Assessment of Knowledge, Attitude and Practice of Family Planning among Married Evangelical Women in six Evangelical Churches in Gulele Sub city, Addis Ababa


Master's Thesis, 2015

58 Pages, Grade: 3.0


Excerpt

Contents

Acknowledgements ii

List of Acronyms v

List of Tables and figures vi

Abstract vii

1. Introduction
1.1. Background and Statement of the problem
1.2. Rationale of the Study
1.3. Objectives of the study
1.3.1. General Objective of the study
1.3.2. Specific Objectives

2. Review of Literature
2.1. Religion and Family Planning
2.2. The Ethiopian Evangelical churches
2.2.1. Protestantism in Ethiopia
2.3. The Involvement of the Church in Family Planning Activities

3. Methodology
3.1. Study area
3.2. Study Design
3.3. Source Population
3.4. Study population
3.5. Inclusion criteria
3.6. Exclusion criteria
3.7. Sampling
3.7.1. Sample size determination
3.7.2 Sampling procedure
3.8. Data collection procedure
3.9. Variables of the study
3.9.1. Dependent (outcome) variables
3.9.2. Independent (Explanatory) Variables
3.10. Data Analysis
3.11. Ethical Consideration

4. Research Results, Findings and Discussion
4.1. Quantitative Data Result
4.1.1. Socio demographic information of the participants April, 2015. (n=164)
4.1.2. Results of the assessment of the knowledge of married evangelical women about family planning
4.1.3. Results of the assessment of the attitude of married evangelical women towards family planning
4.1.4. Results of the assessment of family planning practice of married evangelical women
4.2. Qualitative Data Result
4.2.1. General background of the church leaders interviewed
4.2.2. Church’s attitude towards family planning
4.2.3. Biblical and church teachings
4.3. Discussion
4.3.1. Knowledge about family planning
4.3.2. Practice of Family Planning
4.4. Strength and Limitation of the Study
4.4.1. Strength of the Study
4.4.2. Limitation of the study

5. Conclusion and Recommendation
5.1. Conclusion
5.2. Recommendation

Bibliography

Annexes

Annex 1. Participation consent form

Annex 2. English Questionnaire

Annex 3. Socio-Demographic Data of the Church leaders

Annex 4. Topic guide for in-depth interviews with church leaders

List of Acronyms

Abbildung in dieser Leseprobe nicht enthalten

List of Tables and figures

Table #1. Demographic data of the participants on April, 2015.

Table #2. Knowledge of married evangelical women about family planning

Table #3. Attitude of married evangelical women about family planning

Table #4. The practice of family planning among married evangelical women

Figure #1. Family planning methods known

Figure #2. Response on Bible and family planning

Figure #3. Using contraceptives and sin

Abstract

Introduction: Family is the basic element of the society and the church. To keep the well-being of the family, the members must be healthy. One way of attaining this is through planning family. Family planning is a means to control and decide the size of the family and spacing of children by using different methods. Addressing family health issues in the church allows the church to meet the needs of its members holistically.

Background: Globally of the 6.96 billion people, it is estimated that only 900 million women and their partners practice family planning. Women die due to the consequences of pregnancy related problems like bleeding, unsafe abortion, unwanted pregnancy, and obstructed labor. Many studies show that there is high unmet need in Africa where women live in poor conditions. It is believed that “contraceptive use and unmet need for family planning are keys to understanding profound changes in fertility and to improving reproductive health worldwide.” In Ethiopia the prevalence of family planning has 34% increase within the past 14 years. It is a good progress but a lot of work still needs to be done to increase this number to a significantly higher level.

Methodology and Objectives: Church based cross-sectional study conducted to assess the knowledge, attitude and practice of family planning among married evangelical women in selected evangelical churches and the views of the church leaders in Gulele sub-city, Addis Ababa with the objectives of to evaluate the knowledge, attitude and practice of family planning among evangelical married women and to understand/ describe the influence of the church doctrine/ teachings on marriage in shaping the views and usage of family planning services by the members.

Conclusion: w e can conclude that generally family issues including family health are not as such given due attention in the six evangelical denominations. There is an overall awareness of family planning by the married women and the church leaders. However, the perception of the leaders about contraceptives is rather shallow. The attitude of the married women and the church leaders towards family planning is somewhat positive. There is also not an immense difference of opinion regarding to the minor doctrinal variations of the denominations. Majority of the women do not know what the Bible says about family planning but the response of all of the leaders is that the Bible does not specifically speak about it. God-given conscience is best used to deal with issues like family planning. A widespread practice of planning the size of the family is seen, though some still perceive the practice of family planning sinful, reveals controversy. Besides, there is no policy or guide to follow in the churches to teach about family planning. All of the church leaders believed that there is a gap in fulfilling the mission of the church. That church should be actively involved concerning health matters and in addressing the human needs holistically.

Recommendation: The Church need to address the needs of family holistically than only focusing on the spiritual aspect of individuals and family. There is a need of preparing Bible based holistic teachings and sermons. Church should in a regular basis prepare teaching and training for married women about family planning by inviting health professionals. There should be clearly stated church policy, guide or manual concerning family planning. Church leaders need to have adequate knowledge and a wide scope of understanding about family planning so that they can give a better advice for the married women in the church. Evangelical married women should know better about the contraceptives in order to make their choice wisely and biblically.

1. Introduction

Family is one of the basic components of a nation, society and church. In order to have a productive society, and hence nation family members must be wholistically healthy. Health is a crucial factor for the betterment of the society which in turn affects the advancement of the Kingdom of God. Since health is “a complete physical, mental and social well-being, and not merely the absence of disease or infirmity”1 maintaining the wellbeing of the community is not only limited to the public health sector, but the integration and participation of every institution including religious organizations is crucial. Therefore, the involvement of the church is mandatory and important as its purpose is to serve its members and the community in all rounded aspects.

Reproductive Health is one key aspect in the health care that it is given attention at a global level. Nevertheless, it is not a single and simple goal as it derives its roots from various aspects like human rights, politics, policies, declarations, socio-economic condition, gender relations and so much more. Reproductive health includes reproductive rights which is “the rights of couples and individuals to decide freely and responsibly the number and spacing of their children, and to have the information and the means to do so while attaining the highest standard of sexual and reproductive health and making decisions free of discrimination, coercion or violence” into consideration.2 Hence, in order to reach global and national goals of reproductive health effective implementation of family planning is crucial.

Family Planning is “the scheduling to limit the size, when to have children, and the use of birth control and other techniques to implement such plans.” Methods of family planning include birth control, assisted reproductive technology and family planning programs.3 As a result, the purpose of family planning is to enable families plan their family size while putting their economy, labor division in the family, the care they would provide the children and much more.

Family planning has extensive benefits for sexual and reproductive health including enabling women to exercise choice and control over their fertility, reducing maternal morbidity and mortality, reducing the risk of Sexually Transmitted Infections including HIV transmission, advancing gender equality, and increasing women’s opportunities for education, employment and full participation in society,4 and reduces the need for unsafe abortion.5

Women are the backbones of the nucleic family and the community they belong to. Addressing issues that affect their lives within the context of religion, specifically in the church will in turn add value to the society. Therefore, effective understanding and use of family planning methods helps to rework on the gender construct and bring about gender equity.

This study focuses on the assessment of knowledge, attitude and practice of Evangelical believers in regard to contraceptives as they are part of Family planning. Contraceptive methods can be classified as modern and traditional or natural and artificial. They differ in efficiency, effectiveness and mode of actions.6 The modern methods include Combined oral contraceptives (COCs) or “the pill”, progestogen-only pills (POPs) or "the minipill", implants, progestogen only Injectables, monthly Injectables or combined Injectable contraceptives (CIC)intrauterine device (IUD), levonorgestrel, male condoms, male sterilization (vasectomy), female sterilization (tubal ligation), lactational Amenorrhea Method (LAM), emergency contraception (levonorgestrel 1.5 mg) and the traditional methods (NFP) are withdrawal (coitus interruptus) and fertility awareness methods (natural family planning or periodic abstinence).7

1.1. Background and Statement of the problem

So far, various studies have been carried out concerning family planning both worldwide and locally. Globally of the 6.96 billion people, it is estimated that only 900 million women and their partners practice family planning.8 It is believed that “contraceptive use and unmet need for family planning are keys to understanding profound changes in fertility and to improving reproductive health worldwide.”9

The unmet need of contraception is high in sub-Saharan Africa and in Ethiopia. The economic status of women is an important factor, that is, poor women reported an unmet need of 32 percent compared to 15 percent among wealthy women.10

In Ethiopia, most women living in urban or city like Addis Ababa are more familiar with family planning and the prevalence of married women has increased from 6 percent in 2000 to 40 percent in 2014.11 This increment of 34% in 14 years is a good progress but a lot of work still needs to be done to increase this number to a significantly higher level.

Our country is in the process of development. However maternal mortality, an important indicator of the development of a country, is still high with maternal mortality ratio of 676 per 100,000 births in 2010/11.12

Moreover women’s participation and use of family planning methods may affect the rate of population growth hence contributing to a country’s economic growth and development. It is also known that women’s education and wealth affect the use of contraception.13

1.2. Rationale of the Study

Family Planning prevents pregnancy related health risks by reducing the occurrence of unintended pregnancy.14 Therefore the involvement of the church in family planning is crucial to build and maintain healthy family and to help married women to meet the gap of the unmet need of contraception in the church and society. Thus understanding the various factors contributing to knowledge, attitude and practice of family planning among married evangelical women is important. This study is conducted to assess the willingness of married evangelical women to family planning by investigating their knowledge, attitude and practice. Relevant secondary data in the church are scanty. Since this group is a potential to using family planning services, studying their behavior could provide insights into the church’s role to alleviate the current family planning situation in our country. The findings of this study will ultimately contribute to improve the health problem, to increase family planning usage, allow the church to fulfill her calling of holistic mission, and help attain some of the millennium development goals as well.

1.3. Objectives of the study

1.3.1. General Objective of the study

To evaluate the knowledge and practice of family planning among evangelical married women in Addis Ababa

To describe the influence of the church doctrine/ teachings on marriage in shaping the views and usage of family planning services by the members

1.3.2. Specific Objectives

To investigate the knowledge of family planning among married evangelical women in six evangelical denominations in Gulele sub-city, Addis Ababa

To assess the practice of family planning among married evangelical women in six evangelical denominations in Gulele sub-city, Addis Ababa

To assess the attitude of evangelical church leaders towards family planning in six evangelical denominations in Gulele sub-city, Addis Ababa

2. Review of Literature

Fertility control has been practiced since ancient civilizations like Egypt, Greece, and Rome15. In the first book of the Bible (Genesis 38:9) the withdrawal or Coitus interruptus is mentioned as a contraceptive method. The modern birth control movement began in the 19th century when population growth was challenging the available resources and when the idea of feminism came into picture.16

Family size has been declined from the time of modern family planning, that is, when the first family planning clinic was opened in New York. The proponents continued challenging the public no matter how much they faced challenges from the law. Their main concern was the burden and death of mothers related to pregnancy and delivery. In 1960s birth control pills and Intrauterine devices became available. Since then, family planning services and methods have been improved and become more accessible to wider population.17

International Planned Parenthood Federation also emerged in mid 19s with the fundamental assumption of helping women. It provides sexual and reproductive health services in 172 countries around the world.18

Several studies done in different countries at different times by the Family Health international show that family planning impacts not only the reproductive health but also the physical, psychological, economical, and social lives of women. It seems to bring quality of life, self-esteem to women and empowerment to act in the family, academic achievement and vocational goals of young women participation in the development Process. Furthermore it confirms that family planning plays a major role in women's reproductive decision-making and its relation to psychological well-being, the attitudes of significant others and their mediating effects on impact of family planning on women's participation in development.19

International data about the impact of family planning on women’ health suggest that family planning decreases maternal mortality by decreasing unwanted pregnancies and also analyses show that cardiovascular risks associated with oral contraceptives are low.20

In Africa the rate of contraceptive use is low and fertility rate is high. The major detrimental factors that prevent access to and use of birth control are unavailability, poor health care services, spousal disapproval, religious concerns, and misinformation about the effects of birth control. It indicates that increased use of family planning methods decreases maternal and infant mortality rates, improves quality of life for mothers, and stimulates economic development.21

The knowledge and practice of Family planning in Ethiopia has shown a rise over the years, for instance, during 2000-2014 the knowledge increased from 86 percent to 97 percent22 and the prevalence from 8 percent to 42 percent23. The awareness and services have been provided by public and private health institutions, pharmacies and NGOs. Family planning has been taught, given and facilitated mainly by the ministry of Health in collaboration with sponsored health related NGOs in different sessions through counseling by using teaching aids like posters, flip charts, pamphlets and leaflets.

The Family Guidance Association of Ethiopia began providing family planning services in 1966. It later became an affiliated member of International Planned Parenthood Federation since 1971, with the only objective of promoting public awareness and understanding towards responsible sexual life, reproductive processes, family planning and the effects of population growth on socio-economic development through diverse educational programs, considering the high occurrence of maternal morbidity and mortality.24

The other organization worth mentioning is Marie Stopes International Ethiopia (MSIE) which works with the mission to ensure the provision of quality and sustainable family planning/ reproductive health service and to safeguard the reproductive right of women, men and young people in the country.25

Non-governmental organizations as Pathfinder International work closely with religious organizations. The aim is to expand reproductive health and family planning through religious leaders and faith-based organizations. The experience was an eye opener for the leaders to understand the challenges of their followers and to help them fulfill not only the spiritual need but also answer their physical need.26

According to Society for the Protection of Unborn Children almost all the modern family planning methods have the potential or the risk of causing an early abortion.27

2.1. Religion and Family Planning

Family planning has been the center of debate for hundreds of years. Different religions have diverse views on family planning. Religious people raise arguments about it concerning the moral and ethical issues associated with it. Even the different sects of Christianity hold variety of standings about contraception. 28 The need to address it from different perspectives is evident.

To begin with, the Roman Catholic Church prohibits artificial contraception and also did the protestant churches until 1930. After that most groups came to accept the use of modern contraceptives as a matter of biblically permissible freedom of conscience.29 The Church views the purpose of marriage as unifying and procreative. The Catholic Church focuses more on the reproductive purpose. Therefore, she has always been against the use of artificial family planning methods but only allow using the natural methods.

Protestantism originated from Catholicism in the sixteenth century through the process of reformation. The reformation later on resulted in further division into Lutheran, Presbyterian, Methodist, Baptist, Mennonite, and Evangelical denominations.

The early Protestant reformers like Martin Luther and John Calvin had similar views with their Catholic brothers and prohibited the use of any kind of family planning methods based on Genesis 1:26-28 and Genesis 9:1 accounts. However the current views of the different denominations of the Protestant Church is diverse based on the two purposes of marriage given in the Bible. The Pentecostal churches prohibit any kind of methods; some Presbyterian churches allow full access of contraceptives while Lutherans permit with a precondition. The Anglican churches accept birth spacing and limiting family size by the couples because of the belief that parents have a God given responsibility, Methodists view each couple with the right to responsibly control conception some accept if it is prescribed by physicians and the Baptists permit some of the methods due to ethical reasons.30

A study in the US shows there is difference of opinions among conservative protestants, born again and fundamentalist Christians, and evangelicals from mixed, less positive opinions, to negative views on family planning policy, respectively.31

An article titled “A Call to Christian Common Ground on Family Planning, and Maternal, and Children’s Health” by the New Evangelical Partnership for the Common Good stresses t he association and the confusion of family planning with abortion has caused intense religious opposition by Christians and others with the result that opposition has extended not just to abortion, but to family planning as a whole. And urges evangelicals to come to a similar understanding and position towards family planning to better the lives of women and children in particular and families at large.32

There is a global movement concerning the issue of family planning from the international faith-based organizations. A Survey of Christian Connections for International Health Member Organizations revealed that member organizations uniformly believe family planning is an important component of international health. Several member organizations spontaneously mentioned their desire to extend family planning into the life of their churches and to engage church leaders.33

2.2. The Ethiopian Evangelical churches

2.2.1. Protestantism in Ethiopia

The Protestant churches in Ethiopia are also known as the P'ent'ays. These Churches have different views concerning some issues like baptism and contraception. Somehow they reflect the views and background of the missionaries who brought the good news and planted the church in the area of the land. Due to this there are some doctrinal variations among the different denominations. These churches stand at different levels of views of family planning and contraception.

The evangelical movement in Ethiopia resulted in the establishment of different denominations that include Evangelical church Mekane Yesus, Mulu Wongel, Meserete Kristos (Mennonite),Kale Hiwot, Gubae Egziabehare (Assembly of God), Misgana church, Heywet Birhane, Genet church, Churches of Christ, Birhane Wongel, Emmanuel Baptist churches, Yehiwot Birhan and many more.

The Evangelical church of Mekane Yesus was established in 1959 with the background of Lutheran missionaries34 and has 4,033,413 members.35

Kale Heywot Church evolved from the Evangelical Believers’ Association in 1963 by the SIM.36 It is believed to be the largest evangelical denomination in Ethiopia with about 7,774 local congregation and estimated 6, 7 million members and adherents. The ministries include Evangelism, theological training, Women's ministry, Youth ministry, Children's ministry and Children's Centre, Missions, Urban and Rural Integrated ministries, and diverse training ministries.37 “Meserete Kristos Church "Christ is the foundation Church" is an Ethiopian Anabaptist church. In 1962 the church was officially founded and got its name from the National Mennonite Church in Ethiopia.38 It has 255,462 baptized members and a worship community of over 471,070 persons as of November 2014. The church has over 756 congregations and 875 church planting centers scattered in all 18 Administrative Regions of Ethiopia.”39

The other evangelical church is Mulu Wongel with Pentecostal background and has estimated current members of 4.5 million around the country.40

Evangelical Christians are Christians who belong to one of the denominations in the protestant churches. The knowledge, attitude and practice of family planning among the married evangelical women may reflect the view of the denomination they belong to.

2.3. The Involvement of the Church in Family Planning Activities

Some of the evangelical churches like Evangelical Mekane Yesus Church and Kale Heywet Church have included providing health services in their mission.

The Evangelical Church Mekane Yesus’ priority areas of the development and social services commission include preventive and curative health care services with a focus on HIV/AIDS and family planning among other things.41

The Ethiopian Evangelical Church Mekane Yesus Development and Social Services Commission (EECMY-DASSC) is involved in Amaro synod community based health service Project (AS-CBHSP). Family planning is one of the three major focuses of implementation in the target kebeles. So far, 238 people (118 male and 120 female) are trained as of community sensitizers on the use of family planning services, and 6 community based reproductive health workers selected from target kebeles and got capacity building training to work as voluntary community based reproductive workers and mobilizes community for family planning services. Within three years 152 people (82 female and 70 male) Trained as of voluntary health promoters on family planning. As a consequence of this the percentage of family planning service raised from 10% to 40% as a whole at woreda level.42

3. Methodology

3.1. Study area

The study is conducted in evangelical churches in Gulele sub-city, Addis Ababa. Gulele sub-city is found in the northern part of the city and has a population of 284,865.43

The Evangelical church Fellowship of Ethiopia has a member of 53 main denominations and 451 branch churches in the 17 zones of Addis Ababa. There are 30 Evangelical churches in the sub-city which are members of the Evangelical Church Fellowship of Ethiopia.44 And six churches are purposely selected among them for this study. Namely: Semen Bethel Evangelical Church Mekane Yesus, Semen Mulu Wongel Church, Semen Kale Heywot church, semen Meserete Kristos Church, Gulele Genet Church, and Semen Addis Kidan Baptist Church.

3.2. Study Design

Church based cross-sectional study was conducted in six evangelical churches in Gulele sub-city, Addis Ababa.

Quantitative and qualitative research techniques are employed to assess the knowledge, attitude and practice of family planning among married evangelical women and the church leaders, respectively.

[...]


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Title
Assessment of Knowledge, Attitude and Practice of Family Planning among Married Evangelical Women in six Evangelical Churches in Gulele Sub city, Addis Ababa
Grade
3.0
Author
Year
2015
Pages
58
Catalog Number
V448201
ISBN (eBook)
9783668869110
ISBN (Book)
9783668869127
Language
English
Tags
assessment, knowledge, attitude, practice, family, planning, married, evangelical, women, churches, gulele, addis, ababa
Quote paper
Betelihem Asrat (Author), 2015, Assessment of Knowledge, Attitude and Practice of Family Planning among Married Evangelical Women in six Evangelical Churches in Gulele Sub city, Addis Ababa, Munich, GRIN Verlag, https://www.grin.com/document/448201

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