CHAPTER ONE
BACKGROUND OF THE STUDY
Globally, sexual and reproductive health have been given a lot of attention due to the numerous implications it has on the state of the world in terms of population growth, economies of countries as to how and where to allocate most of their resources, planning for these populations and individuals’ decision making and expenditure (Hadi, 2017). The population of the world in 2017 stood at 7.5 billion with the population of the youth being 1.2 billion people (Kenada & Dupuis, 2017). On a world wide scale an average of 16 million girls in their late adolescence give birth annually accounting for 11% of all births with the majority of these births coming from low and middle income countries (UNICEF, 2010). This notwithstanding, pregnant teenage girls stand a higher chance of having difficulties during pregnancy and the children born to them also stand a greater chance of falling sick or dying (Ghana Demographic and Health Survey, 2014).
Data from the World Bank in 2015 indicated that adolescent birth rates for sub-Saharan Africa was 100 births per every 1,000 women in their late adolescence making it the highest in the world (World Bank, 2016). Twenty thousand girls below age 18 give birth daily in developing countries resulting into 7.3 million births per annum (United Nations Population Fund [UNFPA], 2018). The rate of adolescent births per 1000 women aged 15 to 19 in 2015 stood at 21% for America, Canada (9%), China (7%), Ethiopia (56%), Costa Rica (56%), Mexico (62%) and 10% in Qatar (World Bank [WB],2016). In Ghana, data from the demographic and health survey (2014) indicated that 14% of women between the ages of 15 to 19 years had begun childbearing with childbirth among teenagers in rural areas (17%) being higher than that of their counterparts in the urban areas (12%) (Ghana Statistical Service [GSS], 2015, pp. 69- 70.).
The adolescent stage is a crucial period in the lives of human beings (Mirghafourvand, Charandabi, Sharajabad & Sanaati, 2016). In some cultures, this is the period in which the individual is gradually ushered into adulthood. It therefore marks a transition of physiological, emotional and psychological wellbeing (Shore & Shunu, 2017). The age at which the transformation begins, however, varies significantly among individuals (Stang & Story, 2005), mostly due to differences in nutrition and genetics/hereditary factors (McCauley, Salter, Kiragu & Senderowitz, 1995).
Historical data from Europe and the United States of America indicates that since the 19th century, the age of menarche has in every 10 years reduced by 2 to 3 months (Wyshak & Frisch, 1982). According to Chen et al. (2007), this resulted in a reduction of up to 3 years in the age at which adolescents in America and Europe began to menstruate. This reduction in age of menarche was said to be influenced by improvement in nutrition and healthcare (McCauley, Salter, Kiragu & Senderowitz, 1995). The adolescence stage happens to be one of the most precarious for such young teenagers who are exposed to many dangers that can adversely affect their lives (National Research Council, 2011). Their desire to be free from parental control and curiosity often lead them to unhealthy lifestyles (Eccles, Midgley, Wigfield, Buchanan, Reuman, Flanagan & Mac Iver, 1993). For example, some teens learn how to smoke and drink alcohol during this period (Simons-Morton et al, 2001) while others adopt promiscuous lifestyle and begin to engage in sexual activity which ultimately lead to teenage pregnancy, drug addiction, alcoholism and even deaths (Smart & Fejer, 1972; Arain et al, 2013; Acharya et al, 2010).
On a global level estimates show that 214 million women from developing countries are unable to meet their family planning needs due to cost or poverty (Guttmacher Institute, 2017). For example, a study showed that as of 2014 the cost of providing services related to modern contraceptives, maternal and new-born health care, health care for HIV among pregnant
women and their new-born babies as well as treatment for four common STIs totalled $18.7 billion in developing countries alone (Singh, Darroch & Ashford, 2014). According to the World Health Organization sexual health is not just the absence of disease, dysfunction or ill health but it includes the state of physiological, emotional, psychological and social well-being in relation to sexuality. It encompasses being able to have a healthy sex life that is not forced or discriminated against (WHO, 2006).
Reproductive health on the one hand includes a state of total physiological, psychological and social well-being in relation to the reproductive system and the function it plays (WHO, 2006). Due to the importance attached to teenage sexual and reproductive health globally, attempts were made by the United Nations (UN) to give it some legal backing and ensure it was factored into the health care needs and plans of the health care sectors of various countries (Guttmacher Institute 2017; Singh, Darroch & Ashford, 2014). Therefore, the UN General Assembly Special Session on Children in 2002 decided to formulate and enforce adolescent health programs and policies that would promote their overall wellbeing (Morris & Rushwan, 2015). It is no disputable fact that risky sexual behaviours have multiple negative implications, both on the individual and the family or relatives of the individual involved. According to Mirzaei et al, (2016), such implications may include negative outcomes that affect others other than the individual engaged in it such as break ups of relationships, family disputes, constitutional redress and monetary challenges (Mirzaei et al, 2016). This kind of behaviour can be as a result of peer influence, bad parenting, alcohol and substance abuse, unavailable information to the adolescents, watching of pornography or even living arrangements in their homes (Ugoji, 2014; Doku, 2012; Cooper, 2002; Oluwatoyin, & Modupe, 2014; Ritchwood et al, 2015; Shore & Shunu, 2017).
With respect to the above, there has been an intensive drive to create more awareness about the need to place more importance on sexual and reproductive health issues among people from
various backgrounds, race, religions, occupations and nationalities (Shand et al, 2017; UNICEF, 2012). This has been championed by international organizations, non-governmental organizations, faith based organizations, academics, governments and individuals (Cameron & Bond, 2002; PPAG, 2016).
In Ghana, promoting issues of sexual and reproductive health remain a priority agenda of the Ghana Health Service, Ministry of Health, Planned parenthood association of Ghana, Human rights advocacy centre, Marie stopes international Ghana, USAID among other private organisations (Cameron & Bond, 2002). As such, a lot of work has been done in several parts of Ghana particularly in the rural areas regarding sexual and reproductive health (Aninanya et al. 2015; Gyesaw & Ankomah, 2013; Rondini & Krugu, 2009). Most existing studies have examined issues of family planning, contraceptive use, ante natal and post-natal care, mother- child mortality, exclusive breast feeding and adolescent health programmes (Guttmacher Institute, 2017; Singh, Darroch, & Ashford, 2014; Darroch et al, 2016).
Others (Acharya et al, 2010; Mirzaei et al, 2016; Ritchwood et al, 2015; Shore & Shunu, 2017; Ugoji, 2014) have studied the causes and effects of risky sexual behaviour and its link with teenage pregnancy. What this study seeks to do is therefore to examine how the knowledge and perceptions the teenagers of La have about sexual and reproductive health could make them engage in risky sexual behaviours that can ultimately lead to a negative outcome such as teenage pregnancy.
Problem statement
Teenage pregnancy is a phenomenological problem that thwarts individual, societal and national progress due to its associated social, economic, emotional, psychological and health problems. Besides exposing perpetrators to sexually transmitted diseases and infections it has
the tendency to induce maternal and under-five mortality (Daniels, 2015; Loaiza & Liang, 2013; Gyesaw & Ankomah, 2013). Though teenage pregnancy has been researched into in different parts of Ghana, especially in rural and indigenous communities, by many scholars (Keller, Hilton & Twumasi-Ankrah, 1999; Gyan, 2013; Gyesaw & Ankomah, 2013; Krugu et al, 2016; Sowah, 2016) with poverty being cited as one of the major causes of pregnancy, this study will rather like to look at the teenage pregnancy situation in La (an indigenous community) by looking at the knowledge and perceptions teenagers there have about SRH and how this may lead them to engaging in risky sexual behaviours which could ultimately lead to pregnancy. Information available from the 2010 population and housing census on the La Dade-Kotopon municipality showed that as far back as 2010 the municipality had a high teenage pregnancy rate of 568 births in that year alone (GSS, 2014). Information obtained from the District Health Information Management System (DHIMS 2) showed that the rate of teenage pregnancy in the municipality had over the years been decreasing till 2017. In 2014, 2015 and 2016, a figure of 445, 384 and 282 teenage pregnancies were recorded respectively. However, in 2017, the figure increased to 303. Amongst adolescents (10-14 years) there were 16 cases recorded and 287 cases recorded for adolescents (15-19 years). The information available at the municipal health directorate of the La Dade-Kotopon municipality as well as the La General hospital showed that most of the teenage pregnancy cases have consistently over the years come from the indigenous suburbs of south La such as Agbawe, Apaapa, Burkina, Abafum and Kojo Abesse. This point was also reiterated in a brief discussion with one of the officers of the social welfare department of the municipal assembly and an officer at the municipal health directorate who both expressed concerns that despite the numerous programs embarked on by the municipal assembly over the years in those communities in La to address the issue of teenage pregnancy, the problem still persists. Therefore, the question that comes to mind is why is it mostly teenagers from the indigenous suburbs of La who have
over the years consistently fallen victim to teenage pregnancy than their counterparts in other areas within the municipality such as Burma camp, Labone, Cantonment or South La estate? With the known dangers associated with teenage pregnancy on the teenagers, their families and the community as well as the efforts being made to drastically reduce it by the Ghana Health Service, the La Dade-Kotopon municipal assembly and other non-governmental organizations, it is quite worrying that teenage pregnancy has persisted over the years in the southern part of La. This warranted the need to conduct this research to investigate the knowledge and perception gaps among teenagers to understand their views on SRH and how it leads them to engaging in risky sexual behaviours which could ultimately lead to pregnancy.
Table 1.0 Trend of teenage pregnancy in La Dade-Kotopon
| YEAR | AGE DISTRIBUTION | REGISTRANTS | ATTENDANCE | ||
| 10-14 | 15-19 | 20-24 | |||
| 2014 | 12 | 433 | 1947 | 8793 | 44381 |
| 2015 | 12 | 372 | 1424 | 7600 | 49267 |
| 2016 | 9 | 273 | 1150 | 6662 | 44093 |
| 2017 | 16 | 287 | 1073 | 5640 | 39578 |
Source; District Health Information Management System (DHIMS 2) of Ghana
Research questions
- What knowledge and perceptions do adolescents in La have about sexual and reproductive health?
- What are the attitudes (risky sexual behaviours) that these teenagers in La exhibit?
- Does their knowledge, perceptions and attitudes about sexual and reproductive health help reduce incidence of teenage pregnancy?
