CONTRACEPTIVE PRACTICES AMONG FEMALE SECONDARY SCHOOL STUDENTS IN IKERE LOCAL GOVERNMENT AREA OF EKITI STATE, NIGERIA.
Adolescent girls in developing countries are known to have inadequate access to reproductive health information which could influence their attitude towards reproductive health practices. This study therefore investigated Contraceptive practice among female secondary school students. The study adopted the descriptive survey research design. A multistage sampling technique was used to select 100 in-school adolescent girls in Ikere that constituted the sample. A questionnaire tagged Reproductive Health Information and Attitude of Adolescents Questionnaire (RHIAQ) complemented with focus group discussion, observation and oral interview were instruments used to collect data. Knowledge and prevalence of contraceptive use was found to increase with age, current use and positive attitude. Female students had better knowledge on contraception than male students. Good knowledge on contraception did not translate into increased use, the prevalence of use being only 34% as compared to 75% of students with average to good knowledge. More students reported using the male condom for contraception. Most students (69.5%) mentioned pharmacies and drug stores as their main source of contraceptives. These findings underscore the need for early education on human sexuality and the benefits of family planning. Health care providers, including pharmacists, must be trained to be able to provide adequate basic contraceptive services to adolescents and the general public. There is need to improve access to contraceptive services by adolescents.
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1.1 Background to the Study
Adolescents’ sexuality and reproductive health information needs and services have been a major concern and challenge to the international community for over a decade. This is as a result of the growing awareness of young peoples’ relatively high risk of exposure to inaccurate or incomplete information about reproductive health issues such as sex, HIV and other sexually transmitted infections (STIs), pregnancy, abortion, maternal complications, female genital mutilation and so on (World Health Organization, 2002). The advancement in science and technology has restructured and redefine the way and manner people interact with things that pertains them. For instance, birth control. A lot of devices have been produced to reduce that rate at which people especially women reproduce at the detriment of their health. The issue of pre-marital sex is likening to a burning bush among youths globally. It is worthy of note, to mention that youths engage in pre-marital unprotected sex for several reason such as they don’t enjoy sex when contraceptive is used, contraceptive is too expensive, it is far out of their reach to mention but few reasons. It is after the exercise that they run from pole-to-pole to use one thing or the other so that the unprotected does not result in unwanted pregnancy. Hence, this studies to investigate the practice of contraceptive among female students in secondary school in Ikere Local Government Area of Ekiti State.
Unwanted pregnancy is one of the problems facing adolescent girls. In Sub Saharan Africa it is estimated that 10% of girls become pregnant at the age of sixteen (WHO, 2008).Teenage girls who get pregnant are likely to drop out from school and are unlikely to have the social and economic means to raise their children. In Nigeria, adolescent pregnancy has been identified as one of the reasons for girls dropping out from school (Olukoya and Ferguson (2002). It has been reported that many young people become sexually active at an early age, when most of them have no knowledge on reproductive health. (Reina et al., 2010). A study on adolescents in the rural area of Nigeria reported that school children lack credible knowledge about safe sex (Mushi et al.,2007). Unintended pregnancy is also associated with increased risk of morbidity for women and with health behaviors such as delay in prenatal care which may affect the health of the infant. Educational programs on reproductive health have been conducted in Nigeria, however knowledge and practice of secondary school girls regarding safe days and contraceptive use is not well documented.
Adolescents, according to the World Health Organization (2002), are young people between the age of 10 and19 years, and they constitute about a fifth of the world’s population. Of these, about sixteen per cent live in Africa. In fact, in many countries in Africa, adolescents constitute approximately thirty-three per cent of the population (International Clinical Epidemiology Network, 2006; Olukoya and Ferguson, 2002). In Nigeria, thirty-four per cent of the population are adolescents (Population Reference Bureau, 2006).Adolescence is the transition from the world of childhood to the world of adulthood. It is a period of physical and emotional development almost as rapid as the first decade of life. At this time, the body matures and the mind becomes more questioning and independent (World Health Organization, 2002).
The physiological changes which take place during this period of transition from childhood to adulthood result in the formation of sexuality and present the first challenge to healthy adolescent growth. During this period adolescents engage in sexual exploration and experimentation without adequate knowledge of reproductive health issues, information sources and services that are available (International Clinical Epidemiology Network, 2006). According to Olukoya and Ferguson (2002), evidence from World Health Organisation case studies on sexual relations among adolescence in developing countries indicate that sexual activity seems to start during adolescence, and among a significant number of these adolescents much of the activity is often risky, and contraception and condom use is erratic.
According to Marie Stopes International Worldwide (2002) the health risks which these adolescents are exposed to include sexually transmitted infections, unplanned pregnancies, unsafe abortions, and untimely death. Adolescent mothers are more likely than older women to suffer from serious complications during delivery, resulting in higher morbidity and mortality for both mother and infants (National Population Commission, 2000). Similarly, health statistics show that more than 13% of all maternal deaths occur among adolescents (ages 10 – 19), representing approximately 69,000 maternal deaths annually. In Africa, maternal mortality among adolescents account for up to 40% in some countries (Olukoya, 2004).
A community based study of abortion prevalence among Nigerian women found that one-third of those who obtained abortions were adolescent girls (Otoide, Oronsaye and Okonofua 2001). A hospital based studies also indicated that up to 80% of patients with abortion-related complications were adolescent girls (Otoide, et al, 2001).
Health reports indicate that more than a third of all people living with HIV/AIDS are under the age of 23, and almost two-thirds of them are female. In Sub-Sahara Africa, among young people aged 15 to 24, two girls are infected for every boy and for adolescents ages 15 to 19, five or six girls are infected for every boy in worst affected areas (UNICEF, 2006). In Nigeria, one of the first cases of AIDS in 1984 was in a sexually active 13 year old girl (Fawole, Asuzu and Odunta, 1999). Otive-Igbuzor, (2003) stressed that girls within the age-group 12 – 24 are mostly infected with HIV/AIDS. In fact, HIV/AIDS increasingly is becoming a disease of the young girls in Africa. These startling revelations indicate that adolescent girls are more vulnerable to reproductive and sexual health risks than adolescent boys.
The purpose of this study therefore was to assess knowledge and use of different contraceptive methods among adolescent secondary school girls in some selected secondary schools in Ikere Local Government Area of Ekiti State.
1.2 Statement of the Problem
Access to appropriate reproductive health information by adolescent girls is crucial to the achievement of the Millennium Development Goals of reducing maternal and child mortality by 2015 and halting and reversing the spread of HIV among the most vulnerable by 2010. Yet, literature has shown that secondary school adolescent girls have inadequate access to reproductive health information due to socio-cultural values, religious beliefs, economic factors, inadequate information resources and facilities.
With increasing adolescent sexual activity and the decreasing age at first coitus in developing countries, the knowledge and use of contraceptives become imperative to curb the hazard associated with unplanned pregnancy and its complications especially in the underdeveloped youths. According to Aziken, Okonta and Ande (2003), unintended pregnancy poses a major challenge to the reproductive health of most young adults in developing counties.
The increase in mortality and mortality among adolescents in the developing countries has become a focus of research and policy initiatives (Amaego, Silicia and Obiekezi 2007). These problems were associated with adolescent unprotected sexual activities, low contraceptives awareness and practice and had resulted in increased pregnancy rates and criminal abortions. These had led to the development of Nation Policy on Population which specified reduction of teenage pregnancy by the year 2000. The adolescent pregnancies and sexual embarrassment are presumably high that knowledge, attitude and practice of contraceptives among adolescents in selected secondary schools in Akpabuyo should be known and steps taken in addressing this social menace. It is against this backdrop that this study investigated contraceptive practice among female secondary school students in Ikere Local Government Area of Ekiti State.
1.3 Objectives of the study
The major objective of the study is to examine the extent of practice and use of contraceptives among secondary school female students. The specific objectives of the study are to:
- investigate the state of awareness of female students in secondary school on the contraceptives practices;
- investigate reproductive health information needs of the secondary school female students in Ekiti State;
- determine the level of the secondary school female students access to reproductive health information sources;
1.4 Research Questions
The study has the following research questions:
- What is the level of awareness of contraceptives among secondary school female students in Ikere Local Government Area of Ekiti State?
- What are the reproductive health information needs of secondary school female students in Ikere Local Government Area of Ekiti State?
- What is the degree of secondary school female students’ access to reproductive health information sources in Ikere Local Government Area of Ekiti State?
1.5 Scope of the Study
Though adolescents are young people between the ages of 10 and 19 years the study focuses on young girls (female students) in secondary school girls ages 13-20. It is believed that adolescent girls in the senior secondary classes fall mostly within the 13-20 age bracket. The study will cover access to and use of electronic media, print media, oral and institutional sources of health information that are relevant to adolescent girls health needs. The adolescent reproductive health issues that are of interest in this study include teenage marriage, premarital sex, early and unwanted pregnancy, unsafe abortion, sexually transmitted diseases, and HIV/AIDS. All the 9 senior secondary schools made-up of 100 girls from public secondary schools in Ikere Local Government Area of Ekiti State were involved in the study.
1.6 Significance of the study
The findings of this study will help policy makers and stakeholders who are involved in the provision of reproductive health information and services to adolescents to understand the relationship between access to reproductive health information and the attitude of in-school adolescent girls towards reproductive health practices. This will enable them to design and adopt more appropriate policies and intervention strategies that will enhance the general well-being of in- school adolescent girls.
The result of the study will bring to fore the reproductive health information needs of adolescent girls in Lagos State in particular and elsewhere especially in Nigeria and the Third World. This is expected to provoke government and non-governmental agencies to make concerted effort towards meeting these needs. The outcome of this study may be a basis for reviewing and improving the quality of existing National Health Information Policy, National Health Management Information System and National Sexuality Education Curriculum. Lastly, this study will contribute to knowledge and literature on adolescent reproductive health information which no doubt will be of immense benefit to researchers in the field of adolescent health in Nigeria.
1.8 ASSUMPTIONS OF THE STUDY
- I assume that after this research work on contraceptive practice among female secondary school students in Ikere Local Government, that the ministry of education and other educational agencies in the arm of secondary school education in Nigeria will understand the basic needs for adequate sensitization of the students and the entire public on the need the practice and consequences of contraceptives among secondary students and other educational institutions to curtain the negative use and effect of contraceptives on the students in term of academic output and social life.
- I also assume that this research work will enlighten the people more and educate them widely in the need for the sensitization of secondary students against mis-use of contraceptives.
I assume that this work will put to an end, the problems of abuse practice of contraceptive among students.
1.7 Definition of Terms
Adolescents: Adolescents in this study refer to girls between ages 13 to 20 (the common age bracket for senior secondary schools).
Access: Access refers to the degree of proximity, closeness or nearness to sources, and ease of locating and obtaining reproductive health information from the sources.
Attitude: Attitude refers to what adolescent girls think about, feel about, and their behaviour towards reproductive health practices
Health Information: This includes information for staying well, preventing and managing diseases, and making other decision related to health and health care. It may be in the form of data, text, and/or video. It may involve enhancement through programming and interactivity.
Information: This refers to news, facts, messages, opinions, processed data, images that are capable of improving the reproductive health knowledge of in-school adolescent girls.
Information Source: The point of origin or a supplier of information; a point of emanation of information; first hand document; primary reference work; an individual; institution or media from where a message originates.
Reproductive Health: It refers to a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters related to the reproductive system and to its functions and processes.
Reproductive Health Information use: the application of reproductive health information; that is how in-school adolescent girls in this study apply reproductive health information received from various sources for decision making, prevention and curative purposes.
Reproductive Health practices: It refers to reproductive and sexual health related actions or behaviours such as early marriage, premarital sex, early and unwanted pregnancy, abortion, female genital mutilation.
REVIEW OF RELATED LITERATURE
This chapter reviews literature relevant to the study. The related literature is reviewed under the following sub-headings:
2.1 Academic meaning of Contraceptives
2.2 General Overview of Contraceptive
2.3 Adolescent attitudes towards contraceptives
2.4 Positive attitude towards contraceptive use
2.5 Benefits of using contraceptives
2.6 Beliefs and values about adolescents’ use of contraceptives
2.7 Responsibility to use contraceptives
2.8 Motivation to use contraceptives
2.9 Challenges of using contraceptives
2.10 Beliefs and values that prevent adolescents’ use of contraceptives
2.11 Appraisal of literature review