ABSTRACT
This study was carried out to investigate reproductive health knowledge and unsafe induced abortion among female adolescents in selected communities in Badagry, Lagos State, Nigeria. To achieve this objective, five research questions were generated to guide this study. . The data was collected from both primary and secondary sources. The primary data were collected with the help of a well-structured questionnaire of two sections administered to respondents in secondary schools in selected communities in Badagry, Lagos State, Nigeria. The collected data were analyzed with tables and simple percentages to analyze the research questions. All data were coded using SPSS software. The findings revealed that there is knowledge level of adolescent girls about reproductive health issues generally; there is a level of awareness concerning the existence of family planning services; there is a link between the knowledge level of adolescent girls about reproductive health issues and the incidence of unsafe induced abortion; there is a connection between their level of awareness about family planning services and their usage of these services and there is a link between their knowledge of family planning services and unsafe induced abortion. The study concluded with some recommendations that unsafe induced abortion can be reduced significantly if adolescents could be carefully guided towards making informed choices and decisions about their lives and sexuality.
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND TO THE STUDY
Over the last two decades, adolescents’ sexual and reproductive health has taken the center stage within the global discourse of reproductive health problems. Across the world today, adolescent sexuality has become an important social and medical topic because youths are known to be sexually active, often in situations of little reproductive health information or services (Alubo, 2001; Onifade, 1999; Sai, 1995). Furthermore, adolescents have been considered to form a considerable at-risk group within the larger society. This is particularly evident in Nigeria where a lot of socio-economic factors put them at a greater risk given the challenges and opportunities they face daily in a rapidly changing world. In Nigeria and other low income countries, there are also several reproductive health problems such as unintended pregnancy, maternal mortality, and sexually transmitted infections (STIs) including HIV/AIDS, the transmission of which the youths are particularly disadvantaged, (Onifade, 1999; Lear, 1997). The Population Reference Bureau (2011) has indicated that nearly one third of Nigeria’s total population of over 160 million is between the ages of 10 and 24.
According to a report by Sampson Melodi of the Advocates for Youths, adolescent proportion of the population makes them integral to the country’s social, political and economic development. Nigeria’s development according to this report is compromised by the sexual and reproductive health issues afflicting her youth. Lack ofsexual health information and services make young people vulnerable to sexually transmitted infections (STIs) and unintended pregnancy (Sampson, Advocates for Youths, 2000). While intending to protect young people, some adults may limit young people’s access to information and health services in fear that information will promote sexual behaviour. Information however is the greatest tool young people need to protect themselves against reproductive and sexual ill-health. Reproductive health has been viewed by scholars as a fundamental aspect of general well being, constituting a central feature of human development. It reflects one’s state of health during childhood, adolescence and adulthood, and sets the stage for health beyond the reproductive years for both women and men and also impacts on the health of the next generation (Kotwal, Gupta and Gupta, 2008). A probable unofficial working definition of reproductive health has been given as the state of complete physical, mental and social well-being, and not merely the absence of reproductive disease or infirmity. Reproductive health, therefore, deals with the reproductive processes, functions and system at all stages of life. Alubo (2001) in the African journal of Reproductive Health defined reproductive health as “the whole array of counsel, information and services required and necessary for safe and healthy sexual expression. It concerns health and illness in relation to the body’s reproductive function”. A working definition of sexual health has been given as a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Thus, sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. According to the late professor Olikoye Ransome-Kuti (2001), 30% (one and a half billion people) of the world’s population were between the ages of 5 and 19 years as at 1997. He therefore projected that, by 2025, the proportion of people in this age category would have become one quarter, that is, 2 billion, of a total population of 8 billion. To him therefore, in 3 Nigeria, these age groups constitute about 30% of the population caught between the accepted constraints and order imposed by the traditions and customs of communities and the liberties of an emerging civilization. Adolescents in Nigeria are thus caught between tradition and changing cultures brought about by urbanization, globalized economies and a media saturated environment (AHI, 1999). As stated in one of the monographs published by the Action Health Incorporated (2003), “adolescence is the transition period between childhood and adulthood. It extends roughly through the entire second decade of life.
Abortion is the loss of pregnancy due to the premature exist of the product of conception, (the foetus, fetal membrane, and plancenta)from the uterus due to any cause. (Willianms C., 2018)
Abortion may be spontaneous (termed as miscarriage) or it may be medically induced.
The miscarriage of three or more consecutive pregnancies is termed habitual abortion or recurrent pregnancy loss. The word abortion is often used when talking above induced termination of pregnancy.
When the feotus can survive outside the womb after a similar procedure to this is carried out, we refer to such cases as late termination of pregnancy. According to Raymond; EG; and gross man in 2014 abortion is the ending of pregnancy by removal or expulsion of an embryo or fetus before it can survive outside the uterus.
According to kulier, 2011, modern method use medication or surgery for abortion. The drug mifepristone in combination with prostaglandin appers to be as safe and effective as surgery during the fisrt and second trimester of pregnancy.
Birth control such as the pill or intra uterine devices can be used immediately following abortion.(knapp, N 2013). When performed legally and safety, induced abortion do not increase the risk of long term mental or physical problems, ( LO,h,PA,2014).
In contrast unsafe abortion causes about 47000 dealths & 5million hospital admission each year in developing countries. (Lorch PA, 2014).
Abortion is the expulsion of the offspring in a state of development from the womb between one to seven months of pregnancy (4 weeks – 28 weeks) which is giving birth before the right time. In most cases of abortion it is referred to as miscarriage of birth. Abortion should be considered as a lifesaving situation due to illness (threatening). But however it is being practice at will due to societal changes and operations. It is a situation where life is being tempered and it is becoming too dangerous and threatening to the life of the mother.
Abortion is also a form of removing pregnancy from the womb either by taking pills (medical abortion) which involves taking medicines to cause where the pregnancy is removed from the womb basis which means you do not need to stay at a clinic overnight. Every year almost twelve thousand (12,000) teenage girls have abortion (Bpas, 2019).
Abortion consists of two types which are the PILLS AND SURGICAL abortion. The pills abortion is used after 9 to 24 weeks of pregnancy which involves taking of medicines to cause the womb to contract and push the pregnancy. Also from 22 weeks after which the pregnancy is push out and an injection to the womb is given such injections are given to ensure the homeostatic balance of the uterus. However a checkup visit to the clinic is also required.
Surgical abortion is the dilation and evacuation of the fetus which takes up to 15-24 weeks of the pregnancy. In surgical abortion the doctors are required to remove the pregnancy using narrow forceps passed through the neck of the womb. This form of abortion is carried out under general anesthetic conditions (asleep).
In surgical abortions one of can visit the clinic and return home the same day of abortion (for pregnancy up to 20 week). (Bpas2017).
Abortion is obviously increasing and identical as a problem in so many ways, it destabilizes the teenager’s educational career as useful member of society. She is stigmatized by the society and in the long run returns the girl into a prostitute. Another major incidence of pregnancy and abortion is the socio-cultural background of people within Idah local community. This is attributed to the orientation or beliefs which subjected the girl child to early hawking at a very tender age of about nine to ten years (9-10). These inappropriate exposures make her vulnerable as well as the deceitfulness of irresponsible young boys and old men, usually compromise with her innocence.
It is a common fact that the problem of pregnancy and abortion on girl child education in our secondary schools is spreading in our communities and this need to be eradicated or reduced in the local government in other words to solve this problem the parents and teachers should mould their children to be better adults.
The government should introduce sex education in our secondary schools, and tertiary institutions and introduce relevant academic curriculum in order to reduce the cases of unwanted pregnancy.
1.2 Statement of the Problem
The rate of unplanned pregnancies among adolescent girls around the world today is quite alarming. Cheng (2008), in his report has noted that, approximately 205 million pregnancies occur each year worldwide. Over a third are unintended and about a fifth end in induced abortion. Most abortions result from unintended pregnancies (Bankole et al, 1998), and it has been revealed that adolescents have the highest risks of suffering serious complications from unsafe abortions. Among women admitted to hospitals for treatment of unsafe abortion complications, those aged under 20 years account for 38-68% of cases in many developing countries (Olukoya et al., 2001). These complications include cervical or vaginal lacerations, sepsis, hemorrhage, bowel or uterine perforation, tetanus, pelvic infections or abscesses, chronic pelvic inflammatory disease and secondary infertility. According to a recent study, about 4.4million teenagers engage in abortion annually (Negedu, 2011). This is because, 60% of pregnancies are either mistimed or unwanted among adolescents.
Studies in the past have indicated that, lack of adequate sexual and reproductive health knowledge may possibly represent a key factor preventing the complete elimination of unwanted pregnancies, and unsafe induced abortion among adolescent girls in Nigeria. According to Ipas (2005) unplanned pregnancies are the result of various factors, including lack of knowledge about menstruation and pregnancy, lack of access to, and knowledge about how to use contraceptives; difficulties in using contraceptives because of a partner’s or family objections; contraceptive failure; and sexual assault. Also, adolescents may more often delay seeking care for abortion-related complications due to lack of transportation, lack of knowledge about where post-abortion care can be obtained, fears of censure from their parents and health-care providers, fear of legal repercussions, or lack of money to pay for services (Ipas, 2005). This may be particularly so in rural communities where access to basic infrastructural facilities remain low and inadequate.
As noted by Makinwa-Adebusoye (2006), policy and programming attention has turned towards adolescents’ sexual and reproductive health in the past decade but not much attention has been paid to the reproductive health needs of young adolescent girls, particularly in a developing country like Nigeria. Despite the activities of governmental and nongovernmental organizations (NGOs) in the areas of adolescent reproductive health, the need for accurate reproductive knowledge and skills especially among adolescent girls that reside in poor disadvantaged communities in Nigeria still remain largely unmet. Could the high level of unsafe induced abortion among adolescents be actually attributed to the limited reproductive health knowledge among them? This present study seeks to examine this problem.
1.3 Objectives of the Study
This study therefore has as its objectives the following:
- To investigate the general knowledge level of adolescent girls about reproductive health issues.
- To assess their level of awareness concerning the existence of family planning services.
- To find out the relationship any between the knowledge level of adolescent girls on reproductive health issues and unsafe induced abortion
- To establish the relationship between their level of awareness about family services and their usage of these services.
- To ascertain the relationship between their knowledge of family planning services and unsafe induced abortion.
1.4 Research Questions
The guiding research questions for this study include the following:
- What is the knowledge level of adolescent girls about reproductive health issues generally?
- What is their level of awareness concerning the existence of family planning services?
- Is there a link between the knowledge level of adolescent girls about reproductive health issues and the incidence of unsafe induced abortion?
- Is there a connection between their level of awareness about family planning services and their usage of these services?
- Is there a link between their knowledge of family planning services and unsafe induced abortion?
1.5 Justification of the Study
Inspite of the wide array of literature on adolescent reproductive health, it has been observed albeit sadly that not much has been done in the area of reproductive health knowledge and the incidence of unsafe induced abortion particularly among female adolescents from disadvantaged communities in Nigeria.
The tendency for young people to indulge in premarital sex coupled with their poor access to reproductive health information and services has been viewed as increasing their risk of unplanned and too early pregnancy, HIV infection and other STDs, as well as unsafe induced abortion (United Nations, 1995: para 95). It is believed that, an understanding of the extent of the sexual and reproductive health knowledge of adolescent girls and their usage of reproductive health services will help to better explain the reason for the prevalence of unsafe induced abortion among them in Nigeria. It will also help in reaching a logical conclusion about the depth of adolescents’ reproductive health knowledge that can help in improving public health intervention strategies that will assist in the formulation of feasible policies targeted at the improvement of the sexual and reproductive health status of adolescent girls in the country.
Past studies on the question of unsafe induced abortion have focused extensively on several issues ranging from the illegal status of abortion to poor access and quality of medical facilities to treat complications of abortion and the wide array of people who carry out unsafe abortion (Okonofua, 1993). Thus, Okonofua considers mainly service factors as responsible for the high abortion related mortality in Nigeria.
Similarly, a number of studies have concentrated on the older members of the society, thereby giving little attention to adolescents, particularly adolescent girl who constitute a a serious at-risk group within the society. Quite a number of studies have also focused extensively on married adolescents in the Northern part of Nigeria while little attention has been given to adolescent girls from less privileged areas, particularly poor communities that are usually subjected to neglect in terms of infrastructural facilities in the South-west region of the country. This research work therefore seeks to address this gap.
1.6 Scope of the Study
This study concerns about reproductive health knowledge and unsafe induced abortion among female adolescents in selected communities in Badagry, Lagos State, Nigeria.
1.7 Limitation of the Study
There is no study undertaken by a researcher that is perfect. The imperfection of any research is always due to some factors negatively affecting a researcher in the course of carrying out research. Therefore, time constraint has shown no mercy to the research. The limited time has to be shared among many alternative uses, which includes reading, attending lectures and writing of this research, also distance and its attendant costs of travelling to obtain information which may enhance the writing of this study was a major limitation.
