The Knowledge and Practice of Contraception Among Male Adolescent Students
Chapter One
GENERAL OBJECTIVE
The objective of this study was to determine the level of awareness of male on contraceptive measures to improve this knowledge and increase their compliance with the usage. This will help us in educating them on how to prevent early pregnancies and its negative effects and or infections to their young reproductive organs which may lead to secondary infertility in later life.
SPECIFIC OBJECTIVE
- To assess the knowledge of male students of Federal College of Education Technical Asaba on male contraception.
- To determine the practice of male contraception among the students.
- To assess the factors that influence the use of these contraceptives in this age group of students
CHAPTER TWO
Research design and conceptual framework
Conceptualizing the gap between knowledge and behaviour
The focus of my study is how students in Kaduna Polytechnic in heterosexual relationships relate to the issue of contraception and what social factors shape their attitudes and practices. I am motivated by studies which have revealed a gap between contraceptive awareness and contraceptive use and the negative social and health consequences of unprotected sex among young Nigerian students, including the spread of STIs and the risk associated with unsafe abortions resulting from unwanted pregnancies.
As already noted, growing concerns generated by the increasing reproductive health problems experienced by young people in developing countries of Africa, have resulted in various studies aimed at understanding why people may not use available health services despite their awareness of its existences and usefulness.
I work within a social constructivist framework, starting from the premise that knowledge and reality are created interactively and embedded in specific social contexts, thereby making an individual’s action a product of interchanges with their environment (White, Bondurant and Travis 2000). Thus, I recognise that students in the polytechnic will have varying attitudes towards contraception given that they come from different backgrounds with different orientations. The social constructionist approach further suggests the examination of social processes involved in generating constructs such as the self, gender and sexuality. I thus attempt to find out if social factors, which emerged from my literature review, influences students’ contraceptive practices and how the individual in sexual relationship creates personal meanings in relation to external social realities which in turn informs his or her behaviour, in this case, in relation to the use or non-use of contraceptives. I further recognise students’ attitude towards contraceptive use as being historically and culturally located. Not only are individual attitudes specific to particular periods in history and cultures, it is also considered a product of and dependent on the prevailing arrangements in that culture at that historical period (Burr, 1995).
In my study, I thus distance myself from the position of scholars such as Rosenstock, Strecher and Becker (1988) and, more recently, Glanz, Rimer and Lewis (2002) who have attempted to explain individuals’ attitudes towards health-related issues by means of the Health Belief Model (HBM). This posits that health behaviour is informed by the perceived benefits of the particular behaviour by the individual. They assume that an individual’s behaviour on health related issues is rational; as such the individual will use contraception if he/she is convinced about its benefits. This approach fails to consider how other social factors could serve as barriers to individual’s decision to adapt certain beneficial health behaviours. Such processes could include existing patterns of gender relationships (in which one party may be coerced into sexual activity) as well as other factors such as time, cost, inconvenience, embarrassment or loss of pleasure, religion and cultural norms (Dejoy, 1996). This implies that although students are aware of the benefits accruing from the practice of contraception and may want to use it, there are other social barriers that serve to deter them which the HBM does not explain sufficiently.
Reyna and Farley (2006) reported that although adults often believe that young people view themselves as invulnerable and are therefore incapable of rationally weighing risk and benefits, this is not true, as young people do weigh risk and benefits rationally. However, they also found that even when the benefit is perceived to be greater than the risk, they sometimes go ahead to take the risk. In line with this, Thamlikitkul (2006), in his article on ‘Bridging the gap between knowledge and action for health’, is of the opinion that knowledge about health issues in itself is not enough to improve peoples’ choices towards health practices. Rather for this to be achieved, knowledge must suit the existing diverse social and political context. According to Thamlikitkul, for the ‘know-do’ gap to be bridged, institutions responsible for reproductive health in developing countries need to “invest more resources in promoting professional communicators or intermediaries to narrow the gap as well as develop a culture where decisions taken by policy-makers, health professionals and the public are based on evidence” (2006:605).
While these studies take different approaches to explaining decision-making and choice of options regarding health-related issues among young people, at the centre of them all is the common recognition of social factors impacting on the individual and influencing his/her choice of action regardless of the rational calculation of risk and benefits. Research in Nigeria has revealed that key issues such as gender relations, cultural beliefs and practices, as well as contraceptive accessibility all play significant roles in influencing students’ decision or choice of action with regards to the use and non-use of contraceptives (Orji and Onwudiegwu, 2002; Izugbara and Modo, 2007; Olaleye et al, 2007; Sudhinaraset, 2008). These features, function to shape and inform students’ attitudes to reproductive health issues at tertiary institutions and even at later stages in life (Izugbara and Modo, 2007; Amos, 2007; Sudhinaraset, 2008; Omo-Aghoja et al, 2009; and Avong, 2012). I have thus factored them into my research design. Below I discuss briefly how I understand them in my study.
CHAPTER THREE
RESEARCH METHODOLOGY
Research Design
In conducting my study, I have adopted an exploratory research design. Exploratory studies, according to Fouche and Vos, (2011) are usually conducted to gain more knowledge of a situation or phenomenon within a given population. This form of study is usually employed when there is a lack of information on a particular issue among a given population. Babbie and Mouton (2012) have extended this by arguing that exploratory studies can be employed not only when a researcher is working on a new area of interest but also when the subject of the study is relatively new. As already noted, I was unable to locate any study of contraceptive practices among male students at tertiary institutions in Nigeria, hence my selection of an exploratory research design for my study.
As already noted, I adopted a mixed method approach to address my research questions. This involves the combination of both quantitative and qualitative methods to come up with a broader picture of the research problem (Delport and Fouche, 2011). A quantitative method in the form of a survey questionnaire enabled me to have a wider scope of responses for possible generalisations of findings within my study population, while qualitative interviews complemented the survey by enabling me to get more insight into students’ views on issues of contraception. This also enabled me to explore further on emerging issues in the research process. I used survey questionnaires to find out the levels of contraceptive awareness and knowledge among students in the Polytechnic, their primary sources of contraceptive information, the extent of sexual activity among students, the extent of contraceptive use among sexually active students, as well as issues of contraceptive access and the nature of contraceptive services for male students. I also used questionnaires as a medium to seek a pool of interested respondents who will be willing to make themselves available to participate in the interviews.
The questionnaire is often regarded as being superficial in its coverage of complex social issues since not all information can be reduced to numerical forms (Babbie and Mouton, 2012). As such, a questionnaire on its own could not provide a deeper understanding of students’ vulnerability to unprotected sex. This informed my decision to also conduct qualitative interviews (with a smaller group of students from the initial survey group) to gain a broader understanding of issues around contraceptive practices among the students of Federal Polytechnic Kaduna. Using qualitative interviews, I explored more deeply the meanings respondents attach to their responses in surveys in relation to their beliefs and perceptions (acquired through social interaction) of sexual and contraceptive health issues. Interviews were semi-structured thereby ensuring flexibility and making it possible for me to probe the responses of individuals while being consistent in the nature of questions being asked. Survey and interviews were conducted in English, which is the official language used in the polytechnic and a common language that both the researcher and the respondents understand.
Area of study
My study site is located within Asaba. Federal College of education, Asaba was used precisely for this study. I obtained institutional consent for my research from the institution.
Due to the limited time available for me to conduct my study I thus had to seek an alternative study site very quickly. After consultations with my supervisor, I chose Federal college of education as the new site for my study. The choice of federal college ofeducation was informed by its relative homogeneity in certain characteristics
The college as a tertiary institution in Nigeria has been considered as an agent of change and national development as indicated by the Ashby commission report in 1960. This report saddled Nigerian Tertiary Institutions (the college of education inclusive) with the responsibility (among others) of providing for the academic, social, physical and psychological needs of students and the society at large (Ajayi and Adeniji, 2009). Every year, a large number of students get admitted into the polytechnic, these students come from different backgrounds in different societies. While some are well prepared for life in the new environment; others are ill prepared for it thereby making it difficult for them to adjust to the life changing experiences their new environment confronts them with. My study design is constructed around male students in the campus. The choice of these group of student was informed by the assumption that they would have had different levels of exposure to issues around contraception owing to the the fact that it is basically used by the males and not the females.
The survey
Population and sample design
In selecting my sample, I encountered certain difficulties. First was the challenge of getting to an area with a high concerntration of male students. Owing to the ojectives of the study.
The sample size consisted of 100 male students staying in the male hostel.
CHAPTER FOUR
DATA ANALYSIS AND PRESENTATION
Awareness and knowledge of contraceptives among male students
To ascertain the level of respondents’ awareness of the existence of contraceptive methods, respondents were asked to write down all the methods of contraceptives they knew of. They were not given a list of contraceptive methods from which to select, to prevent skewing the results.
The resulting data, presented in Figure 4, indicates a high level of general awareness of the existence of contraceptive methods, with over 95% of respondents able to mention at least one method. This corresponds with a 2009 finding by Omo-Aghoja et al that almost every student in a tertiary institution in Nigeria has heard of and can mention at least one contraceptive method.
CHAPTER FIVE
RECOMMENDATIONS AND CONCLUSION
Recommendations with regards to findings
Various interventions are required for contraceptive use to be improved, thereby decreasing the risk associated with unwanted pregnancy and the spread of STIs among students in Kaduna polytechnic and by extension students of tertiary institutions in other parts of Nigeria and especially the northern region. The following recommendations are made in line with the findings of my study.
Firstly, due to the low level of contraceptive knowledge, there is a need to improve contraceptive knowledge among students. Accurate and detailed information should be passed to students with the aim of correcting the misperceptions they have about contraceptive methods and creating more positive attitudes in them towards contraception. Intervention programs should be put in place to ensure that students as well as the general public get adequate and correct information on contraceptives. This could be achieved, as suggested by students, if sex education were introduced as part of the institution’s academic programme. Public campaigns should also be organised by the institution through the media (both electronic and print media), seminars and workshops organised for students with regards to educating them about contraception.
Also, religious and cultural beliefs, which were found to influence students’ contraceptive practices by prohibiting contraceptive use, need to be changed to begin seeing youths as sexually active beings and so embrace the inevitability of sexual practices among them. These teachings should be more concerned about promoting safe sexual behaviours among sexually active youths while still encouraging abstinence among the young and those who have not yet made their sexual debut. Cultural beliefs that discourage discussions of sex and contraception among youths should be changed to rather encourage a cordial relationship between adults and youths, parents and children. These relationships should be established on mutual trust and should seek to educate youths and children on issues of reproductive health so as to give them accurate information and develop in them positive attitudes which will eventually help them in making sound decisions in future with regards to contraception and thereby enable them to prevent the devastating dangers of unprotected sex.
Secondly, to ensure the success of these interventions, there is also the need to educate health workers, both within and outside the polytechnic environment, to ensure not only that they have correct information about contraception, but also to change their widely negative perceptions of students who seek contraceptives from them. Health workers should be encouraged (if possible under supervision from relevant authorities) to disseminate such information to students who come to seek for contraceptives from them, and should be given the responsibility of anchoring programmes both in the media and during seminars and workshops with regards to contraception.
Thirdly, given the home as the primary agent of socialization, there is the need for parents to educate their children on issues of reproductive health and contraception. To achieve this, parents need to be encouraged through a general public education programme organised by relevant authorities, using the media, community leaders as well as religious leaders to educate parents on the need for such.
Fourthly, intervention programmes should seek to discuss the dangers of risky sexual behaviours among students and the need for the individual student to prioritise safety above material gains especially in transactional sexual relationships. Unequal gender power relations must also be discouraged; rather, the egalitarian view found among many students about gender and contraception in sexual relationships should be encouraged and propagated at all levels to ensure that a partner should have the capacity to carter for his/her reproductive health needs without being compelled or restricted by the other partner.
Lastly, other factors discouraging students from using contraceptives also need to be addressed. Of great importance is that, contraceptives should be made easily accessible to students at low cost, if not free, and at convenient places where students can access them with ease. I recommend that condoms should be placed in secure boxes in public places such as toilets and other convenient corners where students can access them without the fear of being seen by others. Other methods should also be made available in the polytechnic clinic and its availability be effectively communicated to all students irrespective of their marital status and/or age. Health care providers must also be encouraged to be friendly to students seeking for contraceptives and educate them on the correct ways of using them to prevent against unwanted pregnancies and STIs.
Conclusion
My research attempted to explore contraceptive knowledge and practices among students of Kaduna Polytechnic with reference to the extent of sexual activities, contraceptive use, as well as contraceptive accessibility and influences of social factors on students’ contraceptive practices.
Despite students’ high awareness of the existence of contraceptive methods and continuous engagement in sexual activity, the level of actual contraceptive knowledge as well as the rate of contraceptive use among students was found to be low. Friends and the media were found to be the major sources of contraceptive information for students; this makes it likely that incorrect or incomplete information is conveyed to students, which could lead to them developing negative attitudes towards contraceptive use or being exposed to the dangers of contraceptive accidents.
Patterns of students’ sexual behaviours were found to influence the students’ attitude towards the use or non-use of contraceptives. While having multiple sexual partners was found to encourage students to use contraceptives, other forms of sexual activity, such as transactional sex and engaging in sexual relationships with partners of older ages, tends to limit the students’ capacity to use contraceptives.
Contraceptive use, including emergency contraception, was low among sexually active students. However, the condom and oral pills were found to be the most commonly used methods of contraception among students. . Contraceptives were not easily available for students in the polytechnic. Negative and unfriendly attitudes of health care providers towards students seeking for contraceptives was also found to limit contraceptive use among students in the polytechnic, thereby exposing them to the dangers of unprotected sex. Traditional and religious beliefs and practices were also found to influence the individuals’ attitude towards contraception, while there was evidence to suggest that gender attitudes are shifting and women’s rights to negotiate contraceptive use in sexual relationships is gaining recognition, although unequal power relations still are significant, especially when the woman is significantly younger and economically more vulnerable than the man.
Finally, students at the polytechnic were eager to talk about their concerns and showed a willingness to find out more which is encouraging and should be worked with by the polytechnic authorities.
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