Abstract
The present study was on contraceptive use of in-school adolescents in Udenu LGA of Enugu State. The aim of the study was to determine the proportion of in-school adolescent that use contraceptive and in relation to gender, age and class. Five specific objectives were formulated with five corresponding research questions. Three null hypothesis were formulated to be tested at .05 level of significance.A descriptive survey research design was utilized for the study. The population for this study was 10,464 students which is the total number of in-school adolescents enrolled in public secondary schools in Udenu LGA of Enugu State. The sample for the study was 432 in-school adolescents including 216 male and female students respectively, selected from 12 public secondary schools using the multistage sampling technique. The instrument for data collection was the researcher designed questionnaire called the Questionnaire on Contraceptive Use – QCU. The QCU had two sections: section A sought data on personal data of respondents while section B sought data on contraceptive use. The validity of the instrument was established by five experts in the department of the Health and Physical Education, University of Nigeria Nsukka. Internal consistency of QCU was established using the Split-Half method to yield and inter-item correlation coefficient of 0.73. Frequencies and percentages were used to answer the research questions while Chi-Square statistics were employed to test the hypothesis at .05 level of significance. The results emanating from the study revealed that the proportion of in-school adolescents that use contraceptives is 158 (38.63%) in-school adolescents. The various forms of contraceptives used by in-school adolescents included withdrawal method by 67 (42.41 %), condom 65 (41.14 %), pill 23 (14.56 %), rhythm method 2 (1.27 %) and implants 1 (0.63 %). 127 male in-school adolescents (61.06%) and 31 (15.42%) female in-school adolescents who participated in the study used contraceptives. The older in-school adolescents use contraceptives more that the younger adolescents, hence, in-school adolescents who were 17 – 19 years old, 14 – 16 years old and 10 – 13 years old had 123 (57.34%), 28 (27.15%) and 7 (7.12%) of contraceptive use respectively. The senior classes use contraceptive to a greater extent than those in the junior classes with an average of 135 (63.38%) of those in the senior classes and 23 (11.73%) of those in junior classes. It was recommended among others that the government needs to designs and enforce compulsory health education classes at all levels in the secondary school system.
CHAPTER ONE
Introduction
Background to the study
Unintended pregnancy and unsafe abortion continue to be a major reproductive health problem, globally and in Africa (Akintade, Pengpid&Peltzer, 2011). Unintended or unplanned pregnancy poses a major challenge in young women, especially in developing countries. It has been estimated that out of the 210 million pregnancies that occur annually worldwide, about 80 million (38%) are unplanned, and 46 million (22%) end in abortion (Monjok, Smesny, Ekabuae&Essien, 2010). Increased adolescent sexual activity and pregnancy are alarmingly common in many countries which account for about 30 per cent of all births in sub-Saharan Africa (Idonije, Oluba&Otamere, 2011; Akintade, Pengpid&Peltzer, 2011). Studies have shown that among the major regions of the world, Sub-Saharan Africa has the greatest proportion of adolescent girls who have begun childbearing (Gupta &Mahy, 2003; Mba, 2003; Westoff, 2003). Moreover, in many parts of the region, adolescent sexuality and reproductive health remains a highly charged moral issue, which is compounded by the fact that in most cases, reproductive health services in the region are not oriented towards adequately meeting the needs of teenagers (Kaz&Naré, 2002; Wood &Jewkes, 2006; Obare, Birungi, Undie, Wanjiru, Liambila& Askew, 2011).
In Nigeria, an estimated 1.5 million unplanned pregnancies occur every year, and about half of these result in elective abortion (Abiodun&Balogun, 2009). Abortion is permitted in Nigeria only when pregnancy is a threat to the mother’s life and hence, to save a life. Therefore, adolescents seeking abortion often go to quacks that operate under clandestine and unsafe conditions with about a quarter of the cases resulting in serious complications. Such complications account for 20-40 per cent of about 60,000 maternal deaths that occur yearly in Nigeria (WHO, 2004). In-school adolescents are particularly prone to unintended pregnancies and this is due to a poor use of contraceptives (Idonije, Oluba and Otamere, 2011).
Contraceptives generally refer to techniques or things that could be used to prevent conception. The term contraceptive is derived from the word contraception which literally means “against conception” and may be defined as a process or technique for preventing pregnancy by means of a medication, device or method that blocks or alters one or more processes of reproduction in such a way that sexual union can occur without impregnation. (Glanze& Anderson, 2001). Similarly, Marie (2013) defined contraceptives as every action which, whether in anticipation of the conjugal act, or in its accomplishment, or in the development of its natural consequences, whether as an end or as a means to render procreation impossible. Besides controlling procreation, contraceptives could be useful in preventing unwanted pregnancy and unsafe abortions.
Contraceptives have been identified as an effective means of combating the problem of unwanted pregnancy and unsafe abortion. According to Adewole, Oye-Adeniran, Iwere, Oladokun, Gbadegesin and Babarinsa (2002), contraceptives permits sexually active individuals to be in control of their sexual lives by preventing unwanted pregnancy and other associated conditions such as illegal abortions and complications. Thus, contraceptives are useful in the achieving the goals of family planning.
Contraceptives have been identified as a means to achieve the goals of family planning and include methods which interfere with the performance of the sexual intercourse or the encounter of sperm and egg through mechanical or chemical ways (Grugni, 2011). Family sizes can then be pre-determined and controlled, and consequently, the world population growth can be effectively managed. Therefore, Aderibigbe and Basebang (2011) affirmed that Contraceptives are useful for pregnancy planning, limiting the number of children, controlling the world’s population and other health related benefits.
Contraceptives could be in the form of oral and injectable hormones, sterilization, use of spermicides, barrier methods, and fertility awareness methods to mention but a few. Traditional contraceptive methods have also been identified and tend to be more common than modern contraceptive methods. They include: the periodic abstinence method, coitus interruptus and prolonged breastfeeding (Monjok, Smesny, Ekabuae&Essien. 2010). Others include: postpartum sexual abstinence, herbal juices and concoctions, strings and wooden beads, traditional arbortifacients and the rhythm method (Kalipeni& Zulu, 1993). In recent times, the concept of emergency contraception have been introduced to mean those methods used to avoid pregnancy after unprotected sexual intercourse unlike the regular methods of contraception that are taken before sexual contact. It has the potential, as the last resort, to prevent unwanted pregnancy and therefore abortion; a desirable goal especially when abortion is illegal (Olajide, Odunlade, Afolabi&Olajide, 2012). According to WHO (2004), contraceptive methods available for use by adolescents include: dual protection and dual method use, barrier methods, emergency contraception, low-dose combined oral contraceptives (COCs), combined injectable contraceptives (CICs), new hormonal delivery systems, progestogen-only pills (POPs), progestogen-only injectables, progestogen-only implants, intrauterine devices (IUDs), natural family planning/fertility awareness based methods, lactational amenorrhoea method (LAM), withdrawal, male and female sterilization.
In the context of the present study, Contraceptives will be regarded as any special devices, drugs and techniques used for the intentional prevention of conception following sexual intercourse; for the control of unwanted pregnancy, unsafe abortion and sexually transmitted infections. Numerous contraceptive options exist for adolescents, but the problem lies in contraceptive use.
Use, according to Sinclair (2001) refers to doing something with a thing in order to do a particular job or to achieve something. Soukhanov (2004) defined use as employing something for a purpose: to put something into action or service for some purpose. Therefore, contraceptive use can be said to be employing contraceptive methods in order to achieve birth control or as employing any special devices, drugs and techniques for the intentional prevention of conception following sexual intercourse; for the control of unwanted pregnancy, unsafe abortion and sexually transmitted infections. Al Sheeha (2010) defined contraceptive use as a state of current or previous use of a modern contraceptive method for a minimum of one continuous year. Contraceptive use can be problematic in adolescents due to the frequency of use and the tendency to discontinue using contraceptives.
Contraceptive use by adolescents is not always consistent. The American academy of Paediatrics – AAP (1999) stated that an adolescent’s decision about whether to use contraception is complex. Although trends have improved, as more adolescents are reporting current use and more use of contraception at first intercourse. But the consistent use of any contraceptive has remained a challenge for most adolescents. This is such that only very few adolescents use a contraceptive always. In line with this, Davtyan (2000) asserted that only 29.8 per cent of sexually active girls and women aged 15 to 19 use a contraceptive, and many of them use it inconsistently owing to certain factors.
A number of factors have been found to influence adolescents’ contraceptive use. Factors that contribute to poor contraceptive use, as identified by AAP (1999) include adolescent developmental issues such as reluctance to acknowledge one’s sexual activity, a sense of invincibility (belief that they are immune from the problems or issues surrounding sexual intercourse or pregnancy), and denial of the possibility of pregnancy and misconceptions regarding use or appropriateness of contraception. Adolescents who have taken part in sexual activities tend to assume that it was a mistake and will not happen again, rather than key into the reality and plan against future occurrences. Interestingly, adolescents have a high knowledge of the various forms of contraceptives but the practice of contraception is always inconsistent (Ujah, 1991, Ozumba& Amaechi, 1992, Omo-Aghoja, Omo-Aghoja, Aghoja, Okonofua, Aghedo, Umueri, Otayohwo, Feyi-Waboso, Onowhakpor&Inikori, 2009). In the context of the present study, Contraceptives use will refer to what in-school adolescents in Udenu LGA are currently doing or any method employed (at or about the time of a survey) to delay or avoid becoming pregnant.
In school adolescents are essentially individuals in their adolescence who are currently enrolled in various schools. They undergo all the usual phases associated with the adolescence during their growth and development. In the view of Siziya, Muula, Kazembe, Rudatsikira(2008), in-school adolescents are individuals passing through a critical period for physical, social, and emotional development. In-school adolescents, according to Ramadugu, Ryali, Srivastava, Bhat and Prakash (2012) were defined as school going individuals aged 10-19 years of age.
In school adolescents could belong to any of the three phases identified by the WHO (2004) with each phase having unique characteristics and development tasks including an early phase, a middle phase and late phase. In the early phase, in-school adolescents are characterized by the developmental tasks of physical and cognitive maturation; emotional expressiveness; increased need for belonging and peer membership; and experimentation with social relationships. In the middle phase, in-school adolescents experience developmental tasks and physical changes which tend to become more settled with an emphasis on emotional control, intimacy, moral development, social justice and spirituality. In the late phase, in-school adolescents see an increased involvement in acquiring the practical skills necessary for functioning independently of parents, making critical decisions related to occupation, marriage or partnering, as well as consolidating a moral code and socio-political ideology. For the purpose of the present study, In-School Adolescents will be regarded as people between the ages of 10 to 19 years and are currently enrolled in secondary schools in Udenu Local Government Area.
Udenu LGA is one of the 17 LGAs in Enugu state and is located in Enugu North Senatorial zone. It is bounded to the North and East by Kogi state and Isi-Uzo LGA of Enugu state respectively. The northern axis of the LGA links the Eastern and Northern Nigerian regions, and the Southeast and the North Central Geopolitical Zones. In the West and South of the Local Government are Igbo-Eze South and Nsukka Local Government Areas. The natives are predominantly Christians. At the centre of Local government is The Obollo-Afor market which attracts business people of varying ethnicities such as Hausa, Igalla, Idoma and Fulani; leading to fast urbanization and increase in commercial activities in the LGA. After school, in-school adolescents frequently visit these market places for purposes of hawking food and commodities, engaging in barrow pushing, bus conducting, bike riding (okada riders) or learning one trade or another. There are also a great amount of sexual activities around the market, owing to the number of prostitutes and their potential patrons in the environs. The adolescents are often exposed to sexual activities and sex exploitation which may end in unwanted pregnancies, illegal abortions, STIs and HIV infections. This constitutes a serious problem for the nation and especially, the in-school adolescents.
Some socio-demographic factors have some relationship with contraceptive use of in-school adolescents. Some of such factors which may influence contraceptive use of in-school adolescents in Udenu LGA include: gender, age and class.
Gender variations exist in contraceptive use of in-school adolescents. Female in-school adolescents are less likely to use contraceptives due to the circumstances under which they indulge in sexual intercourse. Manzini (2001) is of the opinion that more females are usually exploited and are likely to have first sex in circumstances outside their control or consent and therefore are not always in position to negotiate contraceptive use. In agreement, WHO (2004) asserted that female adolescents are often socialized to be non-aggressive, and to abstain from sexual activity until marriage. Female adolescents therefore receive positive reinforcement for being quiet, innocent and unaware of sexual matters. This limits their ability to initiate or contribute sincerely and actively in matters of sexual activities and contraceptive use. Female adolescents find it difficult to refuse unwanted sexual advances and to negotiate condom use or safer sexual practices when sexual intercourse is desired (Okafor and Obi, 2005). Hence, female adolescents rely mostly on the decision to use or not use contraceptives of their male partners.
Male adolescents on the other hand, are often in better positions to decide to use contraceptives. This is simply because male contraceptives are easy to obtain and use while there are not much social and cultural barriers against males being sexually active. Drayton (2002) asserted that male adolescents in Jamaica are usually expected to indulge in sexual practices as soon as puberty sets in, in order to avert the stigma of homosexuality. Although male condoms are quite popular, the option of using the withdrawal method of contraception has remained the most practiced contraceptive method. Obi and Ozumba (2005) stated that male adolescents prefer the withdrawal method which has remained the most practiced contraceptive method as they harbour the belief that condom use reduces sexual pleasure. Thus, being male could represent being in control of contraceptive use in any sexual relationship and probably could imply that males use contraceptives more than the females.
