|Year : 2017 | Volume
| Issue : 1 | Page : 16-19
Reproductive health decision-making among adolescents in public secondary schools in Zaria, North-Western, Nigeria
Muhammed Sani Ibrahim1, Shadrach A Adamu2, Musa Yakubu3, Sulaiman S Bashir1
1 Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
2 General Hospital, Kawo, Kaduna State Ministry of Health, Kaduna, Nigeria
3 Department of Community Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
|Date of Web Publication||13-Sep-2017|
Muhammed Sani Ibrahim
Department of Community Medicine, Ahmadu Bello University, Zaria
Source of Support: None, Conflict of Interest: None
Introduction: Risky sexual behavior among adolescents is a major contributory factor to adolescent morbidity. This is mainly because during adolescence, cognitive, and psychological maturity coupled with increased need for autonomy translates into a greater desire for independent decision-making. The study assessed reproductive health decision-making and its sociodemographic determinants among adolescent senior secondary school students. Methods: This was a cross-sectional study involving 384 adolescent senior secondary school students selected through multi-stage sampling. Data were collected through a self-administered questionnaire and analyzed using IBM SPSS Statistics version 20 and results are presented in tables and charts. Results: Mean age of the respondents was 17.5 ± 1.3 years, and 170 (44.6%) were <18 years old. Reproductive health decision-making was good in 116 (30.1%). If they were sexually abused, 187 (48.4%) said that they would report first to their parents. Reproductive health decision-making showed statistically significant association with gender (P = 0.04), and class of the study (P < 0.0001), but not with age (P = 0.24), ethnicity (P = 0.86), religion (P = 0.16), and marital status (P = 0.99). Conclusion: Reproductive health decision was generally poor, and it was influenced by gender and class of the study. Therefore, Government should consider ways of improving reproductive health decision-making among the secondary school students, possibly by including it in their school curriculum. Future studies should identify locally applicable interventions to promote parent–child connectedness for improving reproductive health decision-making among adolescents.
Keywords: Adolescents, decision-making, Nigeria, reproductive health
|How to cite this article:|
Ibrahim MS, Adamu SA, Yakubu M, Bashir SS. Reproductive health decision-making among adolescents in public secondary schools in Zaria, North-Western, Nigeria. Arch Med Surg 2017;2:16-9
|How to cite this URL:|
Ibrahim MS, Adamu SA, Yakubu M, Bashir SS. Reproductive health decision-making among adolescents in public secondary schools in Zaria, North-Western, Nigeria. Arch Med Surg [serial online] 2017 [cited 2018 Oct 20];2:16-9. Available from: http://www.archms.org/text.asp?2017/2/1/16/214560
| Introduction|| |
Risky sexual behaviors lead to unintended pregnancy and sexually transmitted infections including human immunodeficiency virus infections. Among adolescents, these behaviors are a major contributor to morbidity. This is mainly because during adolescence, cognitive, and psychological maturity coupled with increased need for autonomy translates into a greater desire for independent decision-making. As such, the World Health Organization (WHO) has declared addressing the sexual and reproductive health needs of adolescents as a crucial element in promoting the sexual health and safety of all adolescents. Reproductive health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes.
The WHO estimates that at least 33% of all women seeking hospital care for abortion complications are aged under 20 years. In the United States of America, adolescents and young persons' constitute about 25% of the sexually active population but account for up to 50% of newly transmitted sexual infections. In Nigeria and other parts of Sub-Saharan Africa, reproductive health needs of adolescents have been largely ignored. The high rate of unwanted pregnancy, unsafe abortion, and the increasing incidence of sexually transmitted infections are signs that adolescent needs for reproductive health services are not adequate.,, Sexually active adolescents often face barriers to accessing contraception and health services, increasing their risk of unintended pregnancy and unsafely performed abortion. Evidence shows that by the age of 20 years at least 80% of African youths have become sexually active, and each year delivery among adolescent girls accounts for 16% of all births.
This study assessed reproductive health decision-making and its sociodemographic determinants among adolescent senior secondary school students in Zaria, North-Western Nigeria.
| Methods|| |
The study was conducted in senior secondary schools in Sabon Gari Local Government Area (LGA) located within Zaria Township. Sabon Gari LGA is inhabited predominantly by the Hausa-Fulani, with other ethnic groups from different part of Nigeria being present. The major occupations of the people are farming, trading, artisan, and white-collar jobs. The adolescents of Sabon Gari LGA have access to mobile telephone, radio, television, and the internet. There are 121 secondary schools in Sabon Gari LGA; 11 public and 110 private.
This was a cross-sectional study conducted among 423 senior secondary school students aged 12–20 years. The minimum sample size required for the study was estimated as 384 using the Lemeshaw and Lwanga approach by taking the proportion of adolescents who had good reproductive health decision-making skills as 50% (which gives the largest sample size possible), standard normal deviate of 1.96 at 95% confidence interval, and margin of error of 5%. To account for nonresponse, 10% of the calculated minimum sample size was added, making a total of 423. The study population included adolescents in public senior secondary schools of Sabon Gari LGA, excluding those above the age of 19 years.
A multi-stage sampling technique was used to select the participants involved in the study. In the first stage, three districts were selected from a list all six districts using simple random sampling. In the second stage, one public school was selected from each district using simple random sampling, making three schools. In the third stage, 141 students in the senior classes of the study of each school were selected from the class registers through simple random sampling, making a total of 423 students. Data were collected by a team of six research assistants using a structured self-administered questionnaire containing closed-ended questions on sociodemographic characteristics and reproductive health decision-making. The questionnaire was designed by the researchers and pretested by administering it to 40 adolescents who met the eligibility criteria in a senior secondary school in the neighboring Zaria LGA. There was no significant adjustment necessary following the pretest. Questionnaire administration took place in the class rooms in the absence of the respective teachers. This was the choice of the students. Before the questionnaire was given to the students to complete, informed consent was obtained from them, individually, after they were assured of confidentiality. Anonymity was ensured by emphasizing that no questionnaire should be returned carrying any identifier such as student name or admission number on it.
Data collected was analyzed using IBM SPSS Statistics for Windows, Version 20.0. Released 2011. Armonk, NY: IBM Corp. Of the 14 questions that were asked to assess reproductive health decision-making, every correct response was scored one point, and a wrong response was scored zero, giving a maximum possible score of 14 points. A score of 10–14 was considered as good decision-making, 7–9 was fair, and 0–6 poor. Chi-square test was used to assess the statistical significance of the association between reproductive health decision-making and sociodemographic characteristics.
| Results|| |
Out of the 423 questionnaires that were distributed, 386 were returned completed, giving a response rate of 91.3%. The mean age of the students studied was 17.5 ± 1.3 years, and 214 (55.4%) were 18 or 19 years. There were more males 222 (57.5%), Hausa 206 (53.4%), and Muslims 247 (64.0%). Moreover, most of them were single 369 (95.6%) [Table 1].
Reproductive health decision-making was good in 116 (30.1%), fair in 176 (45.6%), and poor in 94 (24.4%). If they were sexually abused, 187 (48.4%) said that they would first report to their parents, 89 (23.1%) to their teacher or school authority, and 12 (3.0%) to their friends [Figure 1].
|Figure 1: The persons students would first report to if sexually abused (n = 386)|
Click here to view
Reproductive health decision-making showed statistically significant association with gender (P = 0.04), and class of the study (P< 0.0001), but not with age, ethnicity, religion, and marital status [Table 2].
|Table 2: Reproductive health decision-making by sociodemographic characteristics of respondents (n=386)|
Click here to view
| Discussion|| |
Overall, this study found that only about one-third of the adolescents had good reproductive health decision-making skills, and reproductive health decision-making was mainly influenced by gender and class of study. Other sociodemographic characteristics did not appear to influence it. The low level of reproductive health decision-making skills in this study is similar to that in a study conducted in Lagos where reproductive health decision-making skill was good in only one-fourth of the adolescents studied. Considering the risks associated with poor reproductive health decision-making,,, urgent actions are needed to address this anomaly.
The observation that a higher proportion of males than females had good decision-making skills, corroborates previous reports of male adolescents being more likely than females to weigh the benefit against the cost of risky decisions. Although this may contradict previous reports of males being more likely to be involved in multiple sexual relationships which in itself is a risky behavior. Another contrast to the findings of this study is seen in the report of a study by Olayiwole et al. conducted among secondary students in Ilorin in which age was found to be a factor that influenced reproductive health (RH) decision-making.
In terms of who the respondents would first report to if sexually abused, the most commonly mentioned was parents. This may be because most of them identified their parents as the most influential factors in their decision-making. If so, this may contradict observations from a previous study in which mass media was reported to be of greatest influence in adolescents' reproductive health decision. Nevertheless, a higher level of intimacy between parents and their children has been reported to be associated with the delayed sexual debut and regular use of contraceptives by sexually active adolescents. In general, these finding highlights the importance of involving parents in educating adolescents on issues relating to safe sex, risky sexual behaviors, and reproductive health decision-making.
The study has a limitation. Due to the sensitive nature of the information requested from the respondents, responses given by them could have been subjected to the willful misstatement. Nevertheless, this study provides basic information on adolescent reproductive health decision-making in Northern Nigeria, which essential for further research and for the development of locally applicable interventions to improve adolescent reproductive health services.
| Conclusion|| |
Reproductive health decision-making was generally poor among the adolescents studied, and it was influenced by gender and class of the study. Therefore, Government should consider ways of improving reproductive health decision-making among the secondary school students, possibly by introducing this into their school curriculum in a socially and culturally acceptable manner. Furthermore, there is the need to involve parents as major stakeholders in promoting adolescent reproductive health decision-making. This is because of the finding that majority would first inform their parents first if sexually abused. Finally, future studies should focus on identifying locally applicable interventions to improve parent–child intimacy for improving reproductive health decision-making among adolescents.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kann L, Kinchen S, Shanklin SL, Flint KH, Kawkins J, Harris WA, et al.
Youth risk behavior surveillance – United states, 2013. MMWR Suppl 2014;63:1-168.
Patton GC, Viner R. Pubertal transitions in health. Lancet 2007;369:1130-9.
Francisco AD, Dixon RM, Arcangues CA. Research issues in sexual and reproductive health for low and middle income countries. In: Switzerland, Global Forum for Health Research. Switzerland: Geneva; 2007. p. 68.
Barnett B. Youth often risk unsafe abortions. Netw Res Triangle Park N
Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: Incidence and prevalence estimates, 2000. Perspect Sex Reprod Health 2004;36:6-10.
Ajuwon AJ, Olaleye A, Faromoju B, Ladipo O. Sexual behavior and experience of sexual coercion among secondary school students in three states in North Eastern Nigeria. BMC Public Health 2006;6:310.
Olayiwole OA, Awodele O, Anisu DF, Kolawole SO, Akande TM. Study of sexuality among adolescent students of a secondary school in Ilorin, Nigeria. Afr J Biomed Res 2009;12:89-94.
Owolabi AT, Onayade AA, Ogunlola IO, Ogunniyi SO, Kuti O. Sexual behaviour of secondary school adolescents in Ilesa, Nigeria: Implications for the spread of STIs including HIV/AIDS. J Obstet Gynaecol 2005;25:174-8.
Hervish A, Clifton D. Status Report on Adolescents and Young People in Sub-Saharan Africa: Opportunities and Challenges. Washington, DC, Johannesburg: UNFPA, PRB; 2012.
Okonofua F. New research findings on adolescent reproductive health in Africa. Afr J Reprod Health 2007;11:7-12.
Bassy M, Ikechukwu N. Adolescent Reproductive Health. Akoka-Yaba, Lagos: University of Lagos Press; 2000.
Belter R, Grisso T. Children's recognition of rights violation in counselling. Prof Psychol Res Pract 1984;15:899-910.
Bamidele JO, Asekun-Olarinmoye EO, Odu OO, Amusan OA, Egbewale BE. Sociodemographic characteristics and health risk behaviours among students of a tertiary institution in South Western Nigeria. Afr J Med Med Sci 2007;36:129-36.
Dittus P, Jaccard J. The relationship of adolescent perception of maternal disapproval of sex and of mother adolescent relationship to sex outcomes. J Adolesc Health 2000;26:268-78.
Ladipo SO, Adeduntan A. Access to media resources as predictor of adolescents' attitude to sexual and reproductive health practices in selected non-governmental organisations in Nigeria. Libr Philos Pract 2012:1-23.
Raffaelli M, Bogenschneider K, Flood MF. Parent-teen communication about sexual topics. J Fam Issues 1998;19:315-33.
[Table 1], [Table 2]