REPRODUCTIVE HEALTH KNOWLEDGE AND UNSAFE INDUCED ABORTION AMONG FEMALE ADOLESCENTS IN SELECTED COMMUNITIES IN BADAGRY
This study examines the association between reproductive health knowledge and unsafe induced abortion among female adolescents (13-19years) in selected communities in Badagry Local government area of Lagos state. Data were obtained through a multi-stage sampling procedure in the study area. A total of 384 in-school and out-of-school respondents were interviewed with the aid of a questionnaire. Two Focus Group Discussions (FGDs) were also conducted to elicit qualitative data which complimented the survey data. The analyses indicate that more than half of both categories of respondents sampled demonstrated a high level of knowledge about reproductive health issues. About 56% of the in-school respondents indicated knowledge about ovulation, 75% had knowledge about their menstrual cycle and 47.8% indicated knowledge on pregnancy prevention.
For the out-of-school category, about 54% had knowledge about ovulation, 69.6% could calculate their menstrual cycle and 49.4% had knowledge on how to prevent a pregnancy. Knowledge level of family planning services was however low: about 30% for in-school and 43% for out-of-school adolescents. Usage of family planning services was also reported to be relatively low among in-school respondents (18.1%) but higher among their out-of school counterparts (25.3%). Cases of unplanned pregnancies were also a bit higher among out-of-school respondents (8.2%) than the in-school population (4%) while incidence of abortion were almost at the same level for both categories (in-school: 2.2%; out-of-school: 3.2%). There is a strong need for effective promotion of the usage of family planning services in addition to sex education that covers every aspect of human sexuality with emphasis on issues that can promote healthy reproductive health among female adolescents.
BACKGROUND TO THE STUDY
Over the last two decades, adolescents’ sexual and reproductive health has taken the center stage within the global discourse of reproductive health problems. Across the world today, adolescent sexuality has become an important social and medical topic because youths are known to be sexually active, often in situations of little reproductive health information or services (Alubo, 2001; Onifade, 1999; Sai, 1995).
Furthermore, adolescents have been considered to form a considerable at-risk group within the larger society. This is particularly evident in Nigeria where a lot of socio-economic factors put them at a greater risk given the challenges and opportunities they face daily in a rapidly changing world. In Nigeria and other low income countries, there are also several reproductive health problems such as unintended pregnancy, maternal mortality, and sexually transmitted infections (STIs) including HIV/AIDS, the transmission of which the youths are particularly disadvantaged, (Onifade, 1999; Lear, 1997).
The Population Reference Bureau (2011) has indicated that nearly one third of Nigeria’s total population of over 160 million is between the ages of 10 and 24.
According to a report by Sampson Melodi of the Advocates for Youths, adolescent proportion of the population makes them integral to the country’s social, political and economic development. Nigeria’s development according to this report is compromised by the sexual and reproductive health issues afflicting her youth. Lack of sexual health information and services make young people vulnerable to sexually transmitted infections (STIs) and unintended pregnancy (Sampson, Advocates for Youths, 2000). While intending to protect young people, some adults may limit young people’s access to information and health services in fear that information will promote sexual behaviour. Information however is the greatest tool young people need to protect themselves against reproductive and sexual ill-health.
Reproductive health has been viewed by scholars as a fundamental aspect of general well being, constituting a central feature of human development. It reflects one’s state of health during childhood, adolescence and adulthood, and sets the stage for health beyond the reproductive years for both women and men and also impacts on the health of the next generation (Kotwal, Gupta and Gupta, 2008). A probable unofficial working definition of reproductive health has been given as the state of complete physical, mental and social well-being, and not merely the absence of reproductive disease or infirmity. Reproductive health therefore deals with the reproductive processes, functions and system at all stages of life. Alubo (2001) in the African journal of Reproductive Health defined reproductive health as “the whole array of counsel, information and services required and necessary for safe and healthy sexual expression. It concerns health and illness in relation to the body’s reproductive function”. A working definition of sexual health has been given as a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Thus, sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.
According to the late professor Olikoye Ransome-Kuti (2001), 30% (one and a half billion people) of the world’s population were between the ages of 5 and 19 years as at 1997. He therefore projected that, by 2025, the proportion of people in this age category would have become one quarter, that is, 2 billion, of a total population of 8 billion. To him therefore, in
Nigeria, these age groups constitute about 30% of the population caught between the accepted constraints and order imposed by the traditions and customs of communities and the liberties of an emerging civilization. Adolescents in Nigeria are thus caught between tradition and changing cultures brought about by urbanization, globalized economies and a media saturated environment (AHI, 1999). As stated in one of the monographs published by the Action Health Incorporated (2003), “adolescence is the transition period between childhood and adulthood. It extends roughly through the entire second decade of life.
It is the period in which patterns of behaviour which have life-long consequences are formed and becomes established…” From this statement we can easily deduce that the period of adolescence is a pretty precarious one and the behavioral patterns (which are usually risky) adopted at this period could result in far reaching consequences. The World Health Organization (1997) has this to say about adolescence – “adolescence is a time of learning which necessarily includes risk taking, but the conditions in which those risks are taken will often make the difference between constructive and destructive outcomes”.
The subject matter of adolescent sexuality can thus be seen as a reality as stated by the former Minister of health, late Professor Olikoye Ransome-Kuti. This is so because, in his opinion, today’s young people reach physical maturity earlier and marry later. Society has a responsibility therefore to ensure that they make responsible sexual choices. A report by the UNFPA has revealed that adolescents aged 10-19 years comprise about one-fifth of the world’s population, which is equivalent to 1.2 billion young persons (UNFPA, 2003). Corroborating this revelation, Ipas (2004) submitted that about 87% of these young people live in developing countries. In fact, in many countries of Africa, young people make up to 33% of the population (Olukoya, 2004).
According to recent findings on adolescents’ sexual and reproductive health, unwanted pregnancies and abortions are increasing among adolescents with serious consequences on their health. Unsafe induced abortion has being identified as the number one cause of death among young adolescent mothers aged 13-19 years in developing countries. About 90 percent of adolescent births (12.8 million) occur each year in developing countries (World Health Organization, UNFPA, 2006). In sub-Saharan Africa and southern Asia, 28 to 29 percent of women give birth by age 18 (Population Reference Bureau, 2006).
The UNFPA (2004) has documented that pregnancy is the leading cause of death for young women ages 15 through 19. Maternal mortality statistics according to Graczyk (2007) underscore how societies have failed women, especially young women in developing countries. As many as 529,000 women die each year from complications of pregnancy and Childbirth (World Bank, 2006). According to a recent USAID report, while maternal mortality figures vary widely by source and are highly controversial, the best estimates for Nigeria suggest that approximately 54,000 women and girls die each year due to pregnancy-related complications (USAID, 2011). It was also found out that, estimates of maternal deaths are under-reported by as much as 50 percent because maternal deaths are more often not counted at all. Additionally, another 1,080,000 to 1,620,000 Nigerian women and girls will suffer from disabilities caused by complications during pregnancy and childbirth ((USAID, 2011)) each year.
It has however been observed that correct and timely sexual and reproductive health information can make available the requisite knowledge and skill that is needed to make informed choices among adolescent girls. As reported by the late Professor Olikoye Ransome-Kuti (2001), “young people often complain about sexuality; that government and churches fail to convey the right messages about sexuality to them; that there is a lack of communication with their parents especially about sex and HIV and AIDS”. Professor Ransome-Kuti further asserted that these young people complain that they learn from their peers and suffer considerable peer pressure. It has also been observed by the World Health Organization (2011) that adolescent mothers often lack knowledge, education, experience, income and power relative to older mothers (WHO, 2011).
A low level of reproductive health knowledge therefore could likely be the reason why there is high incidence of unplanned pregnancies among young adolescent girls which consequently often lead to the fatal decision to abort. Since abortion is not legalized in Nigeria except when a pregnancy poses a serious threat to the life of the woman, findings have revealed that most adolescents girls, in a desperate frenzy to get rid of an unwanted pregnancy, usually self-induce an abortion which poses a serious health risk to the adolescent in question. The decision to abort among adolescent girls also often generates fatal consequences because they lack the appropriate information and support they need especially from family members and the society at large. Pregnancy among adolescent girls is usually frowned upon by the society especially such society that places a high premium on moral values, chastity and education.
An unfortunate pregnant adolescent girl usually finds herself alone in her dilemma to keep or terminate a pregnancy. Young pregnant girls in some societies in Nigeria often face the harsh consequence of being thrown out of the house by their parents. They are often subjected to rejection and denial by the person who impregnated them and they also face the risk of dropping out of school. Because of the fear of being subjected to shame and ridicule, and because of the family name which is at stake, pregnant adolescent girls may engage in unsafe induced abortion procedures which is usually inimical to their health and can lead to serious reproductive health outcomes, and ultimately, death.
This study therefore intends to assess the knowledge level of adolescent girls on sexual and reproductive health issues with particular focus on their awareness of family planning services and usage.
REPRODUCTIVE HEALTH KNOWLEDGE AND UNSAFE INDUCED ABORTION AMONG FEMALE ADOLESCENTS IN SELECTED COMMUNITIES IN BADAGRY
1.1 STATEMENT OF THE PROBLEM
The rate of unplanned pregnancies among adolescent girls around the world today is quite alarming. Cheng (2008), in his report has noted that, approximately 205 million pregnancies occur each year worldwide. Over a third are unintended and about a fifth end in induced abortion. Most abortions result from unintended pregnancies (Bankole et al, 1998), and it has been revealed that adolescents have the highest risks of suffering serious complications from unsafe abortions. Among women admitted to hospitals for treatment of unsafe abortion complications, those aged under 20 years account for 38-68% of cases in many developing countries (Olukoya et al., 2001). These complications include cervical or vaginal lacerations, sepsis, hemorrhage, bowel or uterine perforation, tetanus, pelvic infections or abscesses, chronic pelvic inflammatory disease and secondary infertility. According to a recent study, about 4.4million teenagers engage in abortion annually (Negedu, 2011). This is because, 60% of pregnancies are either mistimed or unwanted among adolescents.
Studies in the past have indicated that, lack of adequate sexual and reproductive health knowledge may possibly represent a key factor preventing the complete elimination of unwanted
pregnancies, and unsafe induced abortion among adolescent girls in Nigeria. According to Ipas (2005) unplanned pregnancies are the result of various factors, including lack of knowledge about menstruation and pregnancy, lack of access to, and knowledge about how to use contraceptives; difficulties in using contraceptives because of a partner’s or family objections; contraceptive failure; and sexual assault. Also, adolescents may more often delay seeking care for abortion-related complications due to lack of transportation, lack of knowledge about where post-abortion care can be obtained, fears of censure from their parents and health-care providers, fear of legal repercussions, or lack of money to pay for services (Ipas, 2005). This may be particularly so in rural communities where access to basic infrastructural facilities remain low and inadequate.
As noted by Makinwa-Adebusoye (2006), policy and programming attention has turned towards adolescents’ sexual and reproductive health in the past decade but not much attention has been paid to the reproductive health needs of young adolescent girls, particularly in a developing country like Nigeria. Despite the activities of governmental and nongovernmental organizations (NGOs) in the areas of adolescent reproductive health, the need for accurate reproductive knowledge and skills especially among adolescent girls that reside in poor disadvantaged communities in Nigeria still remain largely unmet. Could the high level of unsafe induced abortion among adolescents be actually attributed to the limited reproductive health knowledge among them? This present study seeks to examine this problem.