SOCIO-DEMOGRAPHIC CORRELATES OF SEXUAL AND REPRODUCTIVE HEALTH SERVICES UTILIZATION AMONG IN-SCHOOL ADOLESCENTS IN ENUGU STATE

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Abstract

The purpose of the study was to determine the socio-demographic correlates of sexual and reproductive health services utilization among in-school adolescents in Enugu Stateusing a correlational research design. Six research questions and five null hypotheses were posited and tested at .05 level of significance. A researcher-designed instrument known as socio-demographic correlates of sexual and reproductive health services utilization questionnaire (SCSRHSUQ) was used for data collection. Face validity of the instrument was established by five experts. The reliability of the instrument was ensured through split half method which yielded a reliability co-efficient of .75 using Pearson Product Moment Correlation co-efficient. A sample size of 1377 respondents was drawn from a total population of 68, 838 using multi-stage sampling procedure with simple random sampling technique. The data collected was analyzed using Pearson Product Moment Correlation and the null hypotheses were tested with simple linear regression analysis. The study revealed that the extent of utilization of sexual and reproductive health services by in-school adolescent was low. ( =2.45 SD=1.007) Findings also showed that there was very low relationship between age ( = 2.52 SD=.994, =2.39 SD=1.017, = 2.47 SD=1.004) gender (male =2.44 SD=1.094, female =2.46 SD=.964) school type (boys =2.50 SD=.944, girls =2.46 SD=1.031, boys and girls =2.35 SD=1.060) religious affiliation (Catholic =2.51 SD=1.020, Anglican =2.49 SD=.989, Pentecostal =2.40 SD=1.005) and location (rural =2.43 SD=1.015, urban  = 2.24 SD=.980) and utilization of sexual and reproductive health services by in-school adolescents. The null hypotheses of no significant relationship between socio-demographic variables of age, gender, school type, religious affiliation and location and utilization of sexual and reproductive health services were all accepted at .05 level of significance. Based on the above findings, it was concluded that age, gender, school type, religious affiliation and location cannot be used to predict the utilization of sexual and reproductive health services (counselling, health education, prevention, treatment, family planning and referral services) by in-school adolescents. It was recommended among others that parents, teachers and school proprietors should form a team network in enlightening the students on the importance of utilization of sexual and reproductive health services. This will enhance very high extent of utilization of the available services irrespective of age, gender, location, among others.

CHAPTER ONE

Introduction

Background to the Study       `

             Sexual and reproductive health diseases account for high levels of mortality among adolescents in developed and developing countries despite worldwide efforts to improve their overall health. Each year in the developing countries of Africa, 14 million adolescents die from sexual and reproductive health diseases. About 40 per cent of these deaths occur in Nigeria (Otoide, Oronsaye & Okonofua, 2001). Sexual and reproductive health (SRH) problems confronting adolescents in Nigeria has become a focus of research, advocacy, policy and legal initiatives. Otoide et. al. identified the sexual and reproductive health (SRH) problems of adolescents to include early sexual debut, early and forced marriages, female genital mutilation (FGM), unprotected sexual activities, sexually transmitted infections (STIs). Also implicated are HIV and AIDS, low contraceptive use, sexual and gender based violence, inability to negotiate safe sex, unwanted pregnancies, clandestine abortion and other pregnancy related complications. These SRH problems are preventable if adolescents have access to and utilize SRH services. Casey (2001), Doherty (2005) and United States Agency for International Development-USAID (2012) asserted that for adolescents to attain optimal SRH, they need SRH services that are age appropriate, factual, youth friendly and cost effective.

          Sexual health though an integral part of reproductive health goes beyond reproductive health. Girard (1999) defined sexual health as that part of reproductive health which is concerned with healthy sexual development, equitable and responsible relationship and sexual fulfillment, freedom from illnesses, disease, disability, violence and other harmful practices related to sex and sexuality. Department for International Development- DFID (2004) described sexual health as the enhancement of life and personal relations and not merely counselling, education and care related to reproduction and STIs. World Health Organization-WHO (2003) defined reproductive health as a state of complete physical, mental and social well being and not merely the absence of disease or infirmly in all matters relating to the reproductive system, its functions and processes. Sexual and reproductive health according to Kamau (2006) is the ability of individuals to attain optimal sexual development, prevent diseases, disabilities and death from sexuality and reproduction. This implies that people are able to have satisfying and safe sex life and that they have the capacity to have children and the freedom to decide if, when and how often to do so. In this study, SRH shall be described as a state in which adolescents are free from diseases and illnesses of the reproductive system and are free to engage in responsible relationships without coercion. For adolescents to achieve this, they need SRH services that are age appropriate.

         Studies (Population Report (1985), Kuunibe, Nkegbe and Mumin (2012) posited that some factors such as age, gender, school type, religious affiliation and location (urban-rural) have been identified to correlate with SRH services utilization. For example Advocates for Youths (2005) observed that age has a great influence on utilization of health services. According to them, young persons are usually brought to health facilities by either their parents or wards to seek health care.  Tilahum, Simkhada and Regimi (2008) reported that in some health facilities, young people who come to seek SRH services are driven away by health care providers, the reason being that young people who seek such services are either spoilt or wayward and not good for marriage.

        Gender differentials in health services utilization have received consistent attention among researchers. UNFPA (2000) discovered that there are gender variations in the utilization of SRH services among adolescents. Females have been consistently shown to have higher health conscious attitudes and concerns than men but men have more economic empowerment and have more freedom to move about freely. The common reason advanced for gender differences is the different socialization patterns between boys and girls.  Malarchar (2010) reported that girls face social and psychological barriers to accessing SRH services as against their male counterparts due to gender stereotypes.

        School type is a factor that could influence utilization of sexual and reproductive health services. Tilahum, Simkhada and Regimi (2008) reported that school type play a major role in SRH services utilization. According to them, adolescents who attend mixed schools feel more confident to access SRH services than those who attend boys’ only or girls’ only schools.

        Olunloyo (2009) asserted that religion to a large extent greatly influences what people believe value and practice as a people. Parents, community and religious leaders are however divided on issues pertaining to the discussion and provision of SRH services for adolescents. According to them, adolescents should conform to religious principles of pre marital chastity.

         Stone and Ingham (2002) reported that adolescents who live in rural communities where the provision of adolescent sexual and reproductive health (ASRH) services are frowned at may be socially excluded from utilizing existing SRH services. Pate (2001) described the relationship between health services utilization and location noting that the use of health services is higher among urban dwellers than rural dwellers. The National Demographic and Health Survey (2009) reported differences in utilization of health services among rural and urban adolescents attending hospital for services related to SRH.

These socio-demographic variables according to various reports are believed to correlate with SRH services utilization among adolescents.

        Correlation is the extent of relationship or relatedness between two or more variables. Phillips (2005) described correlation as a complementary, parallel or reciprocal relationship between two comparable entities; which the extent is usually expressed as a coefficient called correlation coefficient. Correlation in this study is the relationship between utilization of SRH services and some socio-demographic variables among adolescents.

          The International Conference on Population and Development-(ICPD) (1994) noted that adolescent SRH services are basic human rights and emphasized the importance of the provision of SRH services to adolescents in order to address their reproductive health challenges across the life span. Tilahun, Mengistie, Egata and Reda (2012) reported that sometimes adolescents lack access to and are less comfortable utilizing SRH services. One reason cited for this was that parents, health care providers and educators are sometimes unwilling to provide age-appropriate SRH services to them. The discomfort lies in their belief that providing adolescents with SRH services will encourage sexual promiscuity.  Also, several factors ranging from social, demographic, cultural, economic and gender-related factors also influence the utilization of SRH services by adolescents. Allan Guttmarcher Institute-AGI (2006) reported that approximately 14 million adolescents in both developed and developing countries die from diseases and complications related to SRH. Iyaniwura, Daniel and Adelowo (2007) observed that this could be attributed to the fact that globally adolescents’ utilization of SRH services remains unsatisfactory accounting for high levels of morbidity and mortality. Nigerian adolescents like their counterparts all over the world are also exposed to several sexual and reproductive health-related risks.

         WHO (2003) observed that adolescents are highly vulnerable to diseases and social changes in the environment which predispose them to sexual risk-taking behaviours including early sexual activities with evidence of increased SRH problems.  DFID (2004) reported that despite the inclusion of SRH  in the Millennium Development Goals and the recognized need for SRH service provision for adolescents, they are still neglected in the implementation of health services especially SRH services. Akinyele and Onifade (2006) asserted that the neglect is as a result of the notion that adolescents are believed to be less vulnerable to diseases than children and the aged. The age of sexual debut has increased for adolescents in Nigeria. Nwaorgu, Onyeneho, Onyegebgu, Okolo, Obadike, Ugochukwu and Mbaekwe (2009) revealed that over sixteen per cent of teenage females in Nigeria reported first sexual intercourse by age 15. Among young women aged 20 to 24, nearly half (49.4%) reported first sex by age 18. Among teenage males, 8.3 per cent reported first sex by age 15. Among those aged 20 to 24, 36.3 per cent reported first sexual intercourse by age 18. Similarly, USAID/NIGERIA (2012) reported that the median age of first intercourse for women is 17.7 and for men 20.6 and that there is a likelihood that they will engage in unprotected multiple sexual relationships which may result in sexually transmitted infections (STIs) including HIV, unwanted pregnancies and abortions. STIs have been identified as a predisposing factor in the transmission of HIV infection.  According to Ingwersen (2001) about 500, 000 young people are infected with STI daily. She noted that most STIs are not fatal, but can lead to major complications such as infertility and general ill health. UNICEF (2006) reported 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 females. Otive-Igbuzor (2003) opined that in Sub-Saharan Africa, among young aged 15 to 24, two girls are infected for every boy and for adolescents aged 15 to 19 years, five or six girls are infected.

SOCIO-DEMOGRAPHIC CORRELATES OF SEXUAL AND REPRODUCTIVE HEALTH SERVICES UTILIZATION AMONG IN-SCHOOL ADOLESCENTS IN ENUGU STATE