These were grand multiparous pregnant women (para 5 and above) who presented in the Labor Ward of the hospital for delivery.
Exclusion criteria included those who refused to participate in the study.
After the approval by the hospital research and ethics committee, grand multiparous pregnant women who consented to participate in the study after counseling were recruited over a 7 months' period. On admission, patients' history was taken in details, and the case file reviewed. A pretested questionnaire was used for the collection of biodata, sociodemographic data, reasons for grand multiparity, and social class by the researcher and also by trained residents attached to the labor ward. The data were obtained and filled by direct questioning.
Frequencies and percentages were computed for presentation of all categorical variables of the study that included occupation, educational status, social class, and continuous data were reported as mean ± standard deviation. The data obtained were collated and analyzed using SPSS version 18 statistical program manufactured in 2009 by polar engineering and consulting, New York, USA. Statistical significance was taken at P <0.05.
| Results|| |
During the 7 months study period from March 1, 2015, to September 30, 2015, there were a total of 1898 deliveries, and 166 of these deliveries were grand multiparous women giving an incidence of 8.7% of total deliveries. Mean parity was 5.6 ± 0.9. Of the 166 grand multiparous women who delivered over the study period, 150 women qualified and consented to the study and used for the analysis.
[Table 1] shows the sociodemographic characteristics of the study population. The grand multiparous women were higher with lower educational levels, low social class, polygamous marriage, and traders.
[Figure 1] shows parity distribution of grand multiparous women in the study. Para 5 was highest 87 (58.0%) followed by para 6 with 42 (28.0%) while the least was para 10 with 1 (0.7%).
The reasons for grand multiparity were presented in [Table 2]. Gender desirability 47 (31.3%) was the most common reason for grand multiparity. Other reasons noted were varied including desire for more offspring for large family size 25 (16.7%), replacement of dead children 20 (13.3%), failed contraception 20 (13.3%), and 4 (2.7%) had no reason.
Among the grand multiparous women whose reason for grand multiparity were gender desirability, 37 (78.7%) desired male sex while 10 (21.3%) desired female sex [Figure 2].
| Discussion|| |
The prevalence of grand multiparity in the present study of 8.7% is high. This high incidence could be attributed to strong influence of prevailing cultural attachment for male child, desire for large families, high illiteracy or low educational level, low uptake of family planning, gender inequality, and high infant mortality common in developing countries. This incidence is higher than 7.53% reported in Awka, 6.4% in Uyo, and 4.8% in Ilorin, Nigeria  but lower than 9.4% in Lagos, Nigeria.
In this study, 42% of grand multiparous women belonged to low socioeconomic status (classes IV and V). This low social class among grand multiparous women has been observed by previous authors with 51.2% in Benin, 62% in Enugu, and 80.74% in Lagos. Low social class found among the grand multiparous women are usually associated with poverty, ignorance, low socioeconomic status, high perinatal, and infant mortality which may be an encouraging factor to produce more children. The low social status and level of education are also reflected in the occupation as 30.7% of grand multiparous women were traders and 20.0% were unemployed housewives. Grand multiparous women who are unemployed and of low social class are less likely to utilize contraceptive methods, likely to be unbooked, and present with complications of pregnancy such as anemia, intrauterine growth restriction, and stillbirth. The distribution of grand multiparous women in this study showed that the modal parity was para 5 (58.0%) while the least was para 10 (0.7%). This finding is consistent with a study in Pakistan; however, Eidelman et al. have reported the highest parity to be para 10.
The reason for grand multiparity in this study showed that desire for specific gender ranked highest as the main reason for grand multiparity (31.3%) in our center. This was similar to previous work by Obiechina et al. at Nnewi  but lower than 14.8% by Kuti et al. at Ondo  and 19.7% by Adeniran et al. at Ilorin. This showed that specific gender plays important role in ensuring self-esteem, women confidence, cement marriage, family unity, and stability in our locality. Among the respondents who revealed that specific gender was their reason for grand multiparity, desire for male sex was most common with 78.7% while female sex was 21.3%. This reflects the high premium on male child preference permitted by our cultural norms with the aim of perpetuation of the family name, lineage, family inheritance, male chauvinism, and preservation of marriages. This cuts across all social status and levels of education. The preference for male sex in this study may be more of a reflection of the impact of the other tribes in this study as the predominant tribe in Calabar, the “Efiks” place high premium on the girl child as their culture permits female inheritance. Another strong reason for grand multiparity was desire for more offspring (16.7%) for large family size. Large family size is a norm in many traditional African societies, and much premium is placed on procreation as children are held as blessings from the creator and basic to maintaining family lineage. This is similar to the study by Kuti et al. (25.9%) and Adeniran et al. (33.3%). Change of spouse (11.3%) is another important reason for grand multiparity in this locality. This may be due to death of the previous husband and increasing rate of marriage separation or divorce in our environment., In our locality women prefer to remarry irrespective of the number of separations or divorce, they had in the past, and this predisposes them to having more children to cement their new marriage. The reason may be for protection under their husband, cultural, and social reasons. A total of 2.7% of respondents had no reason for grand multiparity. It is surprising that some women mistake pregnancy and delivery as a way of life and gift from God just to fulfill their reproductive potentials without the knowledge of the consequences of grand multiparity. It has been shown in a study by Umoh and Abah in Uyo that very few of the women (12.5%) are aware of the specific dangers associated with grand multiparity, and this is indeed worrisome. This group of women usually does not utilize any form of contraceptives and usually continued delivery until after their reproductive age or complication occurs. Majority of the reasons for grand multiparity as noted in this study were culturally related (desire for specific gender, large family size) and social factors (spouse change, competition amongst wives). This reveals enormous influence of cultural and social factors in childbearing in our environment with high fertility rate and attendant grand multiparous status. These factors are compounded by low contraceptive prevalence rate in Nigeria of 11%–13%, much lower than the rate in developed countries. Hence, in the countries where the socioeconomic status of women is high and there is a high standard of antenatal and perinatal care, high parity is no longer considered a risk marker for perinatal complications  as against the finding in this study.
| Conclusion|| |
The study revealed that grand multiparity is still common in our region. The grand multiparity was higher among women with lower educational levels, low social class, and polygamous marriage. Gender desirability was the most common reason for grand multiparity followed by desire for more offspring for large family size. The reasons for grand multiparity were complex, multiple, interrelated but preventable. Increased modern, accessible, and effective contraceptive services as well as increased mobilization and awareness of our people on the dangers of grand multiparity through the media, including the male partners, especially in the face of the prevailing harsh economic conditions will reduce grand multiparity. Furthermore, health awareness on the obstetric and social dangers of grand multiparity and vigorous campaigns as well as reorientation of our long-held culture of male child preference and love for large families is also necessary. Improvement on female education, economic empowerment of women, and promotion of gender equality will help women to improve on their social status and discard wrong sociocultural and religious beliefs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Okogbenin SA, Okpere EE. Parity and reproductive outcome. In: Okpere EE, editor. Clinical Obstetrics Revised Edition. Nigeria: Uniben Press Ltd., University of Benin; 2004. p. 401-2.
Omole-Ohonsi A, Ashimi AO. Grand multiparity: Obstetric performance in Aminu Kano Teaching Hospital, Kano, Nigeria. Niger J Clin Pract 2011;14:6-9.
Ogedengbe OK, Ogunmokun AA. Grandmultiparity in Lagos, Nigeria. Niger Postgrad Med J 2003;23:216-9.
Odukogbe AA, Adewole IF, Ojengbede OA, Olayemi O, Fawole BO, Ahmed Y, et al.
Grandmultiparity – Trends and complications: A study in two hospital settings. J Obstet Gynaecol 2001;21:361-7.
Joseph A, Ayuba I, Jeremiah I. Grandmultiparity: Incidence, consequence and outcome in the Niger Delta of Nigeria. Open J Obstet Gynaecol 2013;3:509-13.
Afolabi AF, Adeyemi AS. Grand-multiparity: Is it still an obstetric risk? Open J Obstet Gynaecol 2013;3:411-5.
Ozumba BC, Igwegbe AO. The challenge of grandmultiparity in Nigerian obstetric practice. Int J Gynaecol Obstet 1992;37:259-64.
Ojenuwah SA. Obstetric outcome in grandmultiparae in Bida North Central Nigeria. Trop J Obstet Gynaecol 2006;23:27-9.
Centers for Disease Control and Prevention. National Center for Health Statistics: NCHS Definitions. National Survey of Family Growth; 2004.
Bai J, Wong FW, Bauman A, Mohsin M. Parity and pregnancy outcomes. Am J Obstet Gynecol 2002;186:274-8.
Nassar AH, Fayyumy R, Saab W, Mehio G, Usta IM. Grandmultiparas in modern obstetrics. Am J Perinatol 2006;23:345-9.
Olusanya O, Okpere E, Ezimokhai M. The importance of social class in voluntary fertility control in a developing country. West Afr J Med 1985;4:205-11.
Munim S, Rahbar MH, Rizvi M, Mushtaq N. The effect of grandmultiparity on pregnancy related complications: The Aga Khan University experience. J Pak Med Assoc 2000;50:54-8.
Umeora OJ, Nzerem UN, Eze JN. What drives grand multiparous women in rural Nigeria to seek treatment for infertility. Afr J Med Health Sci 2013;12:15-9.
Holmes HB. Choosing children's sex: Challenges to feminist ethics. In: Callahan JC, editor. Reproduction, Ethics and the Law: Feminist Perspectives. Bloomington: Indiana University Press; 1995. p. 148-77.
Obiechina NJ, Ugboaja JO, Ezeama CO. Grandmultiparity; reasons for index pregnancy. Trop J Med Res 2008;12:34-8.
Kuti O, Dare FO, Ogunniyi SO. Grandmultiparity: Mother's own reasons for the index pregnancy. Trop J Obstet Gynaecol 2001;18:31-5.
Ikeako LC, Nwajiaku L. Grandmultiparity: Experience at Awka, Nigeria. Niger J Clin Pract 2010;13:301-5.
Abasiattai AM, Utuk NM, Udoma EJ, Umoh AV. Grandmultiparity: Outcome of delivery in a tertiary hospital in Southern Nigeria. Niger J Med 2011;20:345-8.
Omokanye LO. Obstetric outcome of grandmultiparous women in Ilorin, Nigeria: A five year review. Niger J Health Sci 2012;12:16-9.
Nnatu SN, Lawal SO. High parity in Nigeria: Problems and solutions. Trop J Obstet Gynaecol 1991;9:28-31.
Gharoro EP, Igbafe AA. Grandmultiparity: Emerging trends in a tropical community. Trop J Obstet Gynecol 2001;18:27-30.
Eze JN, Okaro JM, Okafor MH. Outcome of pregnancy in the grandmultipara in Enugu, Nigeria. Trop J Obstet Gynaecol 2006;23:8-11.
Eidelman AI, Kamar R, Schimmel MS, Bar-On E. The grandmultipara: Is she still a risk? Am J Obstet Gynecol 1988;158:389-92.
Adeniran AS, Fawole AA, Fakeye OO. Grandmultiparity: Reason for index pregnancy, contraception and relation to millennium development goals. East Cent Afr Med J 2014;1:3-7.
Azubuike JI, Ibrahim IA, Israel J. Grandmultiparity: Incidence, consequences and outcome in Niger Delta of Nigeria. Open J Obstet Gynaecol 2013;3:509-13.
Umoh AV, Abah GM. Hazards of high parity: Do the women know? Findings from Uyo, Nigeria. Glob Res J Med Sci 2012;2:9-12.
Bugg GJ, Atwal GS, Maresh M. Grandmultiparae in a modern setting. Br J Obstet Gynaecol 2002;109:249-53.
[Figure 1], [Figure 2]
[Table 1], [Table 2]