ASSESSMENT OF REPRODUCTIVE HEALTH INFORMATION AMONG LEARNERS IN ACADEMIES OF EDUCATION IN NORTH EAST ZONE, NIGERIA
The purpose of this study was to assess knowledge of reproductive health (RH) among students in Colleges of Education in North East Zone,Nigeria. To achieve the purpose of the study, five (5) purposes and five (5) research questions were set. The ex-post facto research design was employed for the study. The total population for the study comprised of 54,042 students in twelve (12) Colleges of Education in the North East Zone of Nigeria. Multi- stage sampling procedures involving simple random sampling stratified random sampling and proportionate sampling techniques were used to draw subjects for the study. A sample of 580 respondents comprising of 341 males and 239 females were drawn for the study.The instrument used for data collection was a researcher developed questionnaire. The questionnaire consistedofsix sections (A- F)covering demographic characteristics and knowledge of reproductive health variables. Out of 580 questionnaires distributed to respondents, 554 (95.5%) were successfully returned and was used for analysis. The datawas analysed using Statistical Package for Social Science (SPSS) IBM version 20. Descriptive statistics of percentages and frequencies was used to analyse demographic characteristics, mean and standard deviation (SD) was used to analyse or answer research questions formulated for the study. One tailed sample t-test was used to analyse research hypotheses 1-4, while Chi-square x analysis was used to analyse hypothesis 5 at 0.05 level of significance. The findings of the study revealed that: students of Colleges of Education under study hadsignificant knowledge on safe motherhood (successful maternal and child birth outcomes)P = 0.000 (p< 0.05), Knowledge of sexually transmitted infections among students in Colleges of Education in North East Zone was also significant(P = 0.000) (p<0.05). While respondents sources of information on RH knowledge was not significant. The study concluded that knowledge of safe motherhood among students in Colleges of Education in North East Zone of Nigeria was adequate. The study also revealed that knowledge of STIs and Family Planning Methods among students in Colleges of Education in North East Zone of Nigeria was adequate. The result showed that information on reproductive health were mostly obtained from radio 242 (43.7%), doctors 232 (41.9%) and school. While services for reproductive health was mostly obtained from General Hospitals 347 (62.6%) and Clinics 200 (36.1%). It was recommended that students should be encouraged tomaintain (use) their knowledge of safe motherhood to reduce pregnancy related complications through proper sex education lessons, public lectures, workshop or seminars organized by College health department. The study also recommended that respondents‘ knowledge on sexually transmitted infections should be encouraged and maintained through intensified peer friendly awareness activities to reduce risk of infections among students in Colleges of Education under study.
TABLE OF CONTENTS
Cover Page i
Title Page ii
Table of Contents viii
List of Tables ix
List of figures x
List of Appendices xi
Operational Definition of Terms xiii
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study 1
1.2 Statement of the Problem 7
1.3 Purpose of the Study 8
1.4 Research Questions 9
1.5 Basic Assumption 10
1.6 Hypotheses 10
1.7 Significance of the Study 11
1.8 Delimitations of the Study 13
CHAPTER TWO: REVIEW OF RELATED LITERATURE
2.0 Introduction 14
2.1 Theoretical Framework 14
2.2 Concept of Reproductive Health 19
2.3 Importance of Reproductive Health Knowledge among Students 19
2.4 Components of Reproductive Health 29
2.4.1 Safe Motherhood 32
22.214.171.124 Antenatal Care (ANC) 37
126.96.36.199 Postnatal Care (PNC) 39
2.4.2 Sexually Transmitted Infections 40
2.4.3 Family Planning and Contraceptives Method 46
2.4.31 Hormonal Methods 49
2.4,3.2 Non Hormonal Family Planning Methods and contraceptives 55
188.8.131.52 Traditional or Natural Family Planning Methods 58
184.108.40.206 Sterilization 62
2.4.4 Sexual and Gender Violence 63
220.127.116.11 Female Genital Cutting 68
18.104.22.168 Commercial Sex (Prostitution) 69
22.214.171.124 Human Trafficking 70
2.5 Sources of Information on Family Planning and contraceptives 73
2.5.1 The School 75
2.5.2 The Peers 76
2.5.3 Hospital and Health Centres 77
2.5.4 Print Media 78
2.5.5 Parents and Relations 79
2.6 Factors influencing Use of Family Planning Methods among Students 80
2.7 Empirical Studies on Reproductive Health Knowledge 82
2.8 Summary 94
CHAPTER THREE: METHODOLOGY
3.0 Introduction 98
3.1Research Design 98
3.2 Population of the Study 99
3.3 Sample and Sampling Procedure 99
3.4 Instrumentation 102
3.5 Validation of Instrument 103
3.5.1 Pilot Study 103
3.6Procedure for Data Collection 104
3.7 Procedure for Data Analysis 105
CHAPTER FOUR: RESULTS AND DISCUSSION
4.1 Introduction 106
4.2 Results 107
4.3 Discussion 121 CHAPTER FIVE: SUMMARY, CONNCLUSION AND RECOMMENDATIONS
5.1 Summary 134
5.2 Conclusion 135
5.3 Contribution of Study to Body of Knowledge 136
5.5 Recommendations 136
5.6 Suggestions for Further Studies 137
Appendices 156 LIST OF FIGURES
Figure: 1 Percentage of women aged 20-24 who gave birth by age of 20 in some
Regions of the world 36
Figure: 2 Experience of sexual violence according to Nigeria Geo-political Zone 66 LIST OF TABLES
Table: 2.1HIV incidence in Nigeria 46
Table: 3.1 Showing Samples of Colleges of Education, Population and Sample Size 101
Table: 3.2Summary of Sampled Schools, Departments and Sample Size of Respondents 101
Table: 4.1 Classifications Demographic Characteristics of Respondents
According to their frequencies 107
Table: 4.2 Mean score of respondents on knowledge of safe motherhood 108 Table: 4.3 Mean score of responses on knowledge of STIs among students
on Colleges of Education 110
Table: 4.4 Mean score of Responses on knowledge family planning
among students of Colleges of Education 112
Table: 4.5 Mean score of respondents on knowledge of sexual and gender violence 113
Table: 4.6 Respondents knowledge of centres where RH services are obtained 115
Table: 4.7 One tailed sampled t-test on knowledge of safe motherhood among
Table:4.8 One tailed sampled t-test on knowledge of STIs among respondents 117 Table: 4.9One tailed sampled t-test on knowledge of family planning methods
among respondents 117
Table: 4.10 One tailed sampled t-test on knowledge of sexual and gender violence
among respondents 118
Table: 4.11 Chi- square analysisshowing knowledge of sources of information
on reproductive health by respondents 119
AIDS – Acquired Immuno Deficiency Virus
CDC – Centre for Disease Control
COCP – Combined Oral Contraceptive Pills
FGC – Female Genital Cutting
FMOH – Federal Ministry of Health
GHEC – Global Health Education Consortium
ICPD – International Conference on Population and Development
IEC – Information Education Communications
PATH – Programme for Appropriate Technology in Health
PMTCT – Prevention of Mother to Child Transmission
RH – Reproductive Health
RTIs – Reproductive Tract Infections
SRH – Sexual and Reproductive Health
STIs – Sexually Transmitted Infections
Operational Definition of Terms
Contraception– refers to respondent‘s ability to know when to become or delay pregnancy Family Planning – the act adopted by the individual or couples to regulate pregnancy or spacing between births during reproductive stages.
Reproductive health – refers to the condition of physical, mental and social wellbeing of the individual in matters related to reproductive system, functionsand processes at all stages of life. Reproductive health knowledge– refers to awareness of condition of physical, mental and social wellbeing of the individual all matters related to reproductive system, functions and processes at all stages of life .
1.1 Background to the Study
Human existence cannot continue without reproductive process. It is this natural phenomenon that makes animals, particularly man remains able to reproduce his offspring continuously through generations. Hence, procreation in man is inevitable and is normally faced with a lot of reproductive health challenges. Reproductive health problems are among the current prevailing health issues that are facing youth in most societies, especially in developing communities. Unexpected or unplanned pregnancies and reproductive tract infections (RTIs) posses a major public health challenges in women of reproductive age especially in developing countries (Monjok, Smensny, Ekabua & Essien, 2010). Youths (persons between 15-24 years of age) are the greatest asset that any nation can have because of their potentialities to invest greatly in a country‘s socio-economic development if they are well nurtured and protected. These individuals are characterized by significant physiological, psychological and social changes that place their lives at high risk particularly on reproductive health matters United State Aids on International Development (UNAIDS 2015).
Programme for Appropriate Technology in Health (PATH) (2011), indicated that the social and economic impact of a healthy and productive youth population is particularly important for developing countries; where young people aged 12 to 24 represent more than 40 percent of the population. Normally, youth is generally a healthy period of life, but too many young lives are lost or compromised due to reproductive health problems including human immunodeficiency virus (HIV) and unwanted pregnancies which often culminate into obstetrical complications or unsafe abortion. Yet young people are usually less informed, less experienced, and less comfortable accessing reproductive health services than adults (Monjok et al, 2010). This poses a major public health challenges particularly in women of reproductive age in many societies, Nigeria inclusive. National Youth Policy (NYP) (2009) indicated that there are 1.3 billion people that live within the age range of 12 – 24 years of which close to 85% of this number lives in developing countries. Similarly, Guttmacher Institute (2012) estimated that of the 210 million pregnancies that occur annually worldwide, about 80 million (38%), are unplanned and 46 million (22%) end in abortion.
Furthermore, youth age is a dynamic stage in life, as many physical, social, and psychological changes that occur during adulthood occur during this timeframe. It is normal that during youthful age, attitudes are defined, long-term skills are acquired and health behaviors are formed in the individual. However meeting these challenges according to PATH (2011), need strategic actions that encompasses; fostering a safe and supportive environment for positive youth development and reproductive health, empowering youth with knowledge, attitudes, and skills related to healthy sexual and reproductive health behaviors and increasing youth access to and use of sexual and reproductive health services and commodities.
The fundamental importance of reproductive health to the country‘s wellbeing leaves so much to be desired. Reproductive health according to International Conference on Population and Development (ICPD) (1994) is the state of complete physical, mental and social well-being of the individual and not merely the absence of disease or infirmity in all matters that relate to reproductive system and its functional processes. In the opinion of Roudi-Fahimi and Ashford (2008), reproductive health entailed the constellation of methods and techniques and services that contribute to wellbeing by preventing and solving sexual health problems. World Health
Organization (WHO) (2000) reported reproductive health as how social and sexual behaviours and relationships affect health and create ill health in the individual. Reproductive health is an area that is relevant to both men and women and to persons of all ages across communities. Generally, reproductive health has the following basic components; safe motherhood which reflects successful maternal and child birth outcomes, sexually transmitted infections, family planning and contraceptive services and sexual and gender violence related activities.
In the context of this work, reproductive health refers to the condition of physical, mental and social wellbeing of the individual in matters related to reproductive system, processes and functions at all stages of life. Reproductive health knowledge on the other hand is viewed as individual‘s awareness of condition of physical, mental and social wellbeing of the individual in matters related to reproductive system, processes and functions at all stages of life. These help youth particularly women to avoid challenges of unplanned births, unsafe abortions, and pregnancy-related disabilities (Women‘s Health West, 2011). It can also be explained as how social and sexual behavior and relationship affect and create ill health in the individual. This concur with assertion of Awusabo- Asare, Abane and Kumi-Kyereme (2004) that adequate information and services made available to men and women through sex education and reproductive health services including contraceptives accessibility can help them understand their sexuality and protection from unwanted pregnancies, STIs and subsequent risk of infertility. However, contraception literally means to avoid conception. A contraceptive device refers to methods or techniques used by the individual to prevent unplanned conception, spacing between births and to some extent protection against STIs. It is normally observed that teenage motherhood has been linked to higher incidences of maternal and child morbidity and mortality which affect both health and educational opportunities in females in developing societies. It is believed that use of family planning services is beneficial for men and women‘s health and important at meeting human immunodeficiency virus (HIV) prevention goals (WHO, 2012). United Nation International Children Fund (UNICEF) (2015) reported that contraceptives use has been shown to be more cost effective to prevent the birth of HIV positive children among HIV positive women in the general population. According to World Fact Book (2013), Nigeria has a population of over 170 million people and has an annual growth rate of 2.5% with only 10% of women using family planning or modern contraceptives methods. It further observed that the low utilization of family planning services including contraceptive use has resulted in high abortion rate of 25% per 1000 women aged 15-44 years.
National Demographic Health Survey (NDHS) (2013), reported that maternal mortality rate (MMR) in Nigeria amount to 576 per 100,000 live births. However in North East zone of
Nigeria, MMR is the highest which stands 1,549/ 100,000 live births in comparison to 165/100,000 recorded (Odujinrin, 2017). This according to the report is relatively due to poor reproductive health information and services and thus contributed to about 10% of global health burden. Additionally the report also added that fertility rate is recorded at 5.5 per woman in
- Despite government effort to ensure achievement of millennium development goals (MDGs) over a decade, Nigeria still lags behind other countries in achieving goals 3, 4 and 5 related to maternal and child health targets in 2015. However considering these unmet MDGs, a new and more elaborate developmental strategy has currently been devised by the United Nations (UN) termed as Sustainable Development Goals (SDGs) which is hoped to be achieved by member nations by 2030. Goal three of SDG – Health and wellbeing focuses on adolescents which are crucial to achieving the goal. Population Reference Bureau (2015) stressed that adolescents have least access to health information and services particularly sexual and reproductive health and the risk factor for non communicable diseases (NCD) – tobacco, alcohol abuse, unhealthy diets and insufficient exercise are behaviours that begins in early adolescent. Reporting their study, Singh, Damrosch and Ashford (2014) observed that about 225 million women in the developing world including Nigeria had an unmet need for modern contraceptive methods. Women with unmet need are defined as those who want to stop or delay child bearing but are not using modern contraceptive methods.
Globally, also most people become sexually active before their 20th birthday and in subSaharan Africa, 75% of young women reported having explored their sexuality by the age of 20, (Blum, 2007). However, despite the geographic, economic and cultural diversity around the world, youth and adolescents express similar concern related to their health, education and economic life. However, it is on record that North East Geo-Political Zone of Nigeria has the second highest records of maternal and child health problems (NDHS, 2013), and that young people aged 15 to 24 years in the region have high rates of reproductive health problems which include sexually transmitted infections (STIs), including HIV/AIDS and have unmet needs of family planning services (Luana & Gladys, 2015). NDHS (2013) further reported that Borno and Yobe states in particular performed worst in matters that relate to reproductive health issues. Their report indicated that 59% and 66% of pregnant women did not receive antenatal care respectively. The survey also added that 20% of women in the region have delivered in a health facility and only 8% in Yobe State. Youths in these communities face numerous reproductive health challenges which usually subject the population to life threatening consequences. Addressing reproductive health needs of young people represents one of the most important commitments this country can make to its future leaders. FMOH (2009) reported the realization of the importance of young people has led to concerted efforts to develop and empower the youth to become healthy and productive Nigerian citizens which would be capable to contribute to nation‘s building. Osotimehin (2016) reported the crucial state of health for the youth particularly girls ―for adolescent girls who survives sexual violence, who are at risk of HIV or unwanted pregnancy, life saving reproductive health services are as vital as water, food and shelter particularly in an emergency situation; we need to do as much better job of helping the most vulnerable, especially the girl child, the researcher added.
University and College students are consistently faced with social health problem which usually culminates into risky life styles such as unplanned pregnancies and increasing high rate of abortion (FMOH, 2009). These conditions have often subjected them to academic challenges affecting their progress in school. Gama (2008) reported that in few cultures, female must prove her ability to conceive before contracting into marriage life. These circumstances highly influence some females’ not to use family planning techniques. Similarly also males want to prove their virility by engaging in sexual act without protection. These subject them to risky reproductive health behaviour and practices.
Generally, adolescent and young adult‘s sexuality is characterized by low and incorrect information or inconsistent use of family planning methods. The consequences are out of wedlock pregnancies, unsafe abortions, contracting STIs, HIV/AIDS inclusive and school dropouts which are common among female adolescents. It is unfortunate that discussing as well as accessing family planning services and sexual reproductive health information by youth is regarded as a taboo in some African societies including Nigeria (Dixon-Mueller, 2009; WHO, 2002). This in turn leads to less willingness to access and accept reproductive health services and thereby increasing reproductive health problems as well as putting the youth‘s lives at risk. However, promotion of family planning in developing societies with high birth rates has the potential of reducing poverty and hunger, while at the same time averting 32% of all maternal deaths and nearly 10% of child mortality (Timothy, Nelson & Tom, 2011). This would contribute substantially to women’s empowerment, achievement of universal primary schooling and long-term environmental sustainability. Furthermore, Chinyere, Egodi, Amalu and Meremikwu, (2013), reported that the trend of sexual behaviour among young people has been of great concern to researchers, educators, programme developers and policy makers in government and other social organizations in the country.
Upon these trends, and other related factors therefore, acquiring adequate knowledge on reproductive health issues among adolescents and young adults in schools cannot be over emphasized. Most literature reviewed in this context reiterated the low level of utilization of protective devices in coitus related activities among youth. Therefore this study was set to assess reproductive health knowledge among students in Colleges of Education in North East Zone of Nigeria.
1.2 Statement of the Problem
It has been generally observed that reproductive health challenges are among the current prevailing health problems that affect youth of our time. Normally youths particularly adolescents experiences changes in their physiological, psychological and hormonal characteristics and thus have inadequate knowledge on how to manage these changes. Inadequate knowledge on reproductive health matters such as understanding their body physiology, safe motherhood which entails going through pregnancy and child birth successfully, how to avoid STIs and family planning problems have remain major challenges facing youth across most societies. Their inability to manage these bodily changes exposes youth to risk unprotected heterosexual relationship that often times results in unwanted pregnancies, induced and unsafe abortion, and prevalence of STIs including HIV/AIDS rates, including risks of sexual and gender related violence becomes common among students. Furthermore incidence of abandoning or throwing away of newly borne babies by teenager mothers on road sides, in toilets, in bushes are increasing at unprecedented rates among female students in our institutions of learning. These challenges pose serious implications on the health, educational achievement, and social wellbeing and to some extent maternal mortality among teenage mothers.
Unprotected heterosexual sex accounts for 80% of the new HIV infections in Nigeria majority among youth aged 15-24 and sex workers (NDHS, 2013). Sanusi, Suleiman and Musa
(2014), reported that teenage pregnancy, abortion, sexual abuse, prostitution, spread of
STIs/HIV/AIDS leads to school dropout and affect the general school programme in Nigeria. Similarly, Bureau of Labour Statistics (2013) reported that majority of young men and women going to college are being influenced by the social and environmental factors present in that setting which makes them susceptible to behavioural problems that affect their reproductive life. Therefore increasing awareness of students of Colleges of Education on reproductive health information becomes necessary to help them make informed and correct decisions on health matters to ensure safe andhealthy reproductive life. It is against this background that this study was set to assess reproductive health knowledge among students in Colleges of Education in North East Zone, Nigeria.
1.3 Purpose of the Study
The purpose of this study was to assess knowledge of reproductive health among students in Colleges of Education in North East Zone of Nigeria. The specific purposes for this study are to assess:
- Knowledge of safe motherhood among students in Colleges of Education (COE) in
North East Zone of Nigeria
- Knowledge of sexually transmitted infections (STIs) among students in Colleges of
Education in North East Zone of Nigeria
- Types of family planning methods known by students in Colleges of Education in North
East Zone of Nigeria.
- Knowledge of sexual and gender violence among students in Colleges of Education in North East Zone of Nigeria
- Source of information on knowledge of reproductive health among students in College of
Education in North East Zone of Nigeria.
1.4 Research Questions
The study was guided by the following research questions:-
- Do students in Colleges of Education have knowledge of safe motherhood in North East
Zone of Nigeria?
- Do students in Colleges of Education have knowledge of sexually transmitted infections in North East Zone of Nigeria?
- Do students in Colleges of Education have knowledge of types of family planning methods in North East Zone of Nigeria?
- Do students in Colleges of Education have knowledge of sexual and gender violence in
North East Zone of Nigeria?
- What are the sources of information about reproductive health among students in
Colleges of Education in North East Zone of Nigeria.
1.5 Basic Assumptions
The following assumptions are made for the study. It is assumed that:
- Knowledge of safe motherhood is low among students in Colleges of Education in North
East Zone of Nigeria.
- Knowledge of sexually transmitted infections is low among students in Colleges of
Education in North East Zone of Nigeria.
- Knowledge of types of family planning methods is low among students in Colleges of Education in North East Zone of Nigeria
- Knowledge of sexually transmitted infectionsis low among students in Colleges of Education in North East Zone of Nigeria
- Sources of information about reproductive health are not the same among students in
Colleges of Education in North East Zone of Nigeria.
On the basis of research questions, the following hypotheses were formulated for the purpose of this study.
Students of Colleges of Education in North East Zone of Nigeria do not have significant reproductive health knowledge of safe motherhood, STIs, family planning methods, sexual and gender violence and source of information on reproductive health matters.
Sub – Hypotheses
- There will be no significant knowledge of safe motherhood among students of Colleges of
Education in North East Zone of Nigeria
- Students of Colleges of Education in North East Zone of Nigeria have no significant knowledge of sexually transmitted infections.
- Students of Colleges of Education in North East Zone of Nigeria have no significant knowledge of family planning methods
- Students ofColleges of Education in North East Zone of Nigeria have no significant knowledge of sexual and gender violence
- There is no significant difference between source of information on knowledge of reproductive health by Students of Colleges of Education in North East Zone, Nigeria
1.7 Significance of the Study
The finding of this study would be significant to the attainment of positive health and wellbeing of the individual in the area of reproductive health. Anonymous (2014) reiterates that … sound reproductive health knowledge and proper utilization of health care services improve pregnancy outcomes in women during reproductive life.
It is expected that the result of this study would provide valuable information to facilitate understanding of reproductive health among students which may possibly bridge the existing gap between knowledge and utilization of reproductive health services among students in Colleges of Education in North East Zone, Nigeria.
It is further expected that teachers in the formal school settings would utilize the information generated from the study to facilitate methods of instruction on reproductive health to help in meeting the needs of students in our school system.
It is also hoped that the findings of the study would reveal some factors that might be responsible for poor reproductive health knowledge among students in Colleges of Education in North East Zone, Nigeria.
It is hoped that the findings of this study will help stimulate, policy makers, programme planners and service providers to address reproductive health needs and problem of students and those populations at risk in the community through intervention for provision of contraceptive devices and other service delivery.
It is also envisaged that teachers and health educators would use the report as guide to advice and counsel young people on matters that relate to their reproductive health challenges to help them take informed and rational decisions.
1.8 Delimitation of the Study
The purpose of this study was to assess reproductive health knowledge among students in Colleges of Education in North East Geo-political Zone of Nigeria. The study wasspecifically delimited to reproductive health knowledge of safe motherhood, sexually transmitted infections, types of family planning methods, sexual and gender violence and knowledge of sources of information on reproductive health matters among students in Colleges of Education in North East Zone of Nigeria.
ASSESSMENT OF REPRODUCTIVE HEALTH INFORMATION AMONG LEARNERS IN ACADEMIES OF EDUCATION IN NORTH EAST ZONE, NIGERIA