FACTORS INFLUENCING CONTRACEPTIVE USAGE AMONG ADOLESCENT FEMALES AGED 13-19 YEARS IN ONDO STATE, NIGERIA
Ilugbami JO1*, Ilugbami FM2, Tayo-ladega O3
1Rufus Giwa Polytechnic, Owo, Ondo State, Nigeria, Rector Office.
2Department of Social Sciences, Rufus Giwa Polytechnic, Owo, Ondo State, Nigeria.
3University of Bangor, United Kingdom.
*Correspondence: Ilugbami JO; firstname.lastname@example.org
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Background: The adolescent stage is characterized by sexual exploration, sexual maturation, and rapid growth. Individuals in this category are between the ages of 10 and 19 years old and are exposed to a greater risk of unintended pregnancies, unsafe abortions, and sexually transmitted infections.
Objectives: To find out the nature of sexual relationship, awareness of contraceptives, the major sources of awareness of contraceptives, the preferred method of contraceptive(s), and the association between awareness of contraceptives and its usage among participants.
Materials and Methods: A quantitative survey of 120 purposively selected adolescent females between the age of 13 and 19 years in Ifedore Local Government Area (LGA) of Ondo State. Data was collected using a closed-ended questionnaire. Data entry and analysis was done using IBM SPSS Statistics version 23.
Results: Response rate was 80.83%. Majority (84.5%) of the respondents were aware of contraceptives. The major sources of awareness of contraceptives were parents, peers, elderly siblings, and social media. The majority (76.3%) of respondents were in a heterosexual relationship. Withdrawal method was the most predominantly used contraceptive method and a smaller proportion of them used the male condom. Some of them (28.4%) would rather take drugs to prevent pregnancy. The study found an association between the awareness of contraceptives and its usage (p-value: 0.023).
Conclusion: This study found that awareness of contraceptives among adolescents aged 13 to 19 years influences their contraceptive use. A need to prevent sexually transmitted infections did not appear to influence choice of contraceptives in most of them.
Keywords: Contraceptive, Contraceptive usage, Adolescent females.
Cite this article: Ilugbami JO, Ilugbami FM, Tayo-ladega O. Factors influencing contraceptive usage among adolescent females aged 13-19 years in Ondo State, Nigeria. Yen Med J. 2022;4(4):78–84.
Adolescents range in age between 10 and 19 years.1 The teenage years are the time of development, change, opportunity, and discovery. They experience both physical and sexual maturity throughout this stage of life. Adolescent development includes cognitive, physical, behavioral, and psychological changes that are marked by high levels of individual autonomy, the development of a sense of identity, high levels of self-esteem, and a gradual separation from adults.2 Making sure that teenagers can safeguard their health, reduce poverty, postpone the first pregnancy, lower maternal mortality, and enhance maternal health outcomes for mothers and their offspring is a crucial priority for world health.3 Girls between the ages of 15 and 19 make up one-fifth of all women worldwide who are of reproductive age.3
Every year, two million girls between the ages of 15 and 19 give birth.4 Furthermore, one in three females in the world’s poorest regions gives birth to children by the time they are 18 years old.1 In comparison to adults, adolescents have the highest risk of maternal mortality, with the risk of death from pregnancy being twice as high for girls between the ages of 15 and 19 years and five times greater than girls between the ages of 20 and 29 years.5 The major cause of death among teenagers in middle- and low-income nations is complications from pregnancy and delivery.
Adolescents who are pregnant are more likely than adults to seek risky abortions. Around three million unsafe abortions among teenage females between the ages of 15 and 19 have been performed each year.4 Almost forty percent of unsafe abortions globally are performed on people between the ages of 15 and 24 years, and early childbearing affects the infants of these women as well. Infants born to teenage mothers have birth-related problems and neonatal fatalities at a rate that is fifty percent greater than that of children born to moms between the ages of 20 and 29. Adolescent women are more likely than older mothers to have low-birth-weight babies.4
Several studies have revealed high rates of maternal and infant mortality among teenagers, which has attracted attention and been given priority for action by researchers and governments throughout the world. There are thought to be 79 million unplanned pregnancies globally each year. In underdeveloped nations, more than one-third of pregnancies are regarded as unwanted, and thirteen percent of all maternal deaths worldwide result from unsafe abortions, which account for around nineteen percent of all births.6 Teenage pregnancy is a significant public health problem since it is linked to worse maternal, neonatal, and fetal outcomes, according to a study conducted in Ghana to evaluate contraceptive awareness, usage, and perception among teenagers.7
Also, adolescent girls who become pregnant are more likely to drop out of school and be unable to care for their offspring.7 Tautz estimates that in 2008, there were 16 million births by girls between the ages of 15 and 19, or roughly 11 percent of all births worldwide. Many of these births took place in underdeveloped countries, and 6.1 million of them were unplanned.8 Sub-Saharan Africa reports 2.2 million unwanted adolescent pregnancies per year. By decreasing the number of women who are at risk and preventing unwanted pregnancy, which accounts for roughly thirty percent of all births in sub-Saharan Africa, the use of contraceptives can lower the number of fatalities among women.9
In underdeveloped nations, women who don’t utilize contraceptives account for almost fifty percent of unwanted pregnancies. According to estimates, there are between 123 and 200 million unmet contraceptive needs worldwide. Over 113 million women in poor nations have unmet contraceptive needs.10 About half of the pregnancies in the United States are unplanned, resulting in 3.1 million unwanted pregnancies and 1.3 million abortions per year.11 Young women have the highest rate of unexpected pregnancies, with 79 percent of pregnancies occurring between the ages of 18 and 19 years and 60 percent of pregnancies occurring between the ages of 20 and 24 years.12
According to a different American survey, the percentage of unplanned births decreased from 51 percent in 2008 to less than 45 percent in 2011.13 In the United States, the percentage of unwanted births among females aged 15 to 17 years declined by roughly 25 percent, in contrast to the findings seen in developing countries. In South Africa, two-thirds of young girls between the ages of 15 and 24 are engaged in sexual activity; half of these women have had at least one unwanted pregnancy.14 Most unexpected births are caused by women who desire to prevent getting pregnant but aren’t utilizing an effective form of contraception. The vast majority of teenage girls’ pregnancies in Nigeria are unintended.
Girls who have their first sexual experience when they are young are more vulnerable to STIs, unexpected pregnancies, and unsafe abortions. Over the world, 79 million girls have unwanted pregnancies, which causes around 40 percent of them to drop out of school.7 Moreover, it is predicted that 33.9% of this population will have STDs, while 18.75% will have unsafe abortions. These issues are especially prevalent in Sub-Saharan Africa, where it is predicted that 2.2 million girls (2.8%) will have unwanted pregnancies, 13.7% will have STIs, and 19% will have unsafe abortions annually.15
Teenagers are susceptible to getting pregnant, contracting STIs, and getting HIV. Contraception can help young ladies avoid the problems of unwanted pregnancy and STIs. For young girls, it will be crucial to offer sexual health and contraception treatments in a setting that is suitable for their age. Adolescent girls who use contemporary contraceptives effectively can postpone their first pregnancies, lower the risk of maternal death, and have better mother and offspring outcomes when they have early female children. Research conducted in Nigeria revealed that adolescent girls are still constrained to use contraception compared to older women, despite the availability of contemporary contraceptive facilities.16
The most recent DHS comparison analysis lists some circumstances that could or might not drive someone to take a contraceptive.14 The paper claims that uptake was impacted by geographic location, whether it was rural or urban. Contraception was used by city dwellers far more frequently than by country dwellers. Also, it supported the results of other studies that showed education had a good impact on usage. Higher education showed a statistically significant connection with contraceptive use among women aged 15 to 24. However, in nations like Burkina Faso, Liberia, Mauritania, and Senegal, education and utilization had the opposite connection. Additional elements cited in the study were personal wealth and income, parity, and awareness of contraception.17 Additional factors were the agreement of the couple, cultural conventions, and the general economic advancement of the nation or area. The use of contraceptives is also influenced by the standard of services provided, women’s education in particular, and religion.18
In this regard, there is a necessity to examine the variables influencing the use of contraceptive methods among teenage girls in the Ifedore LGA. The objectives are to find out the nature of sexual relationship, awareness of contraceptives, the major sources of awareness of contraceptives, the preferred method of contraceptive(s), and examine the association between awareness of contraceptives and its usage among participants.
MATERIALS AND METHODS
Study Design and Setting: The study was a cross-sectional quantitative survey conducted in Ilara-Mokin, Igbara-Oke, and Ijare, which are all situated in the Ifedore Local Government Area (LGA) of Ondo State.
Study Population: These were adolescent females between the ages of 13 and 19 years in the study areas.
Inclusion Criteria: Adolescent females between the ages of 13 and 19 years in the study areas whom their parents gave consent for their participation in the study.
Sample Size: The formula for determination of the minimum sample size for a proportion in a population was used19 as follows:
n = Z2 p (1– p) / E2
n = sample size,
Z = standard normal deviate for level of confidence
p = estimation proportion of the population that presents the outcome of interest
E = acceptable margin of error.
For this study, level of confidence was at 92% with z score 1.75 and acceptable margin of error of 8%. Since the exact number of adolescent females between the ages of 13 and 19 years using contraceptives in the study areas was unknown, 0.5 was assumed (acceptable in situation of unknown population size). Substituting the value for p = 0.5(1-0.5) = 0.25 = 1/4
n = Z2/4E2 = 1.752/4(0.08)2 = 119.63
The sample size was 119.63 but approximated to 120.
Sampling Technique: Purposive sampling technique was used to select 40 participants in each of the three selected towns.
Data Collection: Primary data was obtained from 120 adolescent females aged 13 to 19 years between July 2022 and December 2022 using a closed-ended form of questionnaire.
Data Analysis: Data entry and analysis were done using IBM SPSS Statistics version 23. Categorical variables were summarized using frequencies and proportions. Chi square test of association was used to determine association between independent and dependent variables. A pValue of 0.05 was considered significant.
From this survey, there was a response rate of 80.83%. This implies that valid responses were obtained from 97 participants out of the entire 120 participants. It is essential to note that 80.83% was adequate for data analysis since it was more than 50%.
The demographic characteristics of respondents is shown in Table 1. The awareness, purpose, awareness sources and approaches to contraceptive utilization is shown in Table 2. The association between the awareness of contraceptives and the utilization of contraceptives is shown in Table 3.
Table 1: Demographic characteristics of participants
Junior secondary school
Senior secondary school
Technical or vocational training
Sexual relationship with male
Table 2: Awareness, purpose, knowledge sources and approaches of contraceptive utilization
Awareness of contraceptive utilization
Purpose of utilizing contraceptive
Help to prevent pregnancies
Help prevent infectious diseases
Increase frequent sexual practice
Sources of awareness of contraceptive utilization
Approaches to contraceptive utilization
Table 3: Association between the awareness of contraceptives and the utilization of contraceptives
Awareness of contraceptives
Asymp. Sig. (2-sided)
Utilization of contraceptives
Demographic Characteristics of Respondents
Majority of the respondents were between the ages of 16 and 19 years, were in technical or vocational training, had at least a junior secondary education, were single. Majority of them were in a heterosexual relationship in this study. The finding that most of them were heterosexual agrees with the study of Dombola et al,20 on the factors influencing contraceptive decision making and use among young adolescents in urban Lilongwe, which found that the majority of participants were in a heterosexual relationship.
Awareness of Contraceptive Utilization
Most of the respondents in this study were aware of contraceptives. This agrees with the study of Shahabuddin et al21 on the influencing factors of decision-making regarding contraceptive methods use and childbearing among adolescent girls, which found that majority of participants were aware about contraceptive utilization.
Purpose of Contraceptive Utilization
In this study, most respondents noted that contraceptives help to prevent pregnancies, infectious diseases and increase the frequency of sexual practice in response to the purpose of utilizing contraceptives. This supports the findings of Bankole22 on sexual behavior, knowledge and information sources of very young adolescents in four sub-Saharan African countries. It also supports the findings of Magnusson et al23 on the early sexual debut and risky sex in young adults: the role of low self-control.
Sources of Awareness of Contraceptive Utilization
The major sources of awareness of contraceptives were parents, peers, elderly siblings, and social media. This corroborates the findings of Abdul et al24 in a study done in north central Nigeria, who found that teachers in schools and peers were the most common sources of information on contraceptives.
Method of Contraceptive Used by Respondents
Among the respondents who had heterosexual relationships, contraceptive method used for sexual exposure was withdrawal method, male condom and drug intake. The findings of Kinaro25 is partly in line with this study, which found that the usage of male condoms was the most popular contraceptive employed among adolescent females in Kenya. In this study, with the majority of respondents in a heterosexual relationship, withdrawal method being the most predominantly used contraceptive method, and a mention of drug intake for the purpose of preventing pregnancy, it can be inferred that the majority of the respondents did not practice safe sex, exposing them to a risk of sexually transmitted diseases and unwanted pregnancies.
There was an association between the awareness of contraceptives and the utilization of contraceptives in this study, implying that the more females are aware of contraceptives, the higher the level of utilization. This corroborates the findings of Macquarrier,17 who found that awareness positively influences the uptake of contraceptive services.
It is recommended that awareness of contraceptives be increased both in formal and informal settings, particularly in the study areas and beyond. The implications of unsafe sexual practices and the risk of sexually transmitted diseases should be emphasized alongside unwanted pregnancies during awareness programs. The promotion of common modern contraceptive methods among adolescent females and the usage of dual protection methods should be propagated to address STIs with the prevalence of teenage pregnancies.
This study found that awareness of contraceptives among adolescents aged 13 to 19 years influences their contraceptive use. A need to prevent sexually transmitted infections did not appear to influence choice of contraceptives in most of them.
We appreciate the individuals who have released relevant information for the conduct of this research
JOI: Conceptualization, manuscript draft, manuscript review; FMI: Literature search, data collection, data analysis; OTL: Manuscript draft and manuscript review. All authors have read and approved the manuscript
CONFLICT OF INTERESTS
The author declares that there is no conflicting interest.
The consent of the participants was declared in the questionnaire and was sought through their parents.
- World Health Organization. Adolescent pregnancy. Department of Reproductive Health and Research. Geneva: WHO; 2014. Available from: https://apps.who.int/iris/bitstream/handle/10665/112320/WHO_RHR_14.08_eng.pdf. Accessed October 26, 2022.
- Women’s Refugee Commission, Save the Children, UNHCR, UNFPA. Adolescent Sexual and Reproductive Health Programs in Humanitarian Settings. Available from: https://www.unfpa.org/resources/adolescent-sexual-and-reproductive-health-programs-humanitarian-settings-0. Accessed October 26, 2022.
- Guttmacher Institute, International Planned Parenthood Federation. Facts on the Sexual and Reproductive Health of Adolescent Women in the Developing World. New York, NY: Guttmacher Institute; 2010. Available from: https://www.guttmacher.org/sites/default/files/pdfs/pubs/FB-Adolescents-SRH.pdf. Accessed October 26, 2022.
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