Factors Influencing the Sexual Behaviour and Reproductive Health Problems of Adolescents in Nigeria
CHAPTER ONE
Objectives of the study
To explore the factors influencing the sexual behaviour and reproductive health problems of adolescents in Nigeria in order to recommend a more appropriate adolescent sexual and reproductive health policies and services. The specific objectives of the research:
- To describe the sexual experiences of adolescents in Nigeria
- To describe the knowledge and attitude of adolescents in Nigeria on SRH
- To describe the sources of information and the health seeking behaviour of adolescent on SRH in Nigeria
- To explore the influences to adolescent sexual behaviour in Edo State.
- To explore the reproductive health problems of adolescents and their treatment seeking behaviour in Uromi L.G.A
- To make recommendation that will inform better policy formulation and services that will address the SRH needs of adolescents in Nigeria in general and Uromi Local Government in particular
CHAPTER TWO
LITERATURE REVIEW
This chapter reports the findings of the context in which adolescents in Nigeria are living and their various sexual experiences, sources and preferences of SRH information and services. It describes how the context has implications on their sexual and reproductive choices and behaviour and the outcome of their sexual behaviour if unprotected.
Context of Adolescents Lives Influencing Sexual Behaviour
Individual Characteristics of Adolescents Influence Sexual Behaviour
Many factors act as drivers to adolescent sexual initiation and reasons for sexual relationship. Love, pleasure and fun were among the top reasons given by adolescents who participated in a national survey across 12 states in Nigeria for their sexual activity while others said they were forced into sex. Although sexual debut is reported by some at earlier age, the median age has been 15 years with adolescents between the ages of 15 to 19 years engaging more in sex (Wright, 2016).
Controversy exists from studies about the association between educational status and sexual behaviour of adolescents. While some studies have found that literate adolescents engage more in sex due to exposure to social media, others have found that sexual activity was more among adolescents with no or lower form of education (Gomwalk, 2012).
Socio- economic status viewed as a proxy for poverty was perceived to have influence on sexual behaviour of adolescents. Though arguable, but transactional sex was associated with sexual initiation mainly among female adolescents in Nigeria who viewed it as a means of survival. Financial benefit was also the reason given by some adolescents for sexual initiation especially with older person which restricts their power to negotiate condom use.
On the other hand, data extracted from the 2013 NDHS did not support the view that the high level of sexual activity is a function of household poverty. It reported that although poverty exposed adolescents to sexual risk such as low condom use, those from wealthy homes were exposed to pre-marital sex due to access to media (Nnebue, 2016).
Environmental Influence on Adolescent Sexual Behaviour
Peer influence was the reason a significant number of adolescents in a study in Imo state gave for sexual activity. Pressure from peers to initiate sex and information sharing on sexual activity, how to prevent pregnancy and what to do when pregnant were mentioned as triggers to sexual initiation. The same finding was reported among adolescents in Northern Nigeria. Studies have shown that having sex due to the influence of alcohol was documented mainly among males than females. Other adolescents however stated that their uncontrollable sexual urge is the reason they cannot abstain from sex (Olalekan, 2008).
Quality parental relationships and social support are seen as avenues of communication and sexual education among adolescent. Lack of this connectedness and ties between parents and children allow for negative influence and early sexual activity as reported in some studies in Nigeria. Also, family members are seen to exert some influence on adolescents through their own risky behaviour which adolescent learn very fast (Gomwalk et al., 2012).
CHAPTER THREE
METHODOLOGY
Study area
The study was conducted in s a city located in north-eastern Esan, a sub-ethnic group of the Binis in Edo state, Nigeria. At various points in Uromi’s history, the city and people have been an important part of Edo State. Uromi is not a municipality and has therefore no overall city administration or governance but instead, it is run by the Local government council headed by a Chairman. Uromi is not a local government but is the seat of the local government council governing the Esan-North-East local government area. The administration of the government of Uromi is divided into eleven (11) wards. Each ward delegates a Councillor who represents it at its local council election who is normally tenured for four years.
CHAPTER FOUR
RESULT AND DATA ANALYSIS
Results of case study
This chapter describes the study findings and especially the results of 8 FGDs conducted with adolescent males and females aged 18 to 19 years in school and out of school. Also, the IDI conducted with 4 HCP and 4 Parents.
Age At Sexual Debut
The age at sexual debut (age at first sexual intercourse) was similar for females and males, most of the females reported 10 to 15 years while most of the males reported 11 to 16 years as age of sexual debut. There was no difference in the responses of those in school and those out of school. Two out of the four parents interviewed expressed worry about the early sexual behaviour of adolescents while the other two had no idea what adolescents were doing.
CHAPTER FIVE
Conclusion and Recommendation
Conclusion
Both the literature findings and results of the case study found that sexual debut among Nigerian adolescents begin about the age of 15 years. Various forms of sexual practices were reported ranging from penetrative vaginal to anal sex. Same-sex practice was reported by both sexes but predominantly among in school adolescents.
Diverse reasons have been proffered by adolescent for their sexual activities, those in school mostly mentioned pleasure and love while those out of school mostly initiated sex because they were either forced into it or go into sex for the financial gain.
Transactional sex that is frequently reported among out of school females is now seen among males also. Their sexual partners are either their age mates or much older including close relations. Multiple and concurrent partners were mentioned more among adolescents out of school.
Social media was the most important source of information for adolescents in school unlike those out of school who relied mainly on the information from friends.
Despite the reported challenge of unintended pregnancy, abortion and STI among adolescents, HCP and parents have not approved the provision of contraceptives for adolescents contributing to the reasons why adolescents seek care from unqualified sources.
Recommendation
The following recommendations are made based on the findings of both the literature review and the case study. It is divided into three major sections; research, policy and implementation
Research Needs
There is a need to research into the various methods of abortion especially the local methods of abortion practice by adolescents in Nigeria
Interventional Research should be conducted among the patent medicine dealers (chemist) to ascertain the methods of abortion provided to adolescents.
More research is needed determine the structural influences of transactional sex among adolescents
Government/Policy
Adolescents should be allowed full involvement in the policy formulation, strategic development and the implementation of the strategies. This will ensure better understanding of their problems and design of programme that will address their challenges.
The government should reverse the law decriminalizing abortion in the interest of young females who seek for abortion at the detriment of their lives with quacks The government should come up with a strong policy against school proprietors expelling females from schools as a result of pregnancy, which terminates their education, and expose them to early marriage and poverty It is a violation of human rights for a teacher to have sex with an adolescent student, punitive measures should be taken against both teachers and family members convicted of sexually abusing children
RECOMMENDATIONS
- Adolescent sexual and reproductive health counseling should be constituted in school and out of school to equipped adolescents on how to handle sexual and reproductive health challenges
- Skill Training and acquisition should be organized for adolescents who are out of school as a form of empowerment to limit the rate of transactional sex and childmarriage
- NGO and government should organize workshops and seminars for parents and teachers on ASRH and how to initiate SRH education at home
- ASRH should be part be part of the school curriculum for HCP with refresher training and supportive supervision to improve their skills and attitude on service delivery to adolescents.
- Health care facilities should be organized to provide a convenient environment and opening hours to meet the needs of adolescent.
BIBILOGRAPHY
- Patton GC, Coffey C, Sawyer SM, Viner R M, Haller DM, Bose K et al. Global patterns of mortality in young people: A systematic analysis of population health data. Lancet 2009;374: 881e92.
- WHO. 10 facts on adolescent health. 2008. Available at: http://www.who.int/features/factfiles/adolescent_health/en/index.htm.Last accessed 24/1/2016
- UNFPA: Generation of Change: Young People and Culture. Youth Supplement to UNFPA’s State of the World Population Report New York 2008
- Bankole A, Oye-Adeniran BA, Singh S, Adewole IF, Wulf O, Sedgh G, Hussain R. Unwanted pregnancy and induced abortion in Nigeria: causes and consequences New York: Guttmacher Institute; 2006
- FMOH. National Policy on the Health and Development of Adolescents and Young People in Nigeria. First Revision. 2007: 1-27
- United Nations. International conference on population and development, Cairo 5-13 September, 1994. Programme of action. New York: United Nations, Dept. for Economic and Social Information and Policy Analysis; 1995
- Programmeming for adolescent health and development. Geneva: WHO, UNFPA, UNICEF; 1999
- Envuladu E.A, Agbo H.A, Ohize V.A, Zoakah A.I(2014); Determinants and Outcome of Teenage Pregnancy in a Rural Community in Jos, Plateau State, Nigeria; Sub-Saharan African Journal of Medicine; 1(1):47-52
- Nigeria demographic and health survey. 2013
- NPC. Report of Nigeria’s National Population Commission on the 2006 Census. Population and Development Review. Population Council Stable.2007;33(1):206-210. http://www.jstor.org/stable/25434601. Accessed: 20-01-2016
- World Population Review. 2015. Worldpopulationreview.com/countries/Nigeria-population/. Last accessed 20/1/2016
- United Nations, Department of Economic and Social Affairs. Population Division. World Population Prospects: the 2012 Revision
- Population reference Bureau, 2013
- Population Reference Bureau. 2008 World Population: Data Sheet. Washington, DC: Author, 2008
- Population Reference Bureau. The World’s Youth 2006: Data Sheet. Washington, DC: Author, 2008
- National Population Commission, Nigeria. Population Distribution by Age and Sex. 2006 Census Priority Tables; 4: 1-387
- FMOH, Nigeria. National Strategic Health Development Plan (NSHDP) 2010 – 2015. 2010
- RBM. Facts about Malaria in Nigeria, Abuja. Publication of the Roll Back Malaria. 2005:1-2