RELATIONSHIP BETWEEN KNOWLEDGE OF REPRODUCTIVE HEALTH AND CONTRACEPTIVE USE AMONG TERTIARY INSTITUTIONS STUDENTS IN NIGER STAT
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ABSTRACT
The study „‟Relationship between knowledge of Reproductive Health and Contraceptive Use among Tertiary Institutions‟ Students in Niger State‟‟ was conducted to determine the knowledge of reproductive health and its relationship with contraceptive use among the respondents. A cross-sectional descriptive survey design was used. The thirteen tertiary institutions in Niger State were clustered into University, Polytechnic, Monotechnic, and College of Education. One tertiary institution was selected from each cluster from where 700 respondents were selected to serve as the sample. The instrument for data collection was a structured questionnaire consisting of 52 items covering reproductive health knowledge and contraceptive use. The collected data from the returned questionnaires were statistically analyzed using both descriptive and inferential statistics. Descriptive statistics such as frequency distribution and percentages were used to describe the reproductive health knowledge and contraceptive use among Tertiary institutions students, while chi square statistic was used to determine relationship between them. Student t-test and Analysis of variance (ANOVA) were used to determine the difference between and among the students. The results of the study revealed a significant level of reproductive health knowledge, low contraceptive use, and moderately strong positive relationship between reproductive health knowledge and contraceptive use. Also, significant difference was found to exist in contraceptive use according to sex, religion, and marital status. However, no significant difference was established in the knowledge of reproductive health according to religion, age and ethnicity. Based on these findings, it was recommended that young people be empowered with necessary skills needed to translate knowledge into action, there should be improved access to reproductive health services; also reproductive health education should consider variables like marital status, religion and sex.
| TABLE OF CONTENTS | ||
| Title | i | |
| Declaration | ii | |
| Certification | iii | |
| Dedication | iv | |
| Acknowledgement | v | |
| Abstract | vi | |
| Table of Content | vii | |
| CHAPTER ONE: BACKGROUND OF THE STUDY | ||
| 1.1 | Introduction | 1 |
| 1.2 | Statement of the problem | 3 |
| 1.3 | Significance of the study | 6 |
| 1.4 | Objectives | 6 |
| 1.5 | Basic assumptions | 8 |
| 1.6 | Hypotheses | 8 |
| 1.7 | Delimitation | 7 |
| 1.8 | Limitations | 9 |
| CHAPTER TWO: REVIEW OF RELATED LITERATURE | ||
| 2.0 | Introduction | 10 |
| 2.1 | The Concept of Adolescence | 11 |
| – Significant Physiological changes in Adolescence | 12 | |
| 7 | ||
| – Socio-cultural influence on Adolescent Sexual Behaviour | 12 | |
| 2.2 | Reproductive Health | 13 |
| – Reproductive Health Education in Nigeria | 13 | |
| – Nigerian Guidelines Development Process | 16 | |
| – Goals and Values | 19 | |
| 2.3 | Contraceptive Technology | 20 |
| 2.4 | The Menstrual Cycle | 22 |
| Physiology of Menstrual Cycle | 22 | |
| – | Menstrual phase | 23 |
| – | Proliferative Phase | 24 |
| – | Secretory Phase | 25 |
| 2.5 | Hormonal Contraceptives | 26 |
| 2.6 | Oral Contraceptive (OC) | 26 |
| – | Mechanism of action of Oestrogen as contraceptive | 27 |
| – | Mechanism of action of Progesterone as contraceptive | 28 |
| Combined Oral Contraceptives (COC) | 30 | |
| – | Indications | 31 |
| – | Contraindications | 32 |
| – | Procedure for taking the Pill | 32 |
| – | Effectiveness | 33 |
| – | Side effects | 33 |
| 2.7 | Progestin-only Contraceptives (POC) | 34 |
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| – | Indications | 35 | |
| – | Contraindications | 36 | |
| – Procedure for taking the Pill | 36 | ||
| – | Effectiveness | 37 | |
| – | Side effects | 37 | |
| 2.8 | Injectable Contraceptives | 37 | |
| 2.8.1 Combined Injectable Contraceptives (COC) | 38 | ||
| – | Indications | 40 | |
| – | Contraindications | 40 | |
| – | Procedure for use | 40 | |
| – | Effectiveness | 41 | |
| – | Side effects | 41 | |
| 2.8.2 | Progestin-Only Injectable Contraceptives (PIC) | 42 | |
| – Depot medroxy progesterone acetase | 43 | ||
| – | Indications | 44 | |
| – | Contraindications | 44 | |
| – | Effectiveness | 44 | |
| – | Side effects | 45 | |
| 2.8.3 | Implants | 46 | |
| – | Indications | 46 | |
| – | Contraindications | 47 | |
| – | Procedure for insertion | 47 | |
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| – | Procedure for removal | 48 | |
| – | Side Effects | 48 | |
| 2.8.4 | Intra-Uterine Devices (IUD) | 49 | |
| – | Mechanism of action | 50 | |
| – | Types | 50 | |
| – | Indications | 52 | |
| – | Contraindications | 52 | |
| – | Effectiveness | 52 | |
| – | Procedure for insertion | 53 | |
| – | Removal of IUD | 54 | |
| – | Side Effects | 54 | |
| 2.8.5 | Barrier Method and Spermicidals | 55 | |
| – | Condom | 55 | |
| – | Procedure for condom use | 57 | |
| – | The Female Condom | 58 | |
| – New Condoms for Men | 59 | ||
| 2.8.6 | Diaphragm | 60 | |
| – | Types | 61 | |
| – | Inserting the Diaphragm | 62 | |
| – | Removing the Diaphragm | 63 | |
| 2.8.7 | The Cervical Cap | 64 | |
| – | Types | 65 | |
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| 2.8.8 | Contraindications and Side Effects | 66 |
| 2.9 | SPERMICIDES | 67 |
| – | Effectiveness | 68 |
| – | Insertion of Spermicides | 68 |
| – | Side Effects | 69 |
| 2.9.1 | STERILIZATION | 69 |
| Female Sterilization | 69 | |
| Methods | 70 | |
| Complications | 73 | |
| Tubal Methods | 73 | |
| Effectiveness | 74 | |
| Male Sterilization | 75 | |
| -Complications | 76 | |
| 2.10 | NATURAL FAMILY PLANNING | 76 |
| -Physiological Basis for Natural Methods | 77 | |
| Natural Contraceptive Options | 79 | |
| -Abstinence | 79 | |
| -Withdrawal (Coitus Interruptus) | 79 | |
| -Calender Method | 80 | |
| -Ovulation Method | 81 | |
| -Basal Body Temperature (BBT) Method | 83 | |
| -Sympto-Thermal Method | 83 | |
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| -Lactational Amenorrhoea Method (LAM) | 84 | |
| -Standard Days Method (SDM) | 85 | |
| -The Two Day Method | 87 | |
| -Electronic Fertility Computers | 88 | |
| 9.12 | SUMMARY | 89 |
| CHAPTER THREE: METHODOLOGY | ||
| 3.1 | INTRODUCTION | 91 |
| 3.2 | RESEARCH DESIGN | 91 |
| 3.3 | POPULATION OF THE STUDY | 91 |
| 3.4 | SAMPLE AND SAMPLING PROCEDURES | 92 |
| 3.5 | INSTRUMENT FOR DATA COLLECTION | 95 |
| 3.6 | VALIDATION OF QUESTIONNAIRE | 96 |
| 3.7 | STATISTICAL TECHNIQUES | 96 |
| CHAPTER FOUR: PRESENTATION AND ANALYSIS OF DATA | ||
| 4.1 | INTRODUCTION | 98 |
| 4.2 | RESULTS | 98 |
| 4.3 | Test of Hypothesis | 102 |
| -Sub-hypothesis 1 | 107 | |
| -Sub-Hypothesis 2 | 108 | |
| -Sub-hypothesis 3 | 109 | |
| -Sub-hypothesis 4 | 111 | |
| -Sub-hypothesis 5 | 112 | |
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| -Sub-hypothesis 6 | 113 | |
| -Sub-hypothesis 7 | 114 | |
| -Sub-hypothesis 8 | 115 | |
| 4.3 | DISCUSSION | 117 |
| 4.3.1 | Knowledge of Reproductive Health | 117 |
| 4.3.2 | Contraceptive Use | 118 |
| 4.3.3 | Relationship Between Knowledge of Reproductive Health and | |
| Contraceptive use | 119 | |
| 4.3.4 | Knowledge of Reproductive Health by Demographic | |
| Characteristic | 120 | |
| 4.3.5 | Differences in Contraceptive Use | 121 |
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
| 5.1 | SUMMARY | 123 |
| 5.2 | FINDINGS | 124 |
| 5.3 | RECOMMENDATIONS | 125 |
| 5.4 | RECOMMENDATIONS FOR FURTHER STUDIES | 126 |
| REFERENCES | 127 | |
| APPENDICES | 132 | |
| Appendix A: Request to vet Questionnaire | 132 | |
| Appendix B: Request to administer Questionnaire | 133 | |
| Appendix C: Request for the completion of Questionnaire | 134 |
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| Appendix D: Questionnaire | 135 |
| Appendix E: Marking guide to Section B of Questionnaire | 142 |
CHAPTER ONE
INTRODUCTION
1.0 INTRODUCTION
Adolescence is a period characterized by the onset of primary sexual characteristic changes (that is, the growth and maturation of the reproductive structures such as fallopian tubes, uterus and vagina in females, penis and testes in males) and secondary sexual characteristic changes (such as breast growth, appearance and increase in pubic hair, appearance of facial hair in males, voice change and changes in body shape). Accompanying these changes in anatomical maleness and femaleness are physiological changes that lead to potential realization of the reproductive role. These physiological changes include menstruation and ovulation in the female and the beginning of sperm production in male. (Chiwuzie and Akpakpan, 2001)
At the onset of puberty, however, the adolescent has learnt that he or she is a boy or a girl and looks forward to becoming a man or a woman. He can become comfortable and confident about his developing capacity to be aroused and respond erotically. At this stage, he is preparing to engage in meaningful interpersonal relationships. At the same time, adolescents experience strong, often conflicting emotions and social pressures as they move away from childhood dependence towards more independent adulthood. Most of them are unprepared for the situations they face. As a result, young people’s decisions and sexual activities during their transition to adulthood can affect the rest of their lives.
Most of the serious reproductive health problems among youths especially the adolescents have been attributed to ignorance, misinformation, superstitious beliefs, conservative attitudes and high risk sexual behaviour (Ladipo et al., 1996 and Amazigo et al., 1997). For instance, demographic health survey in Colombia, 1990, revealed that the median age at first sexual intercourse is 20 years, and similar survey in Nigeria at the same period was 16.6 years (McCauley and Salter, 1995).Each year, about 15 million women under age 20 give birth, accounting for up to one-fifth of all births worldwide (Population Reference Bureau [PRB] and Centre for Population Options [CPO], 1994). Many of these pregnancies and births are unintended. Unintended pregnancies often end in abortion (Bledsoe and Cohen, 1998). Most of these abortions are unsafe, and for some, unsafe abortion results in life-long disability, infertility or death (Brabin et al., 1995).
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Young people form one of the largest groups with unmet needs for reproductive health services. They need to be able to protect themselves from unwanted sex, unplanned pregnancies, early childbearing and abortions; and by extension, the resultant life-long disability, infertility or death.
Empowerment with knowledge of reproduction through education has been advocated and acclaimed as one of the most effective intervention activities to reverse the adolescent reproductive health problems, especially at the community level (Family Health International [FHI] 2003).
It is on this basis that the relationship between knowledge of reproductive health and contraceptive use among tertiary institutions’ students in Niger State is undertaken.
1.2 STATEMENT OF THE PROBLEM
One-third of the world‟s population is between 10 and 24 years of age and four out of five of these young people live in developing countries (Friedman, 1993). Many things are tried for the first time in adolescence and new pattern of behaviour that may last a lifetime are also formed in adolescence.
In Nigeria, like most developing countries, children and adolescents are denied access to information on reproductive health subjects and sexuality (Uwakwe, 1993). Reproductive health education for adolescents remains controversial issue in Nigeria. Surveys conducted nationally reveal that parents
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are not forthcoming as expected of them, as primary sexuality educators for their children. Educational institutions also provide little or no sexuality education for young people and so the school children are left to the equally misinformed peers as their primary source of information on these issues (Action Health Incorporated, [AHI], 1996).
Adolescents have therefore remained a major high risk group for reproductive health problems. Oladipo (1999) has shown that sexual activity among unmarried adolescents in Nigeria is high and rising. Unfortunately, majority of the sexual intercourse among adolescents are unprotected, thereby exposing them to sexually transmitted infections, teenage pregnancies and abortions.
In another study, Moronkola and Idris (2000), cited Araoye and Fakeye
(1998) as asserting that despite widespread awareness of contraception and the
sexual transmission of HIV infection, only 72% of respondents had used
contraceptive. The preceding research findings have undoubtedly confirmed that
Nigeria‟s adolescents have remained a major high risk group for reproductive
health problems, with unmet needs for reproductive health services. For
adolescents to be able to protect themselves from risky sexual behaviour, they
need to understand what constitutes risky sexual practices and what to do to
protect themselves from these practices. It is on this basis that the study –
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“Knowledge of Reproductive Health and Contraceptive Use among Tertiary
Institutions‟ Students in Niger State” is undertaken to specifically provide
answers to the following research questions.
Research Questions
- Are students of tertiary institutions in Niger state knowledgeable about reproductive health?
- Do students of Niger state tertiary institutions use contraceptives?
- What is the relationship between knowledge of reproductive health and use of contraceptives among students of tertiary institutions in Niger state?
- Is reproductive health knowledge influenced by demographic characteristics of students of tertiary institutions in Niger state?
- Is use of contraceptive influenced by demographic characteristics of
students of tertiary institutions in Niger state?
1.3 PURPOSE OF THE STUDY
The primary purpose of the study was to investigate the relationship between reproductive health knowledge and contraceptive use among tertiary institutions‟ students in Niger state. The specific purposes of the study are:
- To determine the adequacy of reproductive health knowledge among students of tertiary institutions in Niger state.
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- To determine the relationship between reproductive health knowledge and contraceptive practice.
- To identify contraceptive practice among students of tertiary institutions in Niger state.
- To determine the influence of demographic characteristics on reproductive health knowledge among tertiary institutions‟ students in
Niger state.
- To determine the influence of demographic characteristics on contraceptive use among tertiary institutions‟ students of Niger state.
1.4 SIGNIFICANCE OF THE STUDY
The main focus of this study is to determine the relationship between reproductive health knowledge and contraceptive use among students of tertiary institutions in Niger state. Findings from the study would:
- Highlight the reproductive health needs of adolescents of Nigerian tertiary institutions. These findings would be used by policy makers and educators to address the identified needs.
- Establish a profile of contraceptive practices among students of tertiary institutions in Nigeria.
- Highlight the relative influence of reproductive health knowledge on sexual behaviour among adolescents in Nigerian tertiary institutions.
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- Highlight the relationship between demographic characteristics and reproductive health knowledge and contraceptive use
1.5 HYPOTHESES
To answer the research questions, the following hypotheses are formulated:
Major Hypothesis
- There is no significant relationship between knowledge of reproductive
health and contraceptive use among tertiary institutions‟ students in Niger State.
Sub-hypothesis
- There is no significant difference in reproductive health knowledge of students from different types of tertiary institutions in Niger State.
- There is no significant difference in reproductive health knowledge of tertiary institutions‟ students from different religions in Niger State.
- There is no significant difference in reproductive health knowledge of tertiary institutions‟ students of different age groups in Niger State.
- There is no significant difference in reproductive health knowledge of male and female students of tertiary institutions in Niger state.
- There is no significant difference in reproductive health knowledge of tertiary institutions‟ students of different ethnicity in Niger State.
- There is no significant difference in contraceptive use between male and female students of tertiary institutions in Niger state.
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- There are is no significant difference in contraceptive use among students of tertiary institutions of Niger state according to their religion.
- There is no significant difference in contraceptive use of tertiary institutions students of different marital status in Niger State.
1.6 BASIC ASSUMPTIONS
Based on available research evidence and established knowledge, the following assumptions are made for the purpose of this study:
- Young people often know little or have incorrect information about fertility and contraception.
- Adequate reproductive health knowledge promotes healthy sexual behaviour.
- Young people are less likely to use contraceptive in spite of their sexual activity.
- Ignorance about reproductive health tends to increase risky sexual behaviour.
1.7 DELIMITATION
The study is delimited to:
- Reproductive health knowledge and contraceptive practices among students of tertiary institutions in Niger state.
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- The population of the study is students admitted into tertiary institutions in Niger state.
1.8 LIMITATIONS
Since this study made use of structured questionnaires as the instrument for data collection, self-report on sensitive issues like contraceptive use may not be very reliable. Consequently, adequate efforts were made to ensure confidentiality while collecting data and in the analysis and interpretation of the results.