CHAPTER ONE
Introduction
Background to the Study
The environment in which young people grow and make decisions related to reproductive and sexual health is becoming more challenging than ever before. This is so for many obvious reasons. Today’s adolescents are being bombarded with erotic stimuli and messages through movies, music, novels and magazines. Basen-Engquist and Parcel (1992) affirmed this and noted that adolescents from their earliest years watch television shows and movies that insist that “Sex appeal” is a personal quality that people need to develop to the fullest. Haffiner (1999) opined that TV movies and music are not the only influence; the internet also provides the adolescents with seemingly unlimited access to information on sex as well as steady supply of people willing to talk about sex with them.
Specifically, as it relates to secondary school students who are also adolescents, Action Health Incorporated, AHI, (2003) stated that, today’s adolescents live in a world that may give conflicting messages about what is expected of adolescent’s sexual activity. On the other hand, they are told to abstain or “just say no” without knowing why, for how long, or even knowing exactly how to go about it. In addition, adolescents may see sexual relationships as extremely desirable. For instance music, movies, television, magazines and advertisements present sexuality in a way that glorifies and normalizes sexual behaviour of young people. In line with the above, Gail, Slap, Lucy, Bin, Confort, Theresa and Paul (2000) opined that sexual thoughts, feelings and behaviours present throughout life are often accentuated during adolescence. Dong (2001) further opined that just as sexual preferences are learned behaviour, most of all adolescent’s sexual deviations are learned behaviours with pornography having the power of conditioning them into sexual deviancy. For these reasons adolescents and indeed secondary school students find themselves in an environment of varied sexual attitudes and practices which is challenging.
Ademola (2005), disclosed that some young people have poor understanding of reproductive process, while others harbour misconceptions such as beliefs that pregnancy cannot occur during first sexual episode, and that the use of contraceptives can cause infertility. Some of these misconception and beliefs may lead to abortion (AHI, 2003), elevated risks of sexual transmitted infections-STIs (Aderibigbe & Aroaye, 2008) and unwanted pregnancy (Ekanem, 2010). These preventable problems may have prompted the Guidelines for Comprehensive Sexuality Education (2003) in Nigeria to lament that more and more Nigerian are beginning to realize that if the problems of unwanted teenage pregnancy, STIs and sexual abuse are to be effectively addressed, it is important that people develop accurate, rational and responsible attitudes and behaviours regarding issues concerning reproductive and sexual health. Though the two concepts (reproductive and sexual health) seem to be similar, they are not identical.Thus the need to examine the two concepts.
Reproductive health is now recognized as a crucial part of general health and central feature of human development. As such, National Conference of General Practitioners (1995) stated that, reproductive health covers the entire life Span of an individual. They further believe that it is reflection of health during childhood, adolescence and adulthood and therefore sets the stage for health beyond the reproductive years for both women and men and affects the health of next generation. Vaughar and Abouzahr (2000) associate reproductive health with prevention and treatment of diseases and supporting normal functions such as pregnancy and child birth. Elaborating further, they stated that reproductive health has to do with reducing the adverse outcomes of pregnancy, including maternal deaths and disabilities, complications of abortion, miscarriages, still births and neonatal deaths.
WHO (2008) defined reproductive health as a state of complete physical, mental and social wellbeing in all matters related to reproductive systems, functions and processes. This implies that, people are able to have a satisfying and safer sex life and they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the right of men and women to be informed (about) and have access to safe, effective, affordable and acceptable methods of their choice for regulation of fertility, as well as other methods of birth control which are not against the law and the right access to appropriate health care services that will enable women go safely through pregnancy and childbirth.
For the purpose of the present study, reproductive health is a concept that describes how secondary school students should view and practice their sexuality to remain free from STIs, unwanted pregnancies, regulate their fertility, avoid abortion and its complications and effectively bear and rear healthy children. This definition implies achievement of general reproductive well being.
ICPD (1994) affirmed that reproductive health in the context of primary health care should include: family planning, counseling, information, education, communication and services for prenatal care, safe delivery and post natal care, especially breast feeding and infant and women’s health care. They further stated that it also include prevention and appropriate treatment of infertility; prevention of abortion and the management of the consequences of abortion, treatment of reproductive tract infections; Sexually transmitted infections (STIs) and other reproductive health conditions; and information, education and counseling as appropriate on human sexuality and responsible parenthood. Furthermore, studies (Benagiano 1994; Vaughan & Abouzahr, 2000) corroborating ICPD’S reproductive components and multi-dimensional nature of reproductive health listed various components of reproductive health to include Family planning, maternal mortality, sexual behaviour, maternal care, safe motherhood, abortion, unwanted pregnancy, early child bearing, STIs, HIV and AIDS prevention, infertility and certain reproductive tract malignancies such as cervical cancer.
Reproductive health components as summarized by Benagiano (1994) are responsible reproductive sexual behaviour, available family planning services, effective maternal care and safe motherhood, effective control of reproductive tract infections, prevention and management of infertility, elimination of unsafe abortion, unwanted pregnancy, sexual abuse and prevention and treatment of malignancies of reproductive organs and sound adolescent health and sexuality. Effective reproductive health depends largely on the state of sexual health.
WHO (1975) described sexual health as the integration of the somatic emotional, intellectual and social aspects of sexual being in ways that are positively enriching and that enhance personality, communication and love. The WHO report in-corporating this forward looking description of sexual health laid the groundwork for a comprehensive understanding of human sexuality and its relationship to health outcomes. Also, terms such as sex, sexuality and sexual rights, were integrated as composite of sexual health.
Reproductive Health Matter-RHM (2001) described sexual health as having the freedom to choose how to express one’s sexuality (or how not to). The RHM report noted that sexual health also involves understanding one’s body, being comfortable with oneself and her sexual desires, having desirable sexual relationships with others; learning to identify and doing away with violent or abusive behaviours and learning to cope with the aftermath effects of such relationships. According to Federal Ministry of Health-FMOH (2005), sexual health is part of reproductive health which includes healthy sexual development, equitable and responsible relationship, sexual fulfillment and freedom from illness. Healthy sexual development is built on the acceptance of one’s self and good communication with his/her partner. People who develop healthy intimate relationships believe in themselves and in people around them. Equitable and responsible relationships according to Insel and Roth (2006) include open, honest communication, agreed on sexual activities, sexual privacy, using contraceptives, safer sex practices like use of condom and hugging, sober sex and clear discussion on sexual consequences. Sexual fulfillment entails that in sexual relationship love making must be with the primary aim of satisfying both sexual and psychological needs. Satisfaction of sexual desires and the quality of the relationship are more important to overall sexual satisfaction than sophisticated or erotic sexual techniques.
On the issue of freedom from illness, Insel and Roth (2006) maintained that both partners should be aware of and practice safer sex to guide against STIs. They further stated that partners should be honest about their health and any medical condition and work out plan for protection. For the purpose of this study, sexual health refers to a state of complete physical, mental and social well being in all matters related to the way students view and express their sexuality. It represents situations and conditions where secondary schools students derive sexual pleasure and satisfaction through a variety of sexual activities such as hugging, kissing and caressing.
CDCP (2010) stated that sexual health also encompasses problems of HIV and STIs, unintended pregnancy and abortion, infertility, cancer resulting from STIs, and sexual dysfunction. These components are also embedded in reproductive health. Robinson, Bockting, Rosser, Miner and coleman (2011) identified components of sexual health to include, talking about sex in relation to culture, sexual identity, sexual anatomy and body functioning, Sexual health care, safer sex, body image, masturbation, fantasy, positive sexuality, intimacy and relationships and spirituality.
