The Health Implications Of Sexual Behaviours Among Adolescent: In Uromi Esan North East Local Government Area Edo State, Nigeria.
Abstract
Adolescents in Nigeria initiate sex early and have various sexual experiences with diverse reasons for their sexual behaviour. While some practice safe sex, others engage in unprotected sex resulting in SRH problems such as unintended pregnancy, unsafe abortion and STI. The study aims to explore factors influencing the sexual behaviour of Nigerian adolescents in order to inform contextually appropriate responses in Uromi Local Government in Edo State.
A review of literature and a qualitative study using a combination of FGD among adolescents 18 to 19 years and in-depth interviews with health care providers and parents who have adolescent children. Findings from literature and the case study shows that Adolescents engage in various sexual practices ranging from penetrative vaginal sex to anal sex. Diverse reasons were deduced from the findings for their sexual behaviour to include pleasure; love and peer pressure especially for those in school. Forceful sex and transactional sex was the major reason for those out of school. Multiple and concurrent sexual partners were reported more among out of school females. The major outcomes of adolescent sexual behaviour in both the literature and case study were unintended pregnancy, unsafe abortion and STI/HIV. Reports from the case study revealed adolescents have devised local methods of abortion and others consult quacks and none professionals for abortion due to fear, stigma and judgmental attitude of health care providers. Most parents and HCP with the exception of one did not approve of contraceptives for adolescents.
Most adolescents practice unprotected sex in Nigeria. While most in school adolescents engage in sex for the pleasure, most out of school had either forceful or transactional sex. Multiple, concurrent and sex with older partners was reported more among out of school adolescent. Unintended pregnancy is common in the study resulting mostly into unsafe abortion for in school females and child marriage for out of school females. Based on the findings of this thesis, there is a need to provide both in school and out of school counseling and SRH services for adolescents. The local methods of abortion should be researched into for better understanding and importantly also is the need to train HCP on ASRH in Nigeria.
Key words: Adolescent, sexual behaviour, Sexual and Reproductive health, unintended pregnancy
CHAPTER ONE
INTRODUCTION
1. Background to the Study
Adolescents constitute an important proportion of the population of Nigeria, they are classified by WHO to be individuals within the ages of 10 to 19 years (Patton et al., 2009). It is a delicate stage that presents with challenges especially that of sexual and reproductive health due to the developmental changes (Bankole, et al., 2006). It is important that they experience safe and pleasurable sexual life, the absence of which may expose them to reproductive health challenges (Envuladu et al., 2014). Adolescent sexual behaviour is influenced by several factors. However, having access to the right sexual and reproductive health information and services is an important step in structuring and addressing their sexual and reproductive health needs.
My experience as a field trip coordinator working in some rural communities of plateau state drew my attention to the high rate of teenage pregnancy and child marriage in some communities. This lead to a research that we conducted among 192 teenage females in a district that showed a 25.5% prevalence rate of teenage pregnancy and 45% rate of abortion (Okafor, 2016). My interest in conducting this study came about, as I got more involved with national programme on adolescents health and working with some NGO on girl child marriage in Nigeria. I realized from fieldwork and discussion with adolescents that various factors influence their sexual behaviour, which needs to be understood.
The main objective of this thesis was to explore the influencing factors to adolescent’s sexual behaviour. Also to explore the reproductive health problem with the aim of providing a contextualized recommendation that will help in policy formulation and intervention programme for adolescents. The thesis comprised of a search of relevant literature to assess the factors, which defines the conduct of adolescent sexual behaviour and reproductive health issues in Nigeria and a qualitative case study in Uromi Esan East Local Governmen, Edo State, Nigeria that explore the sexual experiences and the drivers to adolescent sexual practices and health seeking behaviour.
1.2 Statement of Problem
The health indices in Nigeria is poor, the country contributes 32% of the global death due to malaria. While there has been some slight improvement in some health indices such as newborn and child mortality, maternal mortality in the last five years has remained unacceptably high at a ratio of 576 per 100,000 live birth and the worst figures are in the northern part of the country. Child marriage is a major problem in Nigeria; NDHS 2013 shows that 28.8% of females between ages 15 and 19 are currently married. The rate is as high as 76% in the North and 10% in the South Eastern part of the country. Adolescent fertility rate is 122 per 1000 women; amidst the low contraceptive rate among adolescents. To address the sexual and reproductive health problems of adolescent, the national adolescent reproductive health policy was developed with establishment of youth friendly health centers in some part of the country. These centers are however not adequately utilized by adolescents. Edo state is one of the states that has been classified as a “hot zone” of HIV infections with a prevalence rate of 16% in Jos North LGA of the state.25 Some health indices in the state are worse than the national average, like the under-5 mortality rate which was 165/1000 when the national figure was 138/1000 and the MMR that was 800/100,000 live birth when the national figure was 576/100,000. The contraceptive prevalence rate in the state is 15.2% while the use of modern contraceptive is only 14.4% in the state.
The Health system in the state is in three levels, the tertiary health care, which is overseen by the Federal government, the secondary level controlled by the state and the Primary Health care (PHC) level controlled by the LG. In addition, there are some faiths based and privately own health facilities. The primary health care facilities are found in almost all the communities but faced with the challenge of limited resources and staff, so do not run a 24- hour service; while the secondary and the tertiary health facilities are concentrated at the urban areas. There are 904 PHC Facilities, Secondary Health Facilities and tertiary Health Facilities in the state located within 5 to 200km to the users. Most of the health facilities provide maternal health care services ranging from antenatal care, skilled birth delivery, post-natal care and family planning services. There are no specific SRH services for adolescents but the family planning services are open to both married and singles and the treatment of STI is integrated into the health care services.
There are 27 health facilities in the state providing integrated sexual and reproductive health (SRH) and HIV services but not accessible to about 38% of the population in the state due to distance.Although abortion services are not offered in the health facilities, the post abortion and other SRH services available but mostly out of pocket payment and beyond the reach of adolescents.
It has been projected that the population of young people in Nigeria will exceed 57 million by the year 2025, a large proportion of which are adolescents. Recent report shows that about 28% of adolescent in Nigeria are sexually active and the median age of sexual debut is about 15 years. Many adolescents in Nigeria lack the skills to negotiate safe sex and delay the unset of sexual activities. This is of concern considering that age at first sexual intercourse is an important indicator of the possibility of unintended pregnancy and STI.
Inconsistent and incorrect condom use is a common practice among adolescents in Nigeria resulting in unintended pregnancy that ends in unsafe abortion and its complications. It is also exposing them to STI and HIV with a prevalence of 17% among adolescents in the southeastern part and 14% in the northern part of the country.
Nigeria reports a yearly abortion rate of 25 abortions/1000 women more than a quarter of which are from adolescents resulting from unintended pregnancy. In the southern part of Nigeria, about 32% of the cases of unsafe abortion was among adolescents. Worst still is the fact that they are often missed identified by health care providers as children and considered not appropriate target for contraceptive information and services. The youth friendly health centers, which should meet the SRH needs of the adolescents, are also not in the capacity to do so, leaving them to resort to other means.
1.3 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
- Research Questions
- What are the sexual experiences of adolescents in Uromi Local Government Area?
- What are the sources of information and the health seeking behaviour of adolescents on SRH?
- What are the factors influencing adolescent’s sexual behaviour?
- What are the reproductive health problems of adolescents and their treatment seeking behaviours
1.5 Significance of the Study
We all have the right to a satisfying and safe sex life and the freedom to decide when to do so. However, for most adolescents, the decision to protect themselves from pregnancy and STI are influenced by many factors. While many factors have been identified to influence the decisions of adolescents on their sexual behaviour, the influencing factors differ according to geographical, cultural, social, ethnic and economic context. Understanding the different influencing factors based on the context, provides a very significant insight into the SRH challenges and gives a direction on appropriate interventions. It is only when an underlying problem is understood that an appropriate intervention can be proposed to address it. Understanding the influencing factors to adolescent sexual experiences and problems should be done with them and not without them if meaningful progress is to be achieved. This thesis sought to explore the different influencing factors to adolescent sexual behaviour, their RH problems and their perceptions on the SRH needs. The findings from the study will bring to limelight important factors in addressing the sexual and reproductive health problems of adolescents in Edo state state and Nigeria as a whole.
- Scope of the Study
The study is limited to Uromi Local Government Area in Edo State Nigeria, specifically in Uromi Esan North. The study is carried out among adolescent in this area.
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