|Year : 2017 | Volume
| Issue : 1 | Page : 36-42
Cross sectional study on sexuality and contraceptive use among rural youths in South West, Nigeria
Adebayo T Onajole, Adekemi O Sekoni FMCPH, Senior Lecturer , Olanrewaju O Onigbogi
Department of Community Health & Primary Care, College of Medicine of the University of Lagos, Idi Araba, Lagos, Nigeria
|Date of Web Publication||7-Jun-2017|
Adekemi O Sekoni
Department of Community Health & Primary Care, College of Medicine of the University of Lagos, Idi Araba, Lagos
Source of Support: None, Conflict of Interest: None
Background: The youths in the areas of developing nations such as Nigeria have been found to exhibit varying degrees of vulnerability towards sexually transmitted infections (STIs). Most cases of human immunodeficiency virus infection, other STIs and unintended pregnancy occur through unprotected sex. This study, therefore, sought to determine the risky sexual practices and the use of contraceptives among rural youths in two communities in Southwest Nigeria.
Materials and Methods: A cross-sectional study design was used; a semi-structured questionnaire was administered to 640 youths (320 in two separate communities) in 2013. Risky sexual behaviour was measured using five items, namely age at first sexual experience, the use of condom at first sexual intercourse, consistent condom use among youths who had sexual intercourse in the 3 months preceding the study, the number of sex partners 3 months preceding the study and the history of transactional sex. Systematic random sampling technique was used to select one respondent per house. Chi-square at P < 0.05 was used to demonstrate the association between categorical variables. Multivariate logistic regression was used to identify the predictors of risky sexual behaviour and contraceptive use.
Results: The mean age was 19.51 ± 2.62 years, whereas the mean age at first sex was 17.33 ± 2.56 years. About 10% of the respondents had engaged in transactional sex. Among respondents who had previously used condom, 31.2% used it at first sexual act, and this was significantly common (P = 0.032) among the males (55.8%) compared to the females (39.7%). About half of the sexually active respondents used condom consistently, and about a quarter (28.6%) had multiple sexual partners. The most popular modern contraceptive methods were male condoms (49.8%) followed by injectables (46.0%) and the pill (30.1%). Male respondents (90.0%) were more likely to know where to procure family planning services (P = 0.001). All sexually active respondents using contraceptives used the male condom, and <5% used hormonal contraceptive namely the pill. Only 22.1% of the sexually active respondents expressed willingness to use contraceptives; within this group, females (29.5%) outscored the males (15.7%) (P = 0.005). More than a quarter (27.9%) reported a past incidence of unintended pregnancy.
Conclusion: A high proportion of respondents were observed to engage in risky sexual behaviour. There is an urgent need for community-based sexuality education and contraceptive use to promote behaviour change and a qualitative study to explore reasons why youths are not using contraceptives.
Keywords: Contraceptives, Nigeria, risky sexual behaviour, rural, youths
|How to cite this article:|
Onajole AT, Sekoni AO, Onigbogi OO. Cross sectional study on sexuality and contraceptive use among rural youths in South West, Nigeria. J Med Trop 2017;19:36-42
|How to cite this URL:|
Onajole AT, Sekoni AO, Onigbogi OO. Cross sectional study on sexuality and contraceptive use among rural youths in South West, Nigeria. J Med Trop [serial online] 2017 [cited 2020 Aug 14];19:36-42. Available from: http://www.jmedtropics.org/text.asp?2017/19/1/36/207592
| Introduction|| |
According to the World Health Organization African region report for 2008, an estimated 93 million cases of curable sexually transmitted infections (STIs), namely gonorrhoea, chlamydia, syphilis and trichomoniasis, occurred in the region. Unsafe sexual practices have been implicated in the transmission of STIs. Most cases of STIs are asymptomatic but could lead to complications, which include infertility, cervical cancer and congenital malformations. Because of the fact that the age at sexual debut has been decreasing over the years, young people are now acquiring the infection, which has far reaching implications on their future and health.,
At the end of 2015; almost 2% of the global adult population were affected with human immunodeficiency virus (HIV). More than 70% of the people infected lived in sub-Saharan Africa, with the high burden of the disease further compounding the poverty in the region. Some STIs, especially syphilis and genital ulcer disease, have been implicated as co-factors in the transmission of HIV. Most cases of HIV infection and STI occur through unprotected sex. Condoms when used correctly and consistently have been shown to be effective against the transmission of HIV, STIs and unintended pregnancy. It is, therefore, one of the key behavioural components of the HIV prevention strategy.
The world population could increase by as much as six times by 2100 if fertility does not decline, which will aggravate the existing poverty. Nigeria, one of the countries listed by the United Nations as a developing country, has a high population growth rate of about 3% and an estimated population of about 190 million in 2016. Like other less developed regions that have at least 18% of their population as young persons within the 15–24 years age group, a high proportion of the country’s population is young. In 2014, the adolescent fertility rate in Nigeria was 112/1000 for the 15–19 years age group. This presents a challenge and limits the ability of affected young people to complete their education and achieve full economic potential.
Globally, over a period of 20 years (1990–2010), contraceptive prevalence increased by almost 10% from 54.8 to 63.3%. In Nigeria, during the same period of time, the national average increased from 7.2 to 14.4% even though it was higher in urban areas. Unmet need for family planning is highest in developing countries and among disadvantaged individuals who are also more likely to suffer from adverse consequences of unprotected sex. A study conducted among in-school adolescents in Lagos state, Nigeria showed that less than a third of those who were sexually active reported previous use of contraceptives.
Studies conducted in Africa have demonstrated a link between the education of the girl child and the health outcomes in later years. Early sexual activity and low contraceptive prevalence in Africa increase the volume of unplanned pregnancy and its effects on the health of women and children leading to high maternal and child mortalities. The gender parity index for sub-Saharan Africa was 0.77 for adults and 0.86 for youths in 2014, and this is an indication that substantial gender gaps exist with respect to literacy rates in this region. A study conducted in Kenya showed that girls who stayed in school were more likely to postpone their sexual debut than those who drop out of school.
In Nigeria, basic deprivation such as food deprivation is more common among people who live in the slums and rural areas compared to their urban counterparts. This form of deprivation influences the sexual behaviour of out-of-school youths including involvement in multiple sexual partnerships., Out-of-school youths are considered to be a disadvantaged group at risk of not having access to sexuality education programmes including the life skill education, which has been shown to be effective in improving contraceptive knowledge and use as well as the practice of safe sex among young people., This cross-sectional descriptive study was conducted to assess risky sexual practices and the use of family planning methods among youths who can be considered as living in a severely disadvantaged position because they are out of school and live in rural communities. It is hoped that the result of this survey will be useful as evidence to solicit sexual and reproductive health services targeted at out-of-school youths living in rural areas in Nigeria.
| Materials and methods|| |
Two communities with similar characteristics classified as rural by the appropriate authorities in southwest geopolitical zone of Nigeria were selected for the study: Ajara Vetho in Badagry Local Government Area of Lagos state and Ward Three in Ifo Local Government Area in an adjoining state (Ogun state). According to the 2006 census, Badagry had a population of 241,093 (121,232 males and 119,861 females), whereas Ifo had a population of 524,837 (267,587 males and 257,250 females). The local government secretariat estimates for the population of Ajara Vetho and Ward Three in 2013 were 33,791 and 32,673, respectively. The study population was unmarried rural youths (15–24 years). The sample size was calculated using the formula for descriptive study at P = 0.5 and z of 1.96.
There are 87 settlements in Ajara Vetho, whereas Ward Three has 49; 10 settlements were randomly selected from each region. Community mapping was conducted to ascertain the number of houses on each street, and one in two systematic random samplings was used to select houses, whereas simple random sampling was used to select households. Only one eligible respondent was interviewed per house.
Information was collected with a semi-structured questionnaire by four trained research assistants who had a 1-day training on the objectives of the study and the contents of the questionnaire. Pre-testing was conducted in another Local Government Area among 24 out-of-school youths, after which the questionnaire was further modified.
Out of the 640 questionnaires (320 in each community) that were administered, three were discarded because the respondents opted out of the study before providing all the required information. Risky sexual behaviour was measured using five items: age at first sexual experience, the use of condom at first sexual intercourse, consistent condom use among youths who had sexual intercourse in the 3 months preceding the study, the number of sex partners during the past 3 months and the history of transactional sex. Univariate analysis was presented as frequency tables (socio-demographics). For bivariate analysis, chi-square at P < 0.05 was used to demonstrate the association between categorical variables. Multivariate logistic regression was used to identify the predictors of risky sexual behaviour and contraceptive use. Epi Info statistical software version 3.5.3 (Centers for Disease Control and Prevention, Atlanta, GA) was used for data entry and IBM SPSS software version 20 computer software (Released 2011, IBM SPSS Statistics for windows, Version 20.0; IBM Corp., Armonk, NY) for data analysis.
The study was approved by the ethics and research committee of Lagos University Teaching Hospital, Lagos. Permission to conduct the study was obtained from the appropriate authorities in the two local government areas. Participation was voluntary, and written informed consent was obtained from each of the participants who were assured of confidentiality of the information provided. Personal information that could be used to trace participants was not collected or included in the questionnaires.
| Results|| |
Almost half (49.9%) of the respondents were in their late teens (15–19 years), and the mean age for all participants was 19.15 ± 2.62 years. Majority of the respondents were males (58.2%), had at least secondary school education (69.2%), were Christians (70.5%) and employed (95.0%). Almost half of the respondents (44.7%) were sexually experienced. The mean age at first sex for all study participants was 17.33 ± 2.56 years. There was no significant difference between males and females with regard to mean age at sexual debut. More males (48.5%) compared to the females (39.5%) and a higher proportion of the young adults (61.4%) compared to the adolescents (28.0%) reported that they were sexually experienced (P = 0.024 and <0.000, respectively) [Table 1].
|Table 1: Association between socio-demographic variables and sexual behaviour|
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The motivation for first sexual experience in 61.7% was curiosity; 6.7% were forced, whereas 31.9% succumbed to peer pressure. The first sexual partner for <1% of the respondents was of the same gender. Cross-generational sex was not common with the first sexual partner being a boy/girlfriend in 87.0% of the respondents, whereas in 3.1%, it was an older partner. The first sexual act took place in the parents’ house in 83.5% of the cases, whereas in 18.2%, it was at a friend’s residence.
About 10% had engaged in transactional sex with the members of the opposite gender. A higher proportion of the males (13.3%) compared to the females (2.9%). A higher proportion of the Muslim respondents (16.3%) compared to their Christian counterparts (6.2%) reported to have either paid for sex or had collected money/gifts in exchange for sex (adjusted odds ratio 0.19, 0.34 and P = 0.009 and 0.011, respectively) [Table 1] and [Table 2].
|Table 2: Logistic regression showing relationship between sexual behaviour and relevant variables|
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Almost two-thirds (63.8%) reported condom use in the past, and there was gender-based difference in condom use (P = 0.021). More male respondents reportedly used condoms compared to their female counterparts (68.9% vs. 55.2%), and all the respondents had used male condom. Older respondents (67.9% vs. 55.1%) and those with at least a secondary school education (68.0% vs. 53.7%) were more likely to have used condoms (P = 0.037 and P = 0.017, respectively) [Table 1]. Less than a third (31.2%) used condom at first sex, and this was significantly common (P = 0.032) among the males (55.8%) compared to the females (39.7%).
Five percent of the respondents who have had sex used lubricants mostly with condom; none used a water-based condom-compatible lubricant. For individuals who had never used condoms, the reasons were individual-level factors such as perceived effect on sexual pleasure (29.1%), the lack of risk perception in unprotected sex (46.1%) and inability to negotiate condom use with sex partner (18.4%).
Only 23.1% were currently having sex (in the 3 months preceding the study). Among this group, about a quarter (28.6%) had multiple sexual partners, with male respondents (39.6%) more than the female respondents (7.8%). Muslim respondents (38.9%) compared to other faiths (22.6%) were more likely to report having multiple partners (P < 0.001 and 0.035, respectively). About half of the sexually active youths reported consistent condom use.
More than half (60.1%) knew where to access family planning services, with more males (66.7%) compared to the females (51.1%) (P < 0.001). Among sexually experienced respondents, 56.1% had used a modern contraceptive method; this was more common among males (67.3% vs. 57.6%) but was not statistically significant. All contraceptive users had used the male condom, whereas <5% had used the pill.
Among respondents who have had sex, only 22.1% expressed willingness to use contraceptives, with females more than males (29.5% vs. 15.7%) (P = 0.005). More than a quarter of sexually active youths (22.7%) reported a past incidence of unintended pregnancy.
| Discussion|| |
Over the years, age at sexual debut has been increasing with females experiencing it at an earlier age compared to males; the 2013 Nigerian Demographic and Health Survey corroborated this and gave the median age for sexual debut among females in rural areas at 16.4 years and males at 21.3 years. However, in this study, there was no significant difference between the male and female respondents with regard to mean age at sexual initiation. Previous studies conducted among the young people in Africa showed that more males reported being sexually active compared to females., This gender-based difference was also observed among the unmarried rural youths in this study.
Previous studies conducted in Kenya and Nigeria have shown that females who stay in school were more likely to delay having sex compared to their peers who drop out of school., A high proportion of females in this study had at least a secondary school education, which could be responsible for delay in initiating sex, as observed among this study population. With regard to early sexual debut as a risk factor for HIV infection, this group of youths was excluded.
Compared to any other region in the world, evidence exists that more boys and girls in sub-Saharan Africa were sexually active and, sometimes, they have been pressured or forced into non-consensual sexual activity by their peers or adults. Among the respondents in this study, peer pressure and curiosity played a key role in the initiation of sexual activity among a high proportion, which provides the evidence needed for government to invest in sexuality education for rural youths in Southwest Nigeria.
Researchers have been able to estimate from previous studies conducted in sub-Saharan African countries that a sizeable proportion of new HIV infections within stable relationships were as a result of sex with other sexual partners (extra-couple). More than a quarter of sexually active rural youths in this study had multiple sexual partners, thereby putting their main partners at the risk of HIV infection. This proportion is, however, lower than the report of a study conducted among out-of-school adolescents in rural villages in northern Tanzania, which showed that almost three quarters of the young people had multiple sexual partners. Although inconsistent findings have been reported regarding which gender participates more in sexual concurrency, among the respondents in this study, being male was a predictor of participation in multiple sexual partnerships, which is similar to the report of a Tanzanian study conducted among male adolescents.
In this study, there was gender-based difference in condom use among the respondents, which is in contrast to the result of a similar study conducted among a group of in-school and out-of-school unmarried youths in a rural community in Southwest Nigeria. Consistent condom use was, however, poor and similar to what was reported by unmarried young men living in a rural community in northern Nigeria.
Appreciable increase was observed in the proportion of youths who used condom at last sex compared to those who used condom at first sex and this could be due to the enlightenment campaigns on HIV prevention. The 45% obtained is, however, lower than the proportion of unmarried male youths in a nationally representative survey in the country that reported condom use at last sex. It is also lower than the result obtained among secondary school adolescents living in a rural community in the USA but close to the almost 50% recorded among in-school adolescents in a rural community in Osun state of Southwest Nigeria.Awareness of contraceptives has been reported to be high among youths in other studies conducted in Nigeria, and the most common type known and used is the condom.,, These findings were also observed among this study population.
Low contraceptive prevalence has been reported by the studies conducted in Nigeria at the national level, and by those focusing on the specific groups of people, the same trend was observed among these rural youths., The use of condom in pregnancy prevention appears to be a popular practice among young people living in rural communities in Nigeria, as evidenced by the result of a study conducted in South-south Nigeria and our study from the southwest. This is quite different from the practice of women living in an urban community in Southeast Nigeria, where <10% of the respondents reported condom use for family planning purposes. Hormonal contraceptives were not popular among this study population unlike the report of a study conducted in Bangladesh, where even though contraceptive use was poor, the contraceptive pill was the most used. Majority of the youths knew where to access modern contraceptive methods unlike the report of a study conducted among youths living in a refugee camp in Nigeria.
Out of the five risky sexual behaviours studied in this research, rural youths were observed to practice four. A high proportion had multiple sexual partners, did not use condom at first sexual encounter nor did they use condom consistently. About one in 10 had been involved in transactional sex. The use of hormonal contraceptives was also poor even though majority knew where to access it.
The commonest contraceptive reported to be used in this study is the condom. In view of the fact that its effectiveness depends on individual level control namely: correct and consistent condom use which is not being carried out by the youths, the high rate of unintended pregnancy is not surprising.
There is, therefore, a need to conduct a qualitative study to explore reasons why this group of rural youths are not willing to use other modern contraceptives, namely hormonal and Intrauterine contraceptive device (IUCD), even though they are aware of its existence. These out-of-school rural youths will also benefit from community-based sexuality education and HIV prevention programmes to promote behaviour change.
Financial support and sponsorship
This study is supported by Central Research Committee (CRC), University of Lagos, Lagos, Nigeria.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]