ABSTRACT
Though contraceptive knowledge has become widespread among
Female Adolescents in Ghana, its use has persistently remained low for which
the Central Region is no exception. Several studies have shown no evidence of
empirical study conducted on Adolescents knowledge, Access and Usage of
contraceptives among female adolescents in the Cape Coast Metropolis. To fill
this literature gap, this study assessed the Adolescents knowledge level of
contraceptive usage, the availability and accessibility of contraceptive, the
rate of contraceptive usage, and the barriers to contraceptive use, using 150
adolescents in three selected schools in the study area. The descriptive study
style was employed using structured questionnaire which was self-administered.
Frequencies and percentages of data were displayed using tables, non-parametric
equivalent of the One-way ANOVA and the Kruskal-Wallis method of data analysis.
Findings from the study revealed that, knowledge on contraceptives was
universal with almost every respondent being knowledgeable in the variables
provided. Principally most respondents knew the pharmacy as the only sales
point or source for contraceptives. A low prevalence rate of contraceptive use
was also revealed. Aside from that, results from both culture and religion
clearly showed that, both were not in support of contraceptive use for
adolescents. The study therefore recommends the need to improve awareness among
the study population.
CHAPTER ONE
INTRODUCTION
Background to the Study
Adolescent as defined by the World Health Organization (WHO)
(2018), is any young person between the ages of 10 and 19. The period through
which this young person progresses is known as the period of adolescence. This
phase of life stretches between childhood and adulthood (Sawyer, Azzopardi,
Wickremarathn & Patton, 2018). Biologically, Sharp (2018), described this
period as a span of time starting with puberty and concluding with maturity.
Furthermore, the period may be classified into three stages of development
thus, early 10 to 15 years, middle 14 to 17 years and late 16 to 19 years (WHO,
2010).
According to Freud (1925), a whole lot of challenges take
place during this period, which the adolescent has to make adjustments to.
According to him, these challenges have got to do with the self-image where
there is the appearance of pubic hair in sexes, the development of breasts in
females, and the first signs of beard in males. This may be seen as challenges
in the sense that, whether the adolescent likes it or not, he or she would have
to live with these physical appearances though out his or her life time.
Likewise, Hall (1916), also pointed out that, adolescence is
a time of “storm and stress” during which the individual is thrown about by
opposites such as action versus inaction, excitement versus calm, elation
versus depression, self-confidence versus doubts about self-esteem, and the
need for authority versus the need to rebel against authority.
Erikson (1959) also added on that, the adolescent at this
stage also establishes a sense of personal identity and avoid the dangers of
role diffusion and identity confusion. Razak (2016), described this phase as a
period characterized by increased exploration and exposure to risk-taking
behaviours, including unsafe sex. In recent years, adolescents have started to
mature earlier than before, which results in a number of negative implications,
particularly affecting their reproductive abilities and sexual health
(Skrzeczkowska, Heimrath, Surdyka & Zalewski, 2016).
Both the rates of sexually transmitted infectioins and the
number of unplanned or undesired pregnancies in adolescents/young adults is on
the rise (Skrzeczkowska et al., 2016), which calls for the need for preventing
such phenomena. Again Razak (2016), observes that, globally most adolescents
become sexually active before their 20th birthday, and in Sub-Saharan Africa,
75% of adolescents report having had sex by age 20.
Green and Merrick (2015), also submit that, about 1 in 6
people globally are adolescents. This equals 1.2 billion people between the
ages of 10 and 19. Amongst these more than 46,000 adolescent girls give birth
each day (Green & Merrick, 2015). High birth rates according to Maclean
(2016), may not only affect maternal and child mortality but frustrates
governments in the provision of social and health services to communities such
as the provision of national health insurance scheme which provides assistance
to health charges.
In a study, Maclean (2016), reported the great benefits of
investing in family planning, these included reduced poverty levels,
improvement in maternal and child survival, and women’s participation in the labor
market. However, over 200 million girls in developing countries have an unmet
need for family planning despite a global call for promotion of and investment
into family planning (Maclean, 2016).
Yidana, Ziblim, Azongo, Yakubu and Abass (2015), concluded
that, most sexually active adolescent girls in developing countries do not use
contraceptive. This may result in many negative social and health outcomes,
including elevated maternal and newborn death rates, abortion and
abortion-related complications (Green & Merrick, 2015). Recent data from
several countries in sub-Saharan Africa show that only a third of unmarried,
sexually active girls 15 to 19 years old are using contraception, with most of
the others indicating an unmet need for methods to delay or space pregnancy
(Green & Merrick, 2015).
Contraceptives refer to any family planning method used to
prevent a pregnancy. This is achievable by interfering with the normal process
of ovulation, fertilization, and implantation (Deri, 2016). Finding an
effective method that everyone can easily access has been a major hurdle. This
challenge exists primarily because of the push-pull forces of various
contextual factors which can be socio-demographic, cultural, economic, and
religious or even psychological (Deri, 2016).
Yidana et al., (2015), argue that, the sexual and
reproductive health of adolescents is a pressing concern because the world has
a larger population of adolescents now than ever before. This group of people,
have been seen to be sexually active and in need of information about sexual
health and access to contraceptive products and services (Guttmacher Institute,
2015). Most of them in their bid to solicit information from various sources
often miss it by getting exposed to inaccurate or incomplete information
(Yidana et al., 2015).
Furthermore, Feleke, Koye, Demssie and Mengesha (2013), in
their study, submitted that, contraceptive use among married women who are
15–19 years old was only 17 percent, while the use among unmarried sexually
active adolescents, is believed to be even lower. Irrespective of the
consequences likely to occur, these teenage girls unfortunately run or get
themselves into unintended pregnancies which further ruin their lives. Feleke
et al., (2013), further revealed that the risk of dying from complications
related to pregnancy or childbirth is two times higher for those aged 15–19
than for women in their mid-twenties.
An estimated, 225 million women in developing countries would
like to delay or stop childbearing but are not using any method of
contraception (Endriyas, 2017). The worldwide rate of unintended pregnancy in
2012 was 53 per 1,000 women aged 15–44 with the highest regional rate in
Africa. Avoiding barriers to the use of contraceptive methods could avert 54
million unintended pregnancies, 79,000 maternal deaths and one million infant
deaths each year (Endriyas, 2017).
According to Herbert (2015), a number of influences such as
stereotypes, stigma, misconceptions and fear limit uptake of contraception.
Attitude of the service providers are seen as one of the most common barriers
to young people’s use of contraceptives. Notwithstanding, Schuler, Rottach and
Mukiri (2011), also found that, sexual jealousy discouraged contraceptive use,
as men worried that women’s use of contraception might allow them to be
promiscuous and unfaithful without fear of conceiving.
In Sub-Sahara Africa, 20% to 30% of partners and significant
others oppose contraceptives use (Clottey, 2012). In that case, they do not
encourage their adolescents to use contraceptives. It is a taboo in Ghana for
adolescents to talk about sexual issues let alone contraceptives. Some
communities do not openly discuss contraceptives, due to strong cultural and
religious beliefs, hence usage appear to be low and adolescents get exposed to
the increased risk of unwanted or unintended pregnancies (Clottey, 2012).
Furthermore, over 50% of women in Africa are poor and illiterate, thus not
knowledgeable in the correct use of contraceptives, hence the low use (Clottey,
2012).
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