Contraceptives and Their Effects
CHAPTER ONE
Objectives of the Study
General Objective
This research seeks to achieve a general objective of examining the level of contraceptive use and use of contraceptive methods among youth in Abuja metropolis
Specific Objectives
- To examine the level of youth’s contraceptive use and practice in Abuja metropolis.
- To identify factors responsible for level of youth’s contraceptive use and practice in Abuja.
- To find out how effective contraceptive use and practice among youth in Abuja metropolis are.
- To find out the youth’s level of accessibility to contraceptive methods in Abuja metropolis.
- To know the problems youth’s encounters in accessing contraceptive methods in Abuja metropolis.
CHAPTER TWO
LITERATURE REVIEW
Empirical Literature
In this literature review, efforts will be made to examine some of the previous studies related to the title of this work under the following sub-headings: Maternal mortality in developed and developing countries, maternal mortality in Nigeria, adolescent effect of contraceptives, trends in unwanted pregnancy, contraception in Nigeria, preventive factors affecting contraception etc.
Maternal Mortality Ratio in Developed and Developing Countries.
Maternal mortality is a public health issue in many countries especially in the developing countries, where an estimated 585000 women die everyday from pregnancy related deaths (Ali, 2009). Similarly, WHO (2010) report shows that, in developed and developing countries, maternal mortality adds up to 600,000 each year. And that every minute, at least one woman dies from complications arising from pregnancy and child birth. The report further shown that maternal mortality represents one of the widest health gaps between developed and developing nations, with 99% of all maternal deaths occurring in developing countries.
Report by United Nations Development Programme [UNDP], (2003) from a study conducted by Charles (2000) on Maternal Deaths in Europe, shown that in developed countries there are approximately 27 maternal deaths per 100,000 live birth each year, while in developing countries, the average is 18 times high, at 480 deaths per 100,000 live births. The majority of pregnancy related deaths occur after delivery is (61%), in comparison to 24% during pregnancy and 16% during delivery (USAID, 2010).
According to Esperanca (2009) maternal mortality has been an important public health problem, that is why its reduction has being included in the MDG goals. And spontaneous reporting and pregnancy registries were presented as examples of mechanisms that could and should be in place for reduction of maternal deaths in developing countries.
WHO (2007) survey using a Time-Series analysis in estimation of 586000 maternal deaths shows that developing countries accounted for 99% of maternal deaths. Thus, it was also observed from the survey that Sub-Saharan Africa and Asia accounted for 86% of global maternal deaths.
Moreover, Ali (2009) carried out a study on “Make Every Woman Count: Maternal Mortality” in Malawi, India and United Kingdom. The study used an ecological study design, which means to study the relationship between aggregated health data and exposing factors, for a geographical area and time period. The result shows that maternal mortality is highest in Malawi and India, while it is very low in the U.K. the result further shows that in Malawi and India, maternal mortality is caused by direct causes while in U.K it is mainly caused by indirect causes. It was also observed that preventive steps such as family planning, skilled attendance, obstetric emergency care and antenatal care can significantly reduce the maternal mortality rate.
Geubbels (2006) carried out a research on maternal deaths in three districts in the central region of Malawi. The result indicate that there were 28(65.1%) and 15(34.9%) deaths resulted from direct obstetric and indirect obstetric respectively. The study classified other causes of maternal deaths in Malawi, which include postpartum haemorrhage (25.6%), post partum sepsis (16.3), HIV/AIDS (16.3%), ruptured(4.7%), and eclampsis (4.7%). In the final analysis of the study, it was observed that four factors have contributed to the maternal deaths in Malawi as a developing nation. They include:
Health worker factor, administrative factor, patient/family factor and TBA factor.
Similarly, Salvi (2009) conducted a survey research on Health and Family welfare in India. The study was applied to 29 states in a sample of household. He examined that it is estimated that India has 28 million pregnancies annually and this high number is due to prevalent poverty, illiteracy and early marriages. The study further shows that most of the pregnancies lack medical services which result to high maternal mortality in the country.
CHAPTER THREE
RESEARCH METHODOLOGY
Research Design
This study adopted a cross–sectional survey design. May (2001) noted that the application of a cross-sectional survey method is appropriate in obtaining the behavioral pattern of a given population on the basis of their knowledge, opinion, attitude and perception concerning a given phenomenon?
Study Population
The study population consists of youth between the ages of 15-24years in Abuja metropolis. While the target population includes youth aged 15-24 years from the Higher Institutions and Secondary Schools, Traders and Artisans in Abuja metropolis. Students, traders and artisans are chosen for this study since other social categories like Okada riders, Hawkers, and Motor Park touts etc, which may also be relevant to the study, are strictly and highly restricted from operating in the metropolis.
Sample and sampling procedure.
The sample size of this study was determined by using a prevalence of 18.1% for use of modern contraception among all male and female aged 15-24 worked out from the NDHS 2008 report (NPC & ICF Macro, 2009) and confidence interval of 93% with an estimated 3.5% precision level. A sample size of 481 respondents was computed. This will be rounded up to 500 respondents and allowed the detection of difference within 3.5% point of the true difference.
As a result, a sample size of 500 respondents were used for the questionnaire, 200 respondents from Tertiary Institution and 200 respondents from secondary institutions, while 50 respondents each was allocated to traders and artisans respectively. Nonprobability sampling was used to select 10 in-depth interview (IDI) sessions, thereby making the total sample size for the study to be 500 + 10 = 510.
Therefore, using simple random sampling or balloting, one higher institution as well as one secondary school were selected and used for the study. Simple random sampling will be used to select the students, traders and artisans because of its fairness and objectivity, since everyone in the population has the same chance of being selected. However, four departments as well as four classes (i.e SS1 – SS 3) will be randomly selected while the traders and artisans were located in market places and shops. Senior classes were used for the study because they are considered to fall between the age ranges of 15-24 years. Thus, there will be 50 respondents each from the four departments and four senior classes including 50 traders and 50 artisans purposively selected for the study. Ten key informants like traders, artisans, students’ union executives, religious groups and social club leaders will be purposively selected, 1 from each of the 8 classes, while 1 session IDI each will be conducted for traders and artisans, and used for the IDI session. Respondents to the questionnaire will not be used for the IDI session to avoid duplication of ideas.
CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS
Personal Data of the Respondents
This section deals with the socio-demographic characteristics of the respondents in this study. This includes Sex, Age, Religion, Education Qualification etc.
Distribution of Respondents by Sex
The sex of the respondents includes male and female youth in Abuja metropolis.
Table 1 shows that majority of the respondents were female youth (53.2%). While the male respondents were (46.8%) of the sample. This shows that the female respondents were majority and showed more interest to the study at the time of the administration of the questionnaires.
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
Summary of Findings
This study was conducted in Abuja metropolis, among youth between 15 – 25 years old. It covered youth in higher institutions, Secondary schools, and others who are not in school like traders and artisans.
A total sample of five hundred (500) was chosen for this study. The questionnaires were other-administered and were duly completed. In-depth Interview (IDI) was also conducted to revalidate and complement the findings of the survey instruments.
Socio-Demographic Characteristics of Respondents
The respondents for the survey comprised, fifty three percent (53%) males and forty six percent (46%) females. The age range of most of the respondents clustered between 15-19 years. The current level of education of most of the respondents are higher institutions and secondary schools (40%) each respectively and (20%) of traders and artisans who are not privileged to be in school. However, majority of the respondents were Christians (47.4%) and Moslems (45.6%). This shows that populations of those who practices Christianity and Moslem are quite high in Abuja metropolis.
Effect of Contraceptives
Since knowledge is an important prerequisite in gaining access to contraceptives, it means that knowledge of contraceptives level could be promising for better future use.
With above 50% of total population of those who have knowledge of contraceptives from this study, it shows that knowledge of contraceptives among youth in Abuja metropolis is quite high. And with 78.8% of youth who have heard about contraceptives, it shows that knowledge of contraceptives is also quite high in Abuja metropolis. And with 62% means of those who lack knowledge of contraception, It shows that youth/adolescent have limited knowledge and access to contraceptive methods in Abuja metropolis.
Sexual History
The study revealed that 58.2% of respondents were sexually active or have sexual partner. It shows that sexual activity is quite high among youth in Abuja metropolis. The mean age at the sexual debut was 0.83% for males and 0.88% for females. This indicates that females are at higher risk facing consequences of youth sexuality than there male counterparts. Differences in engagements in sexual activity between male and female could be due to various societies in Nigeria’s norms that prohibits youth’s involvements in sexual activity. (Whereby some society considers premarital sexual activity of male as normal but strictly disapprove female involvements in pre-marital sexual activities to avoid unwanted pregnancies). Engagements in sexual activity in this study are quite lower among youth between the ages of 20 years and above.
Contraceptive Use
Majority of the respondents (55.4%) identified that they have not used any contraceptives during their last sexual exercise/intercourse. While the lowest proportion (34.2%) identified that they used contraceptive methods at their last sexual intercourse. Condoms were used by 26.6% of all the respondents at their last intercourse. Shops were identified as the sources of contraception for higher proportion of the respondents at 59.2% while Government Health Centres (42.8%) and private hospital/clinic (33.0%) were the second and third sources of contraceptives used by the respondents at their last sexual intercourse. I know where to get contraceptives, I can afford to buy and I approve use of contraceptives, where the major reasons to get contraceptives from the selected sources for high proportion of the respondents. The main purpose of using contraceptive by the respondents at their last sexual intercourse was to prevent unwanted pregnancy, followed by prevention of sexually transmitted diseases (STDs).
However, for the fact that the rate of use of contraceptive by the respondents at their last sexual intercourse was to prevent unwanted pregnancy, followed by prevention of sexually transmitted diseases (STDs), it shows that youth were more exposed to the risk of unprotected sex. This could also be an indication to give information about unprotected sex before they start to engage in sexual activity is lacking among them.
Barriers to Contraceptive Use
The study found that majority of the respondents who have ever used contraceptives and inconsistent users might reflect the presence of problems that youth face when trying to use contraceptives. Considering the fact that (4.6%) of the female respondents have been pregnant and (4.8%) of male respondents have impregnated a girl, therefore the level of contraceptive use could be even lower and unsatisfactory. In this study most of the respondents identified, embarrassment to buy (60.57%), Religious opposition (59.45%) fear of side effect (63.55%), Afraid of being seen by parents (60.55%) and lack of knowledge (61.30%) means was commonly reported barriers by the respondents.
This is in agreement with qualitative finding that indicted that youth face various barriers both at the level of accessing and using contraceptives considering the reasons for non use especially embarrassment to buy, lack of knowledge, fear of side effect and religious opposition could imply that even youth who have the knowledge and want to use contraceptives, factors like fear of sharing sensitive personal matters and fear of facing side effect could also be a challenge to youth decision to use contraceptives.
The study shows that youth aged 14 – 19 years were less likely to use contraceptives than those aged 20 years and above. And again youth who discuss contraceptives with their friends and those that approve use of contraceptives by youth were more likely to use contraceptives without considering the barriers they may face. This explains why youth at their early stages should need to provide information and guidance. It could also indicate the importance of teachers/parents in providing information about contraceptive use and clearing the negative rumors about contraceptives.
Conclusion
Firstly, the level of knowledge of contraceptives methods was quite high among the youth, but the majority of the respondents ever used any method was quite low. This implies that majority of sexually active youth are highly exposed to consequences of unprotected sex and sexually transmitted diseases.
Secondly, the study found that majority of the youth have who plans to use contraceptives in the future, choose to use modern methods mostly preferred condom and lesser proportion of the respondents identified pills and withdrawals, injectables as their preferred choice.
Thirdly, greater majority of the youth had positive views towards
contraceptives and were interested to know more about it especially before the age they are likely to start sexual activity. Some of them identified they were not properly thought and guided on how to lead their sexual life neither from their parents nor from their teachers.
Fourthly, the study found that sizeable proportion of youth prefers to use chemists/pharmacy shops to avoid identifying them sexually active and to avoid embarrassment by health workers at government and private hospitals, who will request for registration before attention could be given to them.
Finally, the study found that youth faced a wide range of barriers to the use of contraceptives both at accessing it and level of use.
Recommendations
Based on the findings, the following recommendations were proffered:
- Programs promoting safe sexual behaviour should be encouraged among youth and it should be integrated with other behavioural change intervention.
- Provision of information about contraceptive should also include the possible sources of contraceptives, especially where it could be accessed without embarrassment by the providers.
- Youth should be provided with basic knowledge of sexuality and contraception before the age they are likely to engage in sexual activities and effective channels of communication should be used to inform and educate youth using health professionals including, the author, trained teachers, and trained peer promoters and media.
- Creating public awareness (especially on parents, teachers and service providers to create supportive environment to inform youth abut sexuality, encourage abstinence and reduce barrier’s to use of contraceptive by sexually active youth.
- Since Abuja is a modern and developing world class city, youth friendly centers should be encouraged through sensitization of the providers to enhance the function of youth centre which should include recreational, education, income generating activities to reduce fear of youth to utilize the centres.
Areas of Future Research
It will be interesting to conduct further research among youth on the use of contraceptives in various rural communities in the federal capital territory to identify whether they are facing similar barriers to use contraceptives, parents and teachers on their knowledge about and attitude towards youth contraceptive use and provides of different delivery points on their knowledge about and attitude towards youth sexuality and contraceptive needs and how they feel about youth contraceptive use.
Researchers should also be committed to using the findings of research to improve the reproductive health of the youth by embarking in field works in order to find out those factors which affect youth’s reproductive health; as youth’s reproductive health matters a lot being one of the major contributors of death of youth in their youthful ages, (15-20 years ) through incessant abortions and HIV/AIDS infections.
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